Whether you are just starting out, or you been around for a while, some of the most important relationships you will experience during your internship will be with Registered Nurses. Creating an environment of collegiality is mutually beneficial. In time you will come to recognise the expertise of your nursing colleagues and know when to trust their judgement. For nurses they will begin to get a feeling of your familiarity with the clinical area and your confidence in dealing with particular patients.
This mutual understanding, and the fostering of trust, helps to expedite patient care and ensure that patient needs are met. Understanding, trust and collaboration will never be more critical than when you find yourself covering a number of wards. When it is busy the nurses are your eyes and ears. A strong relationship with the nursing staff will enable you to prioritise your workload and filter the important information from the noise.
There are a number of very easy strategies that help to build trust. The first and most intuitive, but often forgotten, is introducing yourself. When you arrive on a ward be sure to say hi to nursing staff. Particularly try to identify and then introduce yourself to the most senior nurse.
After reviewing a patient or updating the plan of care communicate any changes. When discussing a plan of care with nurses try to clearly communicate: the goals of care, why they have been set, and how they might be evaluated. Sometimes it may feel like finding the nurse and discussing the care plan takes too long. But doing so will save you time and a good number of pages later on. Make the effort to explain the plan of care even if you are at the end of your shift. Think of this as paying it forward, saving the next shift the trouble of reading your notes and attempting to communicate your intentions.
At some point you will receive a page (at the most unsociable of hours) to review a patient. Perhaps the nurse will be unable to clearly articulate why he/she is concerned. Sometimes, very rarely, the nurse may suggest that ‘something doesn’t feel right’. Do not dismiss this concern. Experienced nurses are excellent at pattern recognition. They are often able to identify a deteriorating patient even before the patient has obvious symptoms. If you receive one of these calls try asking the following questions, why are you concerned, what are the signs and symptoms, how do you think that this patient should be managed?
These simple questions communicate that you have confidence in the ability of the nurse to assess the patient. This helps to build trust and can add clarity to uncertain situations. But remember that everybody is learning. It is important to exercise your judgement and be cautious. As you begin to understand (and trust) the expertise of your nursing colleagues you will be able to make more informed decisions.
Communication is central, when it is busy and patient complexity increases it can be difficult to remember to be professional, direct, and clear. Yet, it is in these moments when clear inter-disciplinary communication is critical to patient safety (1). When in doubt remember ISBAR (2) and take the time to politely question or seek clarification. Ultimately everyone will be dealing with a challenging and complex workload.
Building trusting relationships and supporting each other is the key to achieving the best patient outcomes. In healthcare this holds true across the spectrum from general practice (3), to critical care (4,5). There are many things that you can learn from your nursing colleagues, and they will seek to learn from you. Take the time to explain your perspective on patient care and this teaching will be reciprocated.
Some of the most important relationships you will have during your internship will be with Registered Nurses. The quality of these professional relationships will influence your capacity to perform during your internship. Nurses want to help you succeed. Early on build strong professional relationships with nursing staff and your workload will be more manageable, and your time @onthewards more pleasurable.
One last tip, at the end of a busy shift say thank you to a nurse that you have been working with… see what happens.
For more tips check out: Abourbih, D., et al. (2015). “Communication between nurses and physicians: Strategies to surviving in the emergency department trenches.” Emergency Medicine Australasia 27(1): 80-82.