by Ken Cohn, MD, MBA, FACS, CEO Healthcare Collaboration
My education on the value that nurses provide spans decades. As a 16-year-old, I asked my father, a practicing neurosurgeon at a community teaching hospital, “Who do the residents learn from? From you or from nurses?” He said, “Mainly from me. Only those who are smart enough learn from the nurses.” (Cohn 2005)
My memories of internship may be distant, but I will never forget the way that Nikki, an Emergency Room nurse, took me aside and said, “Just because that was your eighth patient with the same condition doesn’t mean that it was her eighth ankle sprain.” (Cohn 2008). A few years later, receiving chemotherapy for lymphoma, I was grateful for the compassionate care that both the chemotherapy nurses and my girlfriend (a nurse, now my wife of thirty years) provided during treatment and the side-effects, including a seizure and compression fractures of T7-9 vertebrae (Cohn 1982). Through pillow talk, I learned valuable practical tips, such as to call ahead and ask what would be a good time to do an elective procedure like inserting a central line, so that it did not interfere with processes like change of shift, and to “think Chux,” when doing a procedure, so that nurses do not need to remake a patient’s bed due to a blood spill.
I enjoyed writing two book chapters with nurses. The first (Cohn 2005), exposed me to the differences in communication styles between physicians and nurses and to Marshall Rosenberg’s (Rosenberg 2003)protocol for deescalating conflict, consisting of:
- Observation: “Yesterday, a problem occurred with …”
- Response: “I’m concerned that …”
- Needs: “Because I depend on …”
- Request: “In the future, would you be willing to…?”
The second (Cohn 2006), revealed the power of leveraging resources and relationships to improve patient care outcomes. In viewing residency education as a system capable of improvement, I saluted nurses with whom I worked, who felt that the primary aim of a surgical residency training program should be the teaching of communication skills, not just technique and judgment (Cohn 1997).
Like fellow physician adolescents, I feel that respect is earned rather than commanded. I empathize with the learning journey and wish that we could imbue more painless growth into training healthcare professionals, the primary reason that I have made time to write this essay. Earning professional respect requires respecting fellow healthcare professionals’ time. When we feel our time being disrespected, we feel personally disrespected. The following represent one physician’s suggestions:
- Be prepared, with the patient’s recent vital signs, allergies, medications, laboratory values, and dates of procedures prior to calling a physician, especially at night, mindful that the doctor you call may be covering for the doctor who has been following your patient
- Ask other nurses on your floor if anyone else has something to discuss with the physician whom you are calling, so that they can be prepared as well
- Use a standardized format to communicate your concerns, such as SBAR, as in the following scenario:
o [Situation] “Thank you for calling me back, Doctor X. I am calling because Pt A is experiencing respiratory distress
o [Background] As you know, he is a 79 year old man 2 days status post right hemicolectomy for cancer. He admits to smoking one pack of cigarettes per day and had a stent placed two years ago in his right coronary artery. Before his operation, he was on Lipitor and a Symbicort inhaler. He has no medication allergies. The vital signs that I just took are temperature 98.8, pulse 102, blood pressure 130/80, respirations 30, shallow, and oxygen saturation of 92 on room air. His fluid intake is approximately 5 liters greater than his output
o [Assessment] In view of his past history and recent operation, I am concerned that he is experiencing a cardiopulmonary event that requires rapid evaluation
o [Response] Would it be OK with you if I consulted the hospitalist on duty and the rapid response team and to place some oxygen via nasal prongs at 2 liters a minute to see if his saturation improves while I wait for the team to arrive? Thanks very much. I will give the team your contact information, so that they can discuss their findings with you.”
Although healthcare professionals may differ on how to approach a problem, most agree that the reason that they chose careers in healthcare is to make a difference in patients’ and families’ lives. Nurses make a daily difference in patients’ lives. Thank you all for your dedication to the profession.
Kenneth H. Cohn, MD, MBA, FACS
192 Market Street: Amesbury, MA 01913-1200: 978-834-6089
firstname.lastname@example.org: Fax: 978-834-6911
To the best of his knowledge, Dr. Cohn is the only surgeon/ MBA who speaks, consults, and teaches on hospital-physician relations. As a cancer survivor and husband of a practicing nurse, his insights are grounded in the patient experience. He is a faculty member of the American College of Healthcare Executives, Healthcare Roundtable, and the George Washington University Milken Institute School of Public Health. His books, Better Communication for Better Care, Collaborate for Success, and Getting It Done, have sold over 5,000 copies.
Cohn K: Chemotherapy from an insider’s perspective. Lancet 1:1006-1009, 1982.
Cohn K, Batalden P, Nelson E, Farrell T, Walsh D, Dow R, Mohr J, Barthold J, Crichlow R. The odyssey of residency education in surgery: Experience with a total quality management approach. Current Surgery, 1997; 54:218-224.
Cohn KH, Algeo S, Stackpoole K .2005. “What Physicians and Administrators Can Learn from Nurses, in Cohn KH. Better Communication for Better Care: Mastering Physician-Administrator Collaboration, Chicago: Health Administration Press, 63.
Cohn KH, Cannon S, Boswell C. “Let’s Do Something: A Cutting-Edge Collaboration Strategy,” in Cohn KH. Collaborate for Success! Breakthrough Strategies for Engaging Physicians, Nurses, and Hospital Executives. Chicago: Health Administration Press. 2006.
Cohn KH. 2008. Nursing Collaboration. http://healthcarecollaboration.com/nursing-collaboration/ [Accessed 5/9/14].
Rosenberg MB. 2003. Nonviolent Communication: A Language of Compassion, 2nd ed. Encinitas CA: Puddle Dancer Press.
Supplemental Reading (of potential interest, not referenced in the essay)
Bujak JS. 2008. Inside the Physician Mind: Finding Common Ground with Doctors. Chicago. Health Administration Press.
Groopman J. 2008. How Doctors Think. Boston: Houghton Mifflin.
Boyatzis R, McKee A, Goleman D. Reawakening your passion for work Harvard Business Review April 2002: 86-94.
Cohn KH. A Practicing Surgeon Dissects Issues in Physician Hospital Relations. Journal of Healthcare Management. 2009; 54(1):5-10.
Cohn KH, Friedman L, Allyn TR. The tectonic plates are shifting: cultural change versus mural dyslexia. Frontiers of Health Service Management. 2007; 24(1): 11-26, 41-43. Winner of the Dean Conley Award for best article in a healthcare management journal, 2009.