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November 22nd, 2013

Trying each other’s shoes on for size

By Hoyt Finnamore

There's that old saying that goes something like, "You can't really understand another person until you walk a mile in their shoes." Recognizing that there were plenty of shoes and not enough understanding in the hospital setting, a group of nurses came up with a plan to help them improve the way nurses and medical residents work together by creating a better understanding of each other's roles.

In a (great, in our opinion) guest blog post on the Harvard Business Review Blog Network, two of our very own Mayo Clinic nurses address the issue of, "Bridging the Professional Divide Between Nurses and Medical Residents." Mayo nurses Linnea Benike and Jeannie Clark write that establishing a collaborative relationship between medical residents and nurses has long been a challenge. "Nursing students and medical students have little, if any, interaction in the classroom," they say. And once they are in the workforce, the focus is on "my role." That can lead to a "lack of true collaboration" and ultimately "frustration and communication breakdowns that can negatively impact patient care."

Challenge, shmallenge, they said. (We may be paraphrasing a bit.) Since tackling and solving problems is what Mayo Clinic does best, the folks in the General Pediatric Unit brought together staff nurses, resident physicians, and nursing and physician leadership (okay, they formed a committee) to tackle issues like unnecessary pages to residents and the need for nurses to be present for daily rounds. They took into account both perspectives and adopted "solutions that are mutually acceptable to both groups."

When it became obvious that one of the main issues was that neither group had a clear understanding of the other's work process, they instigated a unique orientation program. "It requires each resident who has just joined the pediatric unit to spend four hours following a nurse," Benike and Clark write. "The residents are encouraged to ask questions and are given opportunities to observe the care that nurses provide … After the shadowing experience, nurses and residents are asked to provide feedback." The response, they say, has been overwhelmingly positive. "Residents and nurses alike have valued the professional relationship building that has resulted from the orientation."

An inpatient medical cardiology unit had a similar goal. They implemented a program that included a monthly meeting to discuss processes, and they also place resident photographs at each nursing station. "Nurses are encouraged to interact with their resident colleagues as individual practitioners — for instance, to call a resident 'Dr. Smith' instead of 'the resident,'" Benike and Clark write. "Similarly, a picture of the nurse caring for each patient is placed at the door of each patient room."

The results went far beyond collegial interaction. "Prior to the program's implementation, the unit's percentile ranking for patient satisfaction with overall teamwork among doctors, nurses, and staff was in the bottom third of the more than 500 hospitals across the United States," Benike and Clark write. "Three to six months following implementation, the unit was consistently ranking in the top quartile, and it received top ranking during January 2012."

The pair opine that, "Taken together, these two nurse-driven programs have demonstrated the importance of bringing nurses and resident physicians together in focused and innovative ways," and that, "All in all, these two programs are contributing to a culture of true collaboration at Mayo Clinic." Both nurses and residents report that the programs are helpful and should be expanded to other units.

Walk (in your shoes or another's) on down to share your comments on this and other stories below.

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