The establishment of Palm Beach County’s first allopathic residency program this summer presented JFK Medical Center in Atlantis, Fla., with the chance to encourage more collegial nurse-physician relationships from the start of these physicians’ careers. And the nurse leaders involved plan to share what they learn with rest of the medical community.
“It was a brand-new start, therefore, we had a brand-new opportunity to mold these professionals and our very experienced nurses we have on the unit in a way that was different,” says Rosemarie Hayes, RN, MSN, chief nursing officer at JFK, which has 424 beds.
Ultimately, JFK hopes to use this experience to launch an internal culture change.From left, Wendy Stuart, RN; Bernardo Obeso, MD; Cheryl Farrell RN; Rosemarie Hayes, RN, CNO; Sharmin Miller Reyes, RN; Asenath Sam Cassell, RN; Audeanne Donaldson, RN; Mignon Metcalf, MD; and Ruth McCaffrey, RN
New kind of residency
The University of Miami Miller School of Medicine at Florida Atlantic University developed a unique three-year residency program designed to offer experiences that represent what the physicians will do when in practice, rather than the traditional scut work associated with this phase of their medical education. Specially prepared community-based attendings guide them.
The newly minted physicians primarily work on a 36-bed medical unit at JFK with the same team of nurses.
Wanting to start out on a solid foundation of best practices, Hayes contacted Florida Atlantic University’s Christine E. Lynn College of Nursing in Boca Raton to discuss methods of preparing nurses to work with residents and foster a learning environment.
Ruth McCaffrey, ARNP-BC, DNP, associate professor at the college, delved into the literature and found evidence to support better collaboration. She learned the Joint Commission’s Sentinel Event Program has demonstrated communication problems are the most common root cause of serious medical errors and the Institute of Medicine and other organizations have recommended improving collaboration between healthcare professionals.
“Good communication between physicians and nurses increases nursing job satisfaction, improves patient care, decreases morbidity and mortality, and decreases length of stay, and many, many other areas are improved,” McCaffrey says.
With a $20,000 grant from the Quantum Foundation of West Palm Beach, McCaffrey developed a curriculum for the 51 incoming residents and the approximately 90 nurses who staff the unit.
The clinicians completed standardized tests, including the Jefferson Scale of Attitudes toward Physician/Nurse Collaboration and the Communication Skills Survey, to determine baseline perceptions. Then the nurses attended a two-hour educational class.
“One of the things we talked about is conflict as an opportunity for change,” McCaffrey says. “[We discussed] how to deal with conflict — use ‘I’ statements, stay calm, negotiate, and try to understand the other person’s position.”
To enhance reporting of condition changes, McCaffrey recommends nurses call with all the details about the situation, their assessments, the likely problems, and orders that are needed. She says when nurses have feelings or intuitions that something is wrong, they need to share that information with physicians.
“The other thing of value was for the staff to sit down and share experiences they had with each other and other practitioners on the floor,” says Wendy Stuart, RN, MSN, associate chief nursing officer at JFK. “They did role playing as to how they would resolve issues with the multidisciplinary team. The sessions were well-received and there was good dialogue.”
The residents received a self-learning packet highlighting the importance of collaboration and communication skills.
“Many times, physicians are not aware of all of the wonderful things nurses do, and this was an opportunity to work with the physicians from the beginning of their residency,” McCaffrey says. She set the groundwork for the residents’ understanding about nurses’ value as colleagues to physicians.
Fine tuning the program
McCaffrey meets biweekly with the nurses, residents, and attendings to discuss how things are going. At the end of six months, the clinicians will complete the validated tools again to see how their ideas about collaboration and communication have changed, and JFK will fine-tune the program accordingly.
Cheryl Farrell, RN, BSN, CCRN, nurse manager of the residency unit at JFK, says, “I think you will see the outcomes of this research study [to be] very effective. The residents eased right into the program.”
As the months pass, JFK and McCaffrey may tweak the educational offerings before compiling a toolkit or manual for other units or facilities. The researchers will share the findings with the Association of Graduate Continuing Medical Education so other residency programs can learn from the experience.
Hospital leaders and academic team members are convinced, with education and research, it is possible for nurses to develop positive, professional communication and collaboration with physicians. And they hope by presenting residents with educational material emphasizing the importance of collegial relationships and the opportunity to interact in such a manner on the special unit, they will establish practice habits that will continue throughout their careers.
“We have been blessed with an opportunity not many hospitals get, and that’s having a new program initiated [here],” Hayes says. “We’re doing it in a way that is an advantage to our patients, to our staff, and to the medical residents’ learning, and, from this, we will continue to change the culture of a very dynamic tertiary-care facility.”
Debra Anscombe Wood, RN, is a Nursing Spectrum contributing writer.