Background: Physician and nursing teamwork is instrumental in delivering high quality, safe and reliable patient care. Sub-optimal teamwork contributes to poor nursing morale and increased burnout. Physicians and nurses often are unaware of each other’s workflows. Building team collaboration through trust, respect, communication and mutual understanding may lead to improved quality of care and staff engagement.
Purpose: We aimed to improve physician-nurse relationships, teamwork and engagement through mentorship groups to create mutual understanding and alignment of both workflow expectations and clinical topics.
Description: Twelve volunteer hospital medicine faculty were assigned to mentorship groups of four medicine-surgical ward nurses each at a 900-bed academic safety net hospital. From October 2022 to October 2023, mentorship sessions were scheduled monthly. Mentorship session goals were broadly divided into two areas: clinical topics and workflow alignment. Clinical topics initially included diabetes mellitus, sepsis and congestive heart failure, then expanded to include other topics. Workflow alignment was discussed in the context of clinical topic reviews and included standardized communication tools and mutual understanding of daily work patterns. Physicians and nurses completed a culture survey, which covered five domains of work culture (physician-nursing relationship, communication, and trust in addition to nursing critical thinking and engagement), prior to starting the mentorship meetings and again after one year. Examples of clinical topics and workflow learnings are reported in Table 1. After one year, nurses reported hospital medicine physicians were more likely to communicate directly with them about what to watch for when worried about a patient’s clinical status (70% vs 48%, p 0.03). Nurses also reported they could better anticipate the physician’s concerns related to patient care (95% vs 79%, p 0.02). Nurses indicated that physicians could also better anticipate their concerns (84% vs 66%, p 0.04). (Table 2) Physicians felt they were more likely to be able to anticipate nursing concerns in relation to patient care (91% vs 36%, p 0.02). There was a trend in improvement in physician perception that nurses could anticipate their concerns about patient care (55% vs 9%, p 0.06) and in physician understanding of nursing workflows (82% vs 36%, p 0.08). Nursing feedback included appreciation for learning each other’s clinical workflows; increased comfort in communicating concerns with physicians; and an improved knowledge base. Physicians enjoyed getting to know nursing colleagues and reported the program was worth their time. Both physicians and nurses recognized the challenges of scheduling conflicts and time constraints, affecting nursing attendance. Turnover in the nursing groups was also a challenge.
Conclusions: Physicians and nurses who participated in Project CREATE forged improved interprofessional relationships, mutual understanding and clinical communication. Nurses felt empowered by gains in both clinical knowledge and comfort in communicating concerns with physicians. Next steps include evolving the program to prioritize newer physicians and nurses to promote mutual workflow understanding and stronger interdisciplinary relationships in early career. Future directions include measurements of institutional psychological safety trends and the program’s impact on quality and safety outcomes.
