Episode 41 - ED Physicians are from Mars and ED Nurses are from Venus?

An evidence-based interesting conversation about the physician-nurse communication relationship that also gets into male-male vs male-female vs female-female communication despite profession.

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Speaker 1 0:02

Yeah,

Speaker 2 0:07

hello, this is money and landon and I always think, oh, everybody's probably heard this before, but I guess it's probably best if we introduce ourselves because this could be the first time they've listened to us, so my name is Monique Mclaughlin and I'm an emergency nurse practitioner in the large urban hospital in British Columbia, Canada and my name's landon and I'm an emergency nurse at a large hospital and also critical care transport nurse in smaller towns. There you go. We were just recently told that when they listen to our podcasts were a little too quiet. You. I wish you could see landon eye rolling right now because I've never been accused of being too quiet, so we are trying very hard to speak louder for all of those people have given us comments that our podcast is a little on the quiet side, so thank you for letting us know that, but as I said, I was quite shocked because I've never been accused of being quiet have. I never will be again. No, never will be so landed on. I had been conferencing for the last, it feels like months last month we were at Nina, which is our national emergency nurses association speaking, which you heard in our previous podcast, we talked about cognitive bias and this month we were at the Canadian Association of Emergency Physician Conference. Landon was the track chair for the theme teamwork in the emergency department and we spoke about communication or perhaps miscommunication between physicians and nurses and we decided that was a great topic for a podcast since you and I certainly have opinions about that. So here we are. Here we are, so it all started when we are trying to build this topic and we started or I started to think about this book back in the 19 nineties, which is not that long ago. I'm sure landon has something to say about the 19 nineties because I was alive then and some of you who are around may have heard of a book called. However, if you want to be totally horrified, what's that? Someone born in 1990. Yes. Can drink in some places. I know it's a bit shocking. That shouldn't be allowed. Should it might 19, 90 during university. I don't want to talk about it. So, um, there was a book in the 19 $90. Yes, for a while. Then there was a book called men are from Mars and women are from Venus and it was by a Dr. John Gray, Dr i use the term loosely. It was the best selling nonfiction book in the 19 nineties and it was criticized for perpetuating gender stereotypes and many believe that the perceived differences between men and women are ultimately a social construction and that socially and politically, men and women want the same things, but it made me consider if we changed the wording to emerge. Docs are from Mars and Ed nurses are from Venus. We could explore the relationship between physicians and nurses and some of the challenges that working relationship. What do you think, landon? I think that's great. Yeah. So why does that relationship

Speaker 3 3:04

matter? Well in 2008, the Joint Commission, which we've said before, but this may be the first time you're listening is the, the major accreditation and certification body for health care organizations in the US. Put out a paper titled Behaviors that undermine a culture of safety in 2010, et Al in the Journal of Advanced Nursing reported on a questionnaire survey they did on a hospital environment, nurse, physician relationship and quality of care. In both of these, it was stated that safety and quality of care that patients receive depends on the quality of practice environment, where care is provided and since physicians and nurses make up the largest group of individuals within this environment, their relationship is a major determinant of the quality of care in the practice environment and therefore impacts patient safety doesn't totally. Yeah. In 2011, Sid lucky a senior nurse, scientists in the office of Nursing Research and innovation at the Cleveland Clinic and Hickson, the senior program administrator in business intelligence at the Cleveland Clinic.

Speaker 2 4:06

They seem to have long titles, but that wouldn't be a business card. That was novel. Hi, my name is said lucky. Here's a book that has my title. That's all it has. That's kind of long titles for the Cleveland Clinic,

Speaker 3 4:18

so she proposed to professional practice environment model. According to this model, the professional practice environment is the place where nursing and medical care take place. Perceptions of relationships between nurses and physicians is a good indicator of the quality of them. I have the

