Healing the Hospital Hierarchy

[NRSKarenRN, BSN, RN]

Another great article by Theresa Brown RN

[h=1]Healing the Hospital Hierarchy[/h]NY Times

March 16, 2013

...Most people in health care understand and accept the need for clinical hierarchies. The problem is that we aren't usually prepared for them; nor are we given protocols for resolving the inevitable tensions that arise over appropriate care. Doctors and nurses are trained differently, and our sense of priorities can conflict. When that happens, the lack of an established, neutral way of resolving such clashes works to everyone's detriment.

This isn't about hurt feelings or bruised egos. Modern health care is complex, highly technical and dangerous, and the lack of flexible, dynamic protocols to facilitate communication along the medical hierarchy can be deadly. Indeed, preventable medical errors kill 100,000 patients a year, or a million people a decade, wrote Rosemary Gibson and Janardan Prasad Singh in their book "Wall of Silence."

Nurses cannot give orders, but they are considered the "final check" on all care decisions that doctors make, and we catch mistakes all the time. The most striking example from my experience: chemotherapy intended to be given intravenously was ordered with the formula for delivery to the brain. Depending on the drug, this could have been a thousandfold dosing error....

[caringfornurses]

After reading this article, several encounters popped into my head. I wish there was a way for physicians to see that we are only trying to help the patient, which will ultimately help them. Looking at the HCAHPS questions like, communication with nurses and doctors, doesn't it stand to reason that the nurses and doctors have to communicate with each other as well. The most important member of the healthcare team must remain the patient, no matter what the other members think. It would definitely be a good thing to remember whenever these encounters happen.

[nursej22, MSN, RN]

Interdisciplinary communication is a joke at our facility between providers and nurses. An illegible SOAP progress note relays the medical plan of care. Phone calls are interrupted at the S in SBAR. I have thrown myself directly into a doctor's path to have an actual conversation.

We tried to have rounding on our floor; the hospitalists decided the best time was 3-4pm, right at shift change and peak discharge/admit time. They weren't willing/able to change the time, nurses felt safe hands took priority.

[kalevra, BSN, RN]

Nursej22

That is also the norm at my facility. Hopefully EHR will make life just a bit easier. Especially when the MDs have to write in their own orders into the system. No more of this whole figure out what they wrote game.

[LobotRN, BSN, RN]

EHR has helped with orders themselves.....but I have yet to see a section in ours where we can place important, but non urgent, information needs that a patient has requested...."Dr. So-n-So, on your next rounding the pt would like to have a conversation re: X"