Nursing Notes

December 2, 2010

Oncology nurse Theresa Brown, on promoting a patient-centered culture

Here is a blog post from SmartBlogs.com by Theresa Brown.  I love to read her thoughts about nursing, so I felt you might enjoy this post, too.  She always has her finger on the center of a significant issue in nursing and she freely discusses cause and solutions.  I find her work to be well balanced and timely.

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Theresa Brown, BSN/RN/OCN, is a  floor nurse in Pittsburgh and author of “Critical Care: A New Nu rse Faces Death, Life and Everything in Between.” SmartBrief editor Kathryn Doherty recently spoke with her about the challenges of communication — with physicians, patients and other hospital departments — facing nurses today and how these challenges affec t patient safety. A condensed version of that conversation follows.

How does the nature of the nurse-physician relationship affect communication between these professionals? Does it affect patient safety?

The hierarchical nature of the nurse-physician relationship often impedes good communication. Nurses are looking out for physicians to be arrogant and dismissive, and physicians can be unfairly impatient with nurses. These kinds of interactions are more likely when people are under stress — and almost everyone working in a hospital is under stress.

The problem begins with our training. In nursing school, I received no training in how to work with physicians, and my sense is that physicians get no training in how to communicate with nurses. Yet, each group completely depends on the other to take care of patients. A half-day or daylong workshop, where nurses and physicians work together to learn how to communicate better, could do wonders.

Safety issues are what make the communication between nurses and physicians so important. A physician who dismisses a nurse’s concern for a patient may be ignoring an important sign that the patient is in crisis. A nurse who fails to bring an important detail to the attention of a physician because talking to MDs makes her uncomfortable is also not giving her patient the best care possible. Simple medication errors could be avoided if the nurse’s question was heard not as a criticism of the doctor’s skill, but as a striving for clarification.

Bedside nurses are considered the closest link to patients. How does this proximity affect nurse-patient communication and overall patient safety in a hospital?

Nurses are the “canaries in the coal mine.” The nurse sees the patient for the entire day or night, and will often be the one who first notices when the patient is having a serious problem. Whatever is affecting the patient that day — physically or emotionally — will be impossible to hide from the nurse.

That proximity can also create friction, if the patient treats the nurse as waitress, maid, counselor or punching bag. Patients who  make unreasonable demands on nurses (and we’ve all had these patients) may not realize that they’re distracting their nurse from paying attention to their health.

What changes in hospital culture could be made to improve patient safety?

A lot of the problems in hospitals would solve themselves if people had time to listen to each other, and then do what needed to be done. My feeling at work is that everyone has a little more to do than can be done in the time available — and sometimes a lot more. If we could slow down, we could keep patients safer.

And one thing that would help nurses slow down would be staffing ratios and well-stocked float pools that could fill gaps when nurses were unable to come to work. “Working short” benefits neither nurses nor doctors, and certainly not patients.

Hospital departments can be very separated, physically and ideologically. How could that situation be improved?

An “Us versus Them” mentality has become endemic in many hospitals, and it makes communication very difficult. Medical people don’t like surgical staff, ICUs don’t like floor nurses, certain nurses don’t like certain physicians, etc.

What I find myself saying over and over again is, “We all have the same goal.” Most people who work in hospitals have a deep commitment to being helpful, or at least started their careers with that feeling. If we could reawaken that feeling in people, make them remember why they got into this crazy work environment in the first place, it might help.

The goal of everyone in the hospital should be to give all patients the best care possible. and institutions need to really commit to that goal, rather than giving it lip service while really focusing on profits.  Staff who don’t appreciate that goal may need retraining or reassignment. The nurses and physicians I like the most and respect the most all share the same professional mantra: “It’s all about the patient.”


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