Speaker 2 4:32

practice environment. I love that. When we talk about quality, right? We always talk about different things and so I love that they acknowledged that the relationship between physicians and nurses actually reflect the quality of care. Totally. Because it's easy to say, well, yeah, but we can all go to work and not be nice to each other. Well, no. This is saying it actually impacts patient care. Yeah, so there was also an opinion piece in the Canadian Nursing Journal in Twenty 12 were an oncology nurse by the name of Theresa Brown who wrote a book about her first year nursing said that nurses get no education and working with doctors and doctors get no education and working with nurses. Then we put those two groups together and say, go to work in this high tech, high stress, high stakes situation. Perhaps not the most thought out plan. Maybe not. Not really good. Now you would think that changes in healthcare culture, increase inter professional education, evolving professional standards, scopes of practice demographics, more than 50 percent of medical students are females and there are increasing men in nursing and social norms that are gradually transforming the traditional physician nurse relationship. That would not be the same thing, right? Like we probably have better at that, but are we? I don't know. Well, in 2015 a survey was done using. This is so funny. Professional practice and environment assessment scale or the P,

Speaker 3 5:58

p, e a s or Ppe Pps. I don't know if they called it [inaudible], but I'm calling it from now on. It was developed by the people with the longest job title in the world. Exactly. Said lucky and Hixon to assess nurse and physician perceptions of the quality of the healthcare environment. It looks at the presence of positive physician and nurse characteristics. Organizational characteristics. So the beliefs about the importance of respectful communication and collaboration and the frequency, frequency of joint patient care, decision making. So the PPS response rate was three percent using pps 47 times in the sentence just to wait. Exactly. So the PPS response rate was 33 percent with a final sample composed of 822 pps nurses and 542 pbs physician. She's not bad for the physician group, right? Like, I mean certainly the nurses would respond, but that's not bad. No, it's not that. So all respondents of the PPS where employees of a large health care center in the Midwest, most nurses were female, 95 percent and most physicians were male. Seventy two percent. The mean age for the sample was 44 for both groups. Uh, and both groups had many years of professional experience averaging out to about 18 or so, although the [inaudible] groups did not differ by age, they did differ by years of professional experience with nurses having more experience than the physician. So the mean age was 18, but more senior nurses in the survey and more junior physicians in the survey. And I can't believe I called it the survey, the PPS. I know you want to take chances and miss two chances. And lastly, the nurses were asked whether you forgot this one. Oh look at that. I know you forgot that you moved the screen. I'm so sorry. I was looking away. In general, physicians rated the overall environment better than nurses and they scored physician characteristics and patient care decision making better than nurses. However, nurses were more likely to hold stronger views on the impact of respect, communication and collaboration on patient outcomes or organizational characteristics than where the physicians, the type of nursing role was found to be significant with staff, nurses and staff managers rating the quality of the professional practice environment lower than clinical nurse specialists, nurse practitioners. Interesting. Interesting. Also, nurse practitioners had a more favorable perception of physician characteristics, the nurses and other roles. I find that fascinating. It's interesting. So the staff nurses thought things were worse off than the professional practice side of the house. Huh? Interesting. Lastly, nurses were asked whether a physician's attitude affects how you ask a question or makes you reluctant to support a change in a patient's clinical condition. To report it. Did we need to research this? Probably not. Three in the morning. You know you're going to get your head bit off. You're not gonna. You're not as inclined to call. Exactly. Some of us would be like, no, I'm calling anyway. I don't care, but let's be honest. Some people wouldn't. So of the 807 nurses who answered the question, 55 percent said yes. It would impact them making that question or call. Yeah. When they analyze the question, they found that the level of education was not predictive of a yes or no response, so that's it makes it difficult to maybe come up with an intervention. However, again, nursing role was predictive, so staff nurses were most likely to be effected by a physician's behavior and the advanced practice nurses, least likely interesting exploratory analysis also found younger nurses, which they define of course as less than 45 years of age, still a younger nurse and slash or less experienced nurses with less than 20 years of experience. When you're out, I'm out. We're more likely to report being affected by negative physician behaviors,

Speaker 2 9:52

so it's really not big surprises to me.

Speaker 3 9:56

The less experience you have or the younger you are, the more you're going to be influenced by the of the personality of that style of response. You're going to get. Exactly. Trying to be nice. That was awkward. I know it was a bit odd. Normal wording would be. Yeah, exactly. So it's not surprising that the joint commission has stated that communication failure between nurses and physicians was found to be one of the leading causes of preventable patient injuries, complications, death, and medical malpractice claims. In fact, it's been reported that communication failures are the root cause of 60 to 70 percent of adverse events. Most notably deaths related to delay in treatment.

Speaker 2 10:38

That's shocking actually, but I think that's quite shocking. So. So it's easy to say, oh well we don't all talk nicely environment, but you know what? Planes crashed because of this and 60 percent of our patients die because of this, because of this. And I think it is important even though you and I probably sit here and say, well, of course the survey, those results make sense to us who are nurses, but you know, when we're actually having to explain to somebody else and we have data that supports, wow, this actually makes a difference, um, and the impact it has on patient outcomes. I think it is important for us to acknowledge that those surveys need to be done. Those numbers need to be there for us to actually affect change because this is going to hugely impact patient care and outcomes. For me, it's interesting when you talked about the survey, I didn't take the survey because I don't live in the Midwest, but, uh, when they were talking about how nurse practitioners advanced practice nurses are much more favorable, um, in their response when talking about communication with physicians, I found that really resonated with me quite a bit because transitioning from being a nurse to an NP had its challenges. And perhaps the biggest challenge for me was role definition and particularly how to communicate that role definition to the public. To my physician and nursing colleagues and it made me very reflective of the roles of nurses, physicians and nps and that interplay between these disciplines, which of course leads us to what everybody likes to say. Oh, well, you know, we all work in collaborative practice, but I actually kind of struggled with that a little bit because I'm not entirely sure what is collaborative practice. Um, and what does that mean for me? Right.

Speaker 3 12:25

Well, so as it's defined by the World Health Organization collaboratives, practical. There you go. We can't even say it. Yeah. Collaborative practice occurs when multiple health workers from different professional backgrounds provide comprehensive services by working with patients, their families, caregivers, and communities to deliver the highest quality of care across settings. So that's obviously a world health view of course, communities, countries, continents, but you know, in, in the microcosm of an emergency department, say it would be, you know, collaborative practice, how nurses, physicians, social workers, Ots, pts lab people, whoever you have working there work together. This isn't a really new concept since the 19 seventies. There've been many reports from conferences, national organizations and reports calling for an interprofessional approach to education and patient care, and for the newer practitioners, this probably is like, why are you telling us about that? We both started in a time when that wasn't really that. No, it wasn't. No. I kind of a new concept, especially back in my day. You got one time of day to talk to the physician during rounds were absolutely. And you told your charge nurse who told the physician you did not talk to the physician, right? Yeah, exactly. And so that was definitely not the model that we experienced now as we've seen from some of this research, not a model that actually helped with outcomes. Exactly. So the evidence is overwhelming that healthcare delivered by a well functioning coordinated team leads to better patient and family outcomes, more efficient healthcare services and higher levels of satisfaction among healthcare providers.

Speaker 2 14:02

Now that's all very interesting and there was a journal Article, the Journal of Clinical nursing and may of 2017 and 10 at all, did an integrative review of 22 studies looking at nurse physician communication. It can be concluded that nurse, physician communication still remains in effective even in 2017, despite all the stuff that we talked about. The problem is current interventions only address information needs of nurses and physicians in limited situations and specific settings, but cannot adequately address the interprofessional communications skills that are lacking in practice. So we're better at giving report because we're giving information that's important, but we're not good about just generally talking to one another when there isn't a specific reporting structure in place. And this disparate views of nurses and physicians on communications due to different training backgrounds kind of calmed, found the effectiveness of these current interventions or strategies. Uh, Dr Susan Phillips, who was a family doctor and a professor of medicine and Queens University Co authored a book on the effect of gender on nurse doctor relationship. She states that in hospitals there are two kinds of hierarchal real relationships, one based on power, which we kind of all know. And the other one, gender, which I, I probably did know. Um, and the historical reality is that most doctors have been male and most nurses have been female. And her research showed that the male female hierarchy was the one that was most operative rather than the nurse Dr One, which I found weird. Interesting. I found that really interesting. Dr Phillips with the Lead Author, who was a nurse, Barbara found that in the responses to scenarios presented to study participants, female nurses were more collegial with female doctors, but also more ready to criticize and instruct them with male doctors. Female nurses were more likely to either go along with areas that physician made or make gentle suggestions, for example, about different medications. They would not undermine the authority of a physician if the physician was male, nor would they intervene even when they observed practices of the male physicians that were neither optimal nor evidence base. So overall, Phillips believes patient care is better served by nurses who are willing to be proactive and speak out about potential errors as female physicians or female nurses do to physicians who are female. It's safer for the patient, obviously now, as more women become not just general practitioners, but specialists, uh, Philip thinks that the nurse physician relationship will evolve and become more equal. She hopes, however, that changing attitudes about what team members can contribute rather than just changes in the sex of the players will be the impetus for improving the relationship. I think that what she would hope for is instead of looking at a hierarchal view, is that we see doctors and nurses as different rather than one is better than another one and I always had that impression, yeah, you picked your two funnels and you put one of them right way up and one of them upside down and the opposition is taking a whole lot of information and trying to funnel it into one diagnosis into nurses taking one possible diagnosis and considering all other possibilities and that's a really good possibilities not being other diagnoses that the physician has missed, but more, but how's the family going to be impacted by this? How are we going to get them home? How are we going to do this? How are we going to do that? And those two work well together. Absolutely not a specialist in necessarily funneling down. Yeah, but I'm the specialist. If you're telling me they have an Moi, great. You're out. Yeah.

Speaker 3 17:50

You've diagnosed them? Yeah, we will take it from here, Dr and we will have everything arranged and we will get everything set up at home and we will make sure that they get home safely and you don't have to worry about writing an order for a taxi voucher. I will get them home safely. Yeah, I find that that's always kind of how I've noticed the two professions where.

Speaker 2 18:07

Well, it's interesting, you know, very recently I've observed to kind of female male kind of gender type things. One of them was a patient came out and spoke to one of our male emergency physicians and asked him if he was the nurse and I thought, let's see how this is going to go. It was quite amazing and he was quite lovely about it. He goes, no, I'm one of the physicians. Did you need one of the nurses? Because you know, I can get a nurse for like, what was it that you needed from us? Oh yes. I actually do need the nurse and say, Oh, okay. So he went and found one, but he didn't get upset about it. Now, interestingly, the other day there were two female emergency physicians and somebody, one of the patient transfer a patient, the patient escort. I came up to them and said, oh, can I, are you the nurse here? And they were really upset about it and they had a little side conversation where they said, well, this is why I no longer wear scrubs because I didn't want to be mistaken for a nurse. And I thought, isn't that such an interesting dynamic? And I think you as a male, I mean I hate, I know you hate when I say when we say or denote the profession by the gender, but you know, as an, as a male who was in a nursing profession, do you find that something that was difficult for you?

Speaker 3 19:36

I get called Dr all the time and when I walk into a room, if the assumption is that I'm a physician and you know, is it the way I, I walk in present myself, is it my gender? Is it. Who knows? I care not to necessarily over investigate that because the first thing out of my mouth is I'm a nurse. I'm London, one of the nurses. Yeah, and I'll never say just the nurse. I know both of our pet peeves. Oh No, I'm just the nurse. I am the nurse. Yes, exactly. One of the nurses. The nurses. Yeah,

Speaker 2 20:09

and it's interesting as the nurse practitioner, I introduced myself as the nurse practitioner and often the physicians will call me or the patients will call me Dr and I correct them and they keep calling me doctor. So it's a very interesting whether it's a gender thing or it's an attitude thing or was it a professional. The way that you carry yourself professionally.

