Editor’s Note: This content originally published in ACHE’s Physician Executive Forum Newsletter. That forum has since become the Physician Executives Community.
By Timothy M. Carrigan, PhD, RN, FACHE
Despite the turbulence we’ve seen in 2020, healthcare professionals have met the challenges presented by the pandemic with perseverance, innovation and empathy. Direct care clinicians have come together to handle unprecedented surges of sick patients and to devise resourceful care delivery solutions.
Like many hospitals and health systems across the globe, Loyola University Medical Center began to see an influx of patients requiring inpatient care for COVID-19 in mid-March of 2020. The organization had to act fast to dedicate numerous units to the exclusive care of patients with COVID-19, including ICUs, general floor areas, and areas for pediatric and obstetric care.
Although the changes we made were quick and disruptive to our typical day-to-day operations, effective collaboration between physicians and nurses on the front lines and all the way up through executive-level leadership made those transitions less disruptive to normal patient care. Our direct care clinicians made recommendations to the physician and nurse leaders working with the incident command center team to make decisions quickly.
In honor of National Nurses Week (May 6–12), let’s take a look at how to foster an environment that breeds collaboration and positive working relationships between all clinicians, even during the most difficult times.
3 Tips for Effective Clinician Collaboration
The relationship between physicians and nurses has evolved considerably over the last 50 years. While nurses might once have been viewed as “assisting” the work of physicians, much of that has changed as the scope of nursing practice has become more deliberate, distinct and evidence-based. Still, disagreements and areas of tension may still occur between clinicians from time to time. When that happens, it helps to focus on these three best practices:
- Promote patient-centered care versus discipline-focused care. Throughout the pandemic, the most important goal has been to protect the health and safety of our patients, visitors/families and staff. Our true north has been to prevent unnecessary exposure and preserve PPE. Focusing on safety and wellness has removed much of the focus on specific positions and what each discipline or role traditionally provides for patient care. For instance, to prevent multiple staff members from entering the room of patients with COVID-19-like symptoms, physicians would obtain cultures to send to the lab during exams, something nurses or other clinicians typically do.
- Ensure all professions are practicing at the height of their licensure. The practices of medicine and nursing are distinct and separate professions. Having both doctors and nurses practice at the top of the scope is always important, and became even more critical during the height of the pandemic. The circumstances created by COVID-19 led Loyola and other health systems to truly capitalize on advanced practice nurses and physician assistants for both telehealth and in-person visits. Top of license practice allows both APNs and PAs to independently assess, diagnose and treat patients. This is particularly important during a health crisis when resources and manpower are limited, and the principle is relevant at all levels of clinical care. The COVID-19 pandemic has shown just how important this is, as APNs and PAs have taken on new responsibilities in areas where physicians may have previously practiced.
- Play to clinicians’ strengths at a systems level. By nature of nursing education, nurses are taught to be critical thinkers, problem solvers and coordinators. When physicians and nurses collaborate at a systems level to create care pathways, it’s important to consider the unique strengths of each clinical profession. One ongoing problem related to COVID-19 is hospital visitor restrictions, which limit in-person family and caregiver involvement with patients’ discharge plans. This problem provided an opportunity for nurses to coordinate care differently, by using various technologies as well as discharge phone calls to involve family members in the patient’s post-acute plan of care.
Caring for Caregivers Amid COVID-19
Making sure clinicians are working collaboratively with one another is crucial to ensuring the best possible care delivery for patients. That said, it’s also important to make sure our healthcare organizations are taking care of our caregivers as well, especially during these trying times.
One powerful tool Loyola Medicine has embraced during the pandemic is debriefing after critical events. Whether the critical event is related to COVID-19 or not, our clinical team are coming together after each traumatic experience to regroup, discuss the emotions around the event, review the work that went into the care provided and identify areas of improvement. Not only have the debriefs allowed physicians, nurses and other staff members to lean on one another, they have also helped leaders identify people who may need additional check-ins or to be referred to more formal assistance programs.
Debriefing has been a valuable tool for Loyola Medicine’s clinicians, but we know from research that ensuring the wellness of care providers must be multimodal. As healthcare professionals review the operational, clinical and financial lessons they have learned from leading through a global pandemic, considerable attention must also be paid to the ongoing support physicians, nurses and other front-line workers will need to recover from delivering patient care during these trying times.
Timothy M. Carrigan, PhD, RN, FACHE, is the CNO of Loyola Medicine in Maywood, Ill. (firstname.lastname@example.org).