Health care professionals widely recognize that safe, efficient, and patient-centered care relies on effective teamwork and communication between physicians and nurses. While most understand the importance of interdisciplinary collaboration between physicians and nurses, interprofessional education (IPE) often involves collaboration between nursing and medical students, rather than integration into the clinical environment.

Though IPE programs exist in a variety of didactic formats, a global review of IPE for nursing and medical students suggests these interventions predominantly occur through simulation and role play, and few studies have examined the impact of interprofessional rotations that pair medical students with nurses in clinical settings.

However, one recent study however on a one-week nursing rotation for medical students in Nepal demonstrated meaningful shifts in medical students’ discourses about nursing responsibilities to more collaborative and communication- centered frameworks after the rotation. Given the expertise nurses possess, IPE opportunities where medical students learn from nurses in teaching roles in the clinical environment may present unique experiences for students to gain significant knowledge and develop essential communication skills relevant to clinical practice.

Medical students often receive limited formal instruction on nursing responsibilities, workflow, and daily demands. Based on feedback and interest shown from medical students, faculty at a large academic medical center developed an elective called “Interprofessional Practice: A Nursing Perspective.” The aim of this two-week elective was to expose third- and fourth-year medical students to the workflow of registered nurses on a medicine floor, while observing and assisting nurses in their daily tasks and responsibilities.

One Student’s Experience

On the general medicine floor of the hospital where this elective took place, each nurse is responsible for five patients. One medical student who participated in this elective expressed that before going through this experience, they had not fully understood the roles and responsibilities of nurses. For instance, it was realized during the elective that virtually every order placed for those five patients is carried out by a single nurse, with some assistance from CNAs and phlebotomy for certain tasks. In their experience on the physician’s end, a simple task such as “give Metoprolol” often entailed a discussion around patient management and a series of clicks to place the order. On the nursing end, “give Metoprolol” meant walking to the medication storage cabinet, scanning the order, collecting the medicine, walking to the patient’s room and greeting them, sometimes waking them up, communicating what medicine they had brought, and finding the safest way for that patient to take that medicine (with sips of water, with a spoonful of applesauce, crushed