Speaker 3 20:28

That's interesting though in what you said was that someone came up to a male physician, are you the nurse and and you know, 25 years ago when when I got into this gig that would never have had to have happened. I know. It was amazing. We'd walk up to a male in the hospital and and I think society

Speaker 2 20:48

at that point didn't even comprehend that men could, could be. I thought that was amazing and so that, that's A. I actually wanted to get up and older patient or a younger person. It was an older patient. Interesting. What's very interesting. I loved it. I thought, wow, this is an I, you know, being a fly on the wall, watching what was going on. I was thrilled about it. So I loved what you were talking about the funnel and the differences in how we approach things differently because I do wonder if in some people's mind that when we talk about different professional backgrounds, different somehow means that some are more important or necessary than others. So instead of collaborative practice in my philosophy, I kinda liked the term complimentary practice. What you said is we both, we need both of those in order for it to function well. So complimentary practice for me addresses the concept of recognizing, respecting and embracing the fact that physicians and nurses bring different but complimentary skills to patient care. After all, Aristotle said that the whole is greater than the sum of its parts and who could argue with aristotle? Yeah, because he's dead. I could argue with him because he's talking about. So if [inaudible] and rns or. Sorry, physicians, let's not just physicians, sorry guys, if you're listening and girls don't look at me like it's gender all over again. I know here we are. So if physicians and nurses

