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As anyone in healthcare knows, a strong nurse-physician dynamic is critical to achieving successful patient outcomes. To provide a quality care experience, it is essential to have a clinical team that knows how to collaborate to achieve that goal. If we don't know how to work together, or how to coordinate our care, it's going to be very difficult to maintain a safe environment for the patient.
Nurses are at the center of the care experience, spending the most one-on-one time with patients and serving an integral role in training future practicing physicians. Looking back at my time as a resident, I often recall a particularly stressful moment during a code when a senior nurse had my back through the entire situation. Experiences such as this help to build long-lasting relationships between resident physicians and nurses, and these crucial connections ultimately foster better patient care.
A Broken Relationship
Unfortunately, multiple factors are damaging the nurse-physician dynamic. Staffing shortages, which have only been exacerbated by the pandemic, continue to plague health systems across the country. Within the next 2 years, it is estimated that there will be a shortage of more than and a need for 450,000 more nurses. Additionally, we're seeing increased burnout and attrition rates. In 2021, nurse turnover increased by a , resulting in a national average of 27.1%. In the past 5 years alone, the average hospital has turned over .
With these staffing changes and challenges come some unintended consequences. Experienced nurses are the cornerstone of patient care, acting as patient advocates. They have an innate understanding of life at a hospital and how to collaborate, communicate, and coordinate with other services and roles -- including physicians. Now, an increased number of newer nurses just joining the workforce are not as seasoned and don't yet know how best to navigate the role and the environment.
Resident physicians have a structured support system with a senior-level physician or an attending physician who supervises and oversees their training. Yet nurses often go directly from nursing school to a certain degree of patient care without this protective framework. To succeed, physicians need nurses at the bedside who are going to help us navigate the waters of patient care. At the same time, nurses need the support and tools necessary to effectively step into that role.
Setting Nurses and Physicians Up for Success
Despite staffing and retention challenges, there are ways to improve this damaged relationship between nurses and physicians to create a better experience, lessen burnout, and improve communication.
Improve training and support for new nurses. Many hospitals are beginning to implement more structured training with more senior nurses supervising junior ones to help advance their understanding and pass along institutional knowledge. When newer nurses receive the support and training they need, they'll have more bandwidth to seamlessly step into their role as an integral part of the care team to support both patients and physicians better.
Implement new institutional training. Harvard Medical School is sponsoring a course co-taught by a nurse and a physician covering instituted programs of code and training of residents, physicians, and nurses in certain aspects of patient care. Obviously, there are a lot of differences in our roles, but there are also a lot of things we can learn together. One example is a code blue, where someone is crashing or dying. This is a situation where nurses and doctors converge to provide patient care, so training nurses and physicians on this together makes sense. Experiences like this help to foster a relationship and a dynamic between the nurses and physicians and ultimately help to improve patient care.
Leverage technology to streamline communication and staffing. Having the right technology platforms in health systems allows healthcare workers to effectively communicate. Physicians and nurses need a reliable and fast means of communication to take care of a patient. Role-based messaging and community linking ensure the right message gets to the right person, role, or team to accelerate critical and care-team coordination. Additionally, hospitals need to figure out ways to staff units and floor services that don't overwhelm nurses. Scheduling functionalities must manage master and ancillary schedules and handle status changes to ensure proper staffing. This improves the healthcare worker experience and enables nurses to properly care for patients without burning out and leaving the workforce.
Looking Ahead
Creating an environment where physicians and nurses have the tools they need to succeed and establish long-lasting and mutually beneficial relationships is essential to providing proper care. Moving forward, the healthcare ecosystem needs to work on tackling staffing shortages and improving retention through a combination of increased support, more institutional training between nurses and physicians, and implementing technology solutions to help improve communication and collaboration.
Angel J. Mena, MD, is an internal medicine physician and healthcare executive. Ali Morin, MSN, RN, is a nurse and healthcare executive.
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