ACP - ACP Hospitalist - July 2007 - MDs and RNs speak different languages

Clinical Information

MDs and RNs speak different languages

Simple tips to improve nurse–physician communication

By Stacey Butterfield

Are you a holistic communicator who includes a lot of details and emotion in your stories, or someone who talks in bullet points, getting your thoughts across as quickly and succinctly as possible?

Effective provider communication is important not only to help physicians and nurses get along, but also to ensure patient safety. Photo by Comstock Complete

Effective provider communication is important not only to help physicians and nurses get along, but also to ensure patient safety. Photo by Comstock Complete

Most hospitalists fit into the second category but many nurses are in the first, and understanding differences in communication styles is necessary for effective nurse–physician communication, said Sally Szumlas, RN, MS, during a session at the Society of Hospital Medicine's annual meeting in Grapevine, Texas, in May.

Effective provider communication is important not only to help physicians and nurses get along, but also to ensure patient safety, Ms. Szumlas said. A Joint Commission study found that failures of communication were the major cause of sentinel events between 1985 and 2004.

Hospitalists are in a unique position to improve health care provider communication, noted co-presenter Winthrop F. Whitcomb, ACP Member and hospitalist.

"Nurses had to deal with absentee doctors before. With hospitalists, a physician is finally available during the day and off hours," he said.

Just being available to communicate with nurses is a start, but there are a few more steps required to build the kind of communication system that will truly enhance patient care, the experts said.

The first task is to establish a forum for nurses and hospitalists to discuss any communication problems—such as unanswered pages or ignored instructions—and to develop action plans to correct those issues. The forum can take a variety of forms, from a group meeting to a conversation between two representatives.

"At the very least, a nurse leader and the hospitalist medical director should meet regularly," said Dr. Whitcomb.

Next, any effort to better integrate nurses into rounds will help avoid potential miscommunication, Dr. Whitcomb noted. Ideally, nurses would attend all rounds so that all health care providers are up to speed on a patient's condition and treatment plan. "In reality, multidisciplinary rounds are very difficult. Everybody's busy taking care of patients," Dr. Whitcomb acknowledged. However, including nurses in rounding whenever possible will make a difference, he said.

Because face-to-face time between hospitalists and nurses is so limited, the communication of patient care information should be "chart-based, not relying on happening to run into each other," said Dr. Whitcomb. He recommended the use of daily goal sheets in every chart, on which the hospitalist and nurse communicate the plan of care and daily goals for the patient.

Charts should also include an RN–MD communication log sheet with the time and date listed on each entry. The log sheet is a safer alternative to the yellow stickies that gather on the front of charts, with requests like "Patient hasn't had bowel movement. Please prescribe laxative," with no time or date listed.

Hospitalists also can facilitate communication by making their schedules and responsibilities clearer to nurses, said Dr. Whitcomb. He advocated distributing the hospitalist's census to all nursing units by 8 a.m. daily. There also should be some way for nurses to know when a hospitalist's shift is ending—ideally, a posted schedule.

Better communication between hospitalists, specifically concise yet detailed handoffs, also can avoid errors in physician–nurse interactions, Dr. Whitcomb said. "If you don't get good information at sign-out, you have to get the information from the nurse."

Routine night rounds are another means to proactively avoid confusing communication situations. "Don't wait for the fight to come to you," advised Dr. Whitcomb.

Technology can be an asset to communication but sometimes inhibits it as well, the presenters noted. Text messages from nurses to doctors can back up and get ignored, and telephone orders from doctors to nurses can be misunderstood more easily than written orders. Whenever possible, "take the time to write the order while you're there," Dr. Whitcomb advised physicians.

Creating a system of successful physician–nurse interactions really comes down to patience in the end, Dr. Whitcomb concluded. "It takes time and it takes commitment from all of us to make it happen, so keep going," he said.

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