Speaker 3 22:14

communicate differently, how do we ensure that when there's information that needs to be delivered related to patient care, it can be done accurately. And are there any tools out there that might help? So studies show that there are many advantages to using a standardized model. And you referenced this before that we kind of touched on that episodic. Yeah. I need to communicate one item to you right now. The s bar is one of those communication models and uh, interestingly enough it was originally developed in the United States navy as a communication mechanism used on nuclear submarines later adopted by the hospital industries in the nineties at Kaiser Permanente in California as part of their efforts to focus on foster a culture of patient safety. So again, we're, we're big soapboxes of this. Everything we know know from aviation and we would be wise to listen to them because they don't crash planes every day because they foster respectful communication. Yeah. And they have, you know, 200 and some patients at a given time, so as far allows healthcare providers to maintain a focus in the information transfer and keeps it concise, accurate and easy to understand. As far as a two way street though. Yeah. I know that the receiver needs to be willing to hear and, and the willingness to hear comes into the are the recommendation. And so what I want you to do from this is blah blah blah blah, blah, blah blah. Exactly. I've actually, you know, in my own practice, totally not researched editorial time. I've actually started putting my request first. Yeah, me and where, uh, where this has come up and I'm maybe I've talked about in podcast before, I don't remember because I do talk about it quite often, is now that I am the person on the phone on my way to do a critical care transfer. We support the sites. We go to over the phone and sometimes they will phone while we were on their way there for, for the physicians or the nurses for, for recommendations on hemodynamics, ventilation strategies, whatever. And I find sometimes I answer the phone and they start giving me this story and I'm listening to this very long story and I'm thinking, I'm not sure what you want. And so then you get to a point and they go, so what? I try to use s bar and so my recommendation is, you know, throw throat a simple thing we put in a Foley Catheter. And I'm like, whoa. So was not going down the Foley Catheter road. Exactly. I was listening to the, uh, the norepinephrine dose and the ventilation mode you were on and your title volumes and sorry, why are you phoning me to ask about a catheter? Exactly. And I missed that. He had had prostate surgery two days ago and you know, the nurses worried about output versus doing more trauma. And so I've, I've sort of, I've changed the way I do it and go, the reason I'm calling today is I want recommendations on putting in a Foley Catheter. So let me tell you, situation, background, however you frame it. As far as one way, I have found that that is so impactful in that. So the person looks at it with that lens all the way through. I agree with you. I think maybe this is a research paper that you and I should do. Maybe we don't have time. I know we don't, but I do the exact same thing. Landon, I, when I consult a specialist, that's the first thing I do is I tell them I'm calling you because I need your advice or I need you to come down to see the patient and then I go into my information. I kind of set it up so that they know what it is and I think they listen more with a um, decision making, listening or a more thoughtful listening. Know what you're getting at. It's not like, hi, I'm a nurse. I don't know what to do. Right. It's the pressure 60. We're at 40 of Mike's on Livalo. Yes. I want to know if you want me to go higher or sad and epinephrin infusion. Exactly. Now here's all the story. Yeah. I remember my initial question was exactly the higher on the leaves are starting to open up because I may listen to it with that Lens, that Lens, that better. Anyway, it's just totally. This is script. That's exactly. Yeah. I won't make a trump reference. Uh, I don't even know where we are to be honest. We. Well, we said earlier. So the bar thing allows you to focus on information transfer. It makes it concise and it's episodic, right? So the general cultural. Absolutely. And that's basically what we're saying. So let us talk about an example. Who patient comes into the Ed with clpd exacerbation physician standing at the bedside, ordering several interventions, nabs, bipap, whatever. And internally the physician has a plan. Yeah. But it might not be voiced, probably not. So the nurses wonder, why aren't we intubating this person? This person needs to be intubated. So really trying to foster that, hey guys, here's what I'm thinking. Here's plan a plan. He is going to be, let's get some nibs in. Plan B is going to be bipap, plan C is going to be intubation and here's how we'll know we're heading down plan C and I, I find, and this is totally anecdotal again, that our younger physicians are much better at talking out loud their plans and you know, just a constant rumble of, hey guys, this is what I'm thinking now when we get this next and if that doesn't work, what we're looking at down the road is this, can someone maybe go drop some intubation drugs obviously don't give them, but that's going to be maybe 15 to 20 minutes from now if this doesn't turn around. Like there's a lot more of that discussion. Then the more senior physicians who I find pontificate a lot and not saying they're not smart. No, I would, you know, my, if I were to surmise something, it would be that when they grew up as physicians, nurses actually weren't taught as much as they are now. Exactly. And so you could have that rambling discussion, but when they grew up, nurses would sort of not necessarily be as um, and it's, it's hard to say this because you know, I don't want to be offensive to anyone. No, I understand. He's, even when I went to nursing school, I didn't learn as much as they do now. They come out with all this physiology and everything. I was taught for the most part, how to give medications on time. I have to know my drugs. I was a Whiz at getting people up and out of their beds, which is all very effective. But to stand there and have a conversation about treatment pathways, bipap versus nitrates versus this. That was not something we were focused on.

