Rochester General Health System
Physician-Nurse Collaboration Studied at Rochester General Hospital
* Results Published in Society of General Internal Medicine 2009
Successful, collaborative interactions have powerful and long lasting effects on doctors and nurses according to findings of a study done at Rochester General Hospital in Rochester, New York, and published in the Journal of General Internal Medicine (February 09). Prior to this study, it was already well known that doctor-nurse collaboration affects patient care and safety, patient and family satisfaction with care and nurse satisfaction and retention. Little was known about the effect of collaboration on medical trainees save one thing: the effect of negative interactions on medical students was devastating.
Despite the fact that it is now acknowledged that collaboration and effective teamwork are essential skills for medical professionals, most of what physician and nurse trainees learn about these interactions is still learned by watching and listening, what is referred to as the ﾓhidden curriculum.ﾔ
At the request of one of the doctors in training at Rochester General, a decision was made by the physician training program leadership in Internal Medicine, and enthusiastically supported by the hospital and nursing administration at Rochester General, to create an educational exercise that would bring doctors and nurses together to learn from each other about their respective roles and personal experiences of collaboration.
The approach taken to this educational exercise is called Appreciative Inquiry in which medical residents and staff nurses share their personal stories about successful collaboration. This approach emphasizes what works well and why, and how we might do more of what we do well. There was no opportunity to dwell on conflicts, or on entrenched differences.
Stories of the 67 nurse and medical resident attendees were then analyzed by 2 physicians and 2 nurses to see what could be learned from the experiences they described.
The researchers found that physician trainees and nurses often begin a potentially collaborative interaction feeling worried about their patient and sometimes uncertain of what might be the best thing to do. The successful interactions end most often with the individuals feeling valued, respected, and understood. They also experience a sense of accomplishment, satisfaction, and pride in a job well done.
The RGH researchers suggest that collaboration needs to be moved out of the ﾓhidden curriculumﾔ and that it needs to be actively taught and evaluated much as other skills are taught and evaluated.
They also point out that previous research has demonstrated that how medical professionals are taught and how they are treated by one another is reflected in how they, in turn, interact with patients and families.
Finding innovative ways to enable this inter-professional learning and successful collaboration is not just a ﾓniceﾔ thing to do. It is essential to achieving the safe, effective, high quality care we all desire.
ﾓThis study reinforces the notion that physicians, patients and families as well as other health care professionals, profoundly influence each other, every day with every interaction, on every level within the health care system. There is enormous opportunity through these interactions to create a truly caring community for those who are ill and for those who care for them,ﾔ said Kathleen McGrail, MD, an attending physician at Rochester General Hospital, and one of the authors of the study.