Speaker 2 28:39

Absolutely. And the thing is landon, I think we both have to acknowledge that technology moves forward. And I think that if we did not, it was no technology. I don't think I remember when we had one pulse oximeter in the hospital. Right, exactly. So at we were at the Cape Conference where one of our former colleagues, Dr Tom Lee, won an award for Mentorship, I think wasn't it, a clinical education leadership and clinical education and he just recently retired. Not that he needed to because he is still probably one of the best diagnosticians I have ever worked with. But he said something to me that resonated and kind of speaks to what you were saying. He said now that we're actually doing ecmo for cardiac arrest management, I'm out like that's not what I learned in medical school or even in residency. It's not that I don't want, I can't learn it, but it's like this is be like, I don't think I want to take on that next step. So I think it's not, it's not insulting to have that discussion that back in the day that didn't happen. This is now an expectation and we do have to move forward because otherwise you have this internal dialogue between physicians and nurses. Like why aren't they doing this? Why are they doing this? And so there's a lot of ambiguity. So it's interesting because I recently had listened to a Ted talk and it's a by kind of the guru of effective leadership. His name is Simon Sineck and his talk was called how great leaders inspire action, and I'm going to try to paraphrase him here. He talked about something called the golden circle. Cool. Every everyone knows what to do. One hundred percent of the time, some know how they do it, but very, very, very few organizations or people know why they do it, but it's the why that drives the behavior. He explains the why, how, what model is actually grounded in biology. Of course, like every time we try to do the podcast, this is a garbage truck. This time it's a leaf blower. I can't believe it. It's quite something, isn't it? So when we look at a cross section of the brain, literally waited for the leaf blower to go away. Okay, so now carry on. Okay. So looking at the cross section of the brain from the top down, it corresponds with this golden circle that a Simon Sinek talks about and he says, we started the top with our newest evolutionary brain, our homosapien brain. It is our what it is, responsible for all our rational analytical thought and language and the middle two sections make up our limbic brain, which is for feelings, trust and loyalty. It's also responsible for all human behavior and decision making. It doesn't have any capacity for language. So if you only communicate with the what people can understand vast amounts of complicated information, features and benefits and facts and figures, but it just doesn't drive behavior. When we tell people the why, we're talking directly to the part of the brain that controls behavior, then we allow people to rationalize it with the tangible things we say and do, which is what you and I just talked about. When we change our spot because we're asking them, telling them the why we're calling them, and then we give them the what, all the information, which is why it changes our behavior. We should copy, right? Oh, we should totally do that. So that was us bar this bar here. You should've seen the look on her face best. So kind of back to that, just that example you gave Langton. If the physician was discussing with the patient or the nurses, the reason why the team was choosing to go that route first before maybe thinking about intubation, that would help us, all of us as a team be more effective in providing care. We may have gotten the drugs ready, we may have done all these other things around there to support the care and therefore make it a little bit more engaging everybody in

Speaker 3 32:39

there. So I guess you know, in the end we need to acknowledge that nurses and physicians communicate differently. More importantly though, we need to develop some strategies that may be useful in creating a more effective relationship. So one is interprofessional education simulation. We're huge sim fans. We need to simulate so that we can find where we may or may not communicate well. Yeah, we need to include how to communicate at nursing school and in medical school. Big Shocker, right? Come on people. Exactly. I know in my nursing school, every year we had this slight fluff course on ethics and Blah, blah, blah. You know what? I'd probably be way better served by having a course every year in nursing school on communication simulation. Absolutely. Yeah. A interprofessional rounds. Maybe change the time of rounds to make sure that frontline nurses can attend. Is there a time of day rounds are often that, you know, three in the afternoon, right when everyone's busy. Could you do that at seven in the morning? Keeps them night nurses around. Exactly. Release a seven in the mornings typically not jumping, running already, you know, just some thoughts anyway with the goal being include more people and maybe even where you have the rounds, right? If it was like right in the middle of the, I guess a room attached to your department where you could grab everyone if needed. Medical, medical and resuscitation debriefs is also a big thing. So, uh, give equal opportunity for nurses and physicians to speak. Yeah. And um, it was interesting because we, when we presented at Cape, we presented with a Dr Rose rose who is big on medical debriefing and has published on this and runs programs on it and he said something that I have since taken forward in a lot of the things I do not only in healthcare whereas the, the power dynamic in the room. So in his example it was the physician because he works at a hospital where the physicians lead things, but the person who is most powerful in the room or the leader always goes last because it's great for the, the, the team leader to say, well, I thought that went well. Everyone. How did you think it went well? Well, is is a nurse who's not quite 100 percent confident and maybe the things didn't go well. Are they going to then say, well, I thought that didn't go well. Of course not. So go with all of the low, not low people, but the people at in the team that were not in leadership positions first. And then have your leaders go and learning for the leader to. Totally. And I've started doing that in lots of other arenas where I do debriefs and it's amazing and you sort of get people trying to look at you like, were you happy with this view? And it's like I'm not going to show you. I want to hear what you truly believe. And then I'll tell you whether I think things went well or not. And sometimes my opinion changes as it goes around the circle. And I'm like, well, I thought that went better than I guess everyone else did. So my response is just that authentically I thought it went well, but now that I've heard from all of you, maybe it didn't go as well. So.

Speaker 2 35:44

And maybe I need to change my perspective and I do that as the chair of committees. We were just talking about that. I always let everybody else speak before I speak because I think I gained a perspective that I may not have gained if I allowed them to do that first. Well, it's interesting because we were teaching a course or facilitating a course called epic and it was fascinating because at one point I played the physician and I came into the simulation and I asked, you know, who was in charge and the nurse leader who was in charge spoke up. But when, uh, she wanted to talk about the airway, she actually gave that. She goes, now let's use you for an example. She goes, now landed. Was it dealing with the airway? Was there something you wanted to say? Landon about the airway. And by her actually giving that person almost the control, the control stick to come up and speak. It really made a huge difference in that respect. And, and she kind of, the, the nurse kind of came up and you could see her grow in importance in strength. Like, Ooh, this is my moment to shine. And I quite liked.

Speaker 3 36:47

That's interesting. So as, as we're not physicians, we do not want to presume to know what lessons they have learned from nurses. But a nursing blog called [inaudible] dot com, which is by an rn physician, Megan o'keeffe. She was an rn for a position. I guess you could go the other way to. Yeah, you could, couldn't you? Wow. That was something that your judgment right away recently wrote a blog about what nurses could learn from physicians one and this. This is neat, right? One quote literature. Yeah, please. If there's one thing you do in your career, stop saying, I heard or just someone did it the day before. That way that that's the right way. Quote literature. You don't have to be a physician to have evidence based practice. It is easily accessible now on the internet. Go and read a study and then go to your physician colleagues and say, well, it's funny. I was reading a study. Exactly, blah, blah, blah, blah, blah. Exact best not to do it at the bedside in the middle of a resuscitation. Have the conversation before. Use The c words which are consult and colleague. Yeah, yeah. We should be able to discuss clinical ambiguity's and tough decisions professionally. Nurses and physicians,

Speaker 2 38:02

and we should be calling them my. I often say my physician colleagues, my nurse colleagues. Totally because it kind of levels to me, the playing field a little bit, I

Speaker 3 38:10

feel needs to be loved. We all just do different things. Yes, they absolutely don't apologize for doing your job, right? No, don't go to a physician and say, I'm sorry to bother you. Phone them and when they answer say sorry. Sorry to wake you up. No, it's your job. Yes, exactly. We share a common goal called optimal patient care instead of apologizing. Perhaps a thank you for getting back to me. I know you've had a busy, so thanks for

Speaker 2 38:36

getting back to me. Absolutely. So why don't you summarize the last in 30 some minutes and leaf blower. Exactly. So in summary, communication failures between physicians and nurses at the root cause of 60 to 70 percent of adverse effects to collaborative practice or complimentary practice leads to better patient event, family outcomes, more efficient healthcare services and higher levels of satisfaction among healthcare providers. Three and hospitals. The hierarchal relationship, particularly the male female hierarchy, was the one that was most operative rather than the doctor nurse one, and we need to change that. We really need to not have it be a gender issue anymore and this is the hash two worlds we live in and we should not still be having this same discussion for it studies. It's a Hashtag. What did I say? Hash me too. Oh dear. Hashtag me too. See Again, showing my age for study. Show that there are many advantages to using a standardized model to communicate. Um, there's the s bar, but you can use the monique and landon to give the why first and look at that. Why drives human behavior so we actually have some research or some evidence to support the y should come first and a six. Develop interprofessional strategies to improve communication. Well, I think that's it. That was great. That was great. Talking about talking. It's not great. Who Knew? Could talk, talk. You can talk about anything. So we will see you next time. Thank you very much.

Speaker 4 40:18

Have a good month. I guess we do it monthly, so have a great day. Bye. Past episodes and to comment on this episode, please visit our website at [inaudible] dot org. You can follow us on twitter at nursing past and also find us on facebook at neuro, some podcast. We look forward to your comments and suggestions for future episodes. Remember before incorporating anything new into your work, ensure you were supported by your own scope of practice, workplace policies and your own knowledge and some podcast is brought to you by prn education, www.prneducation.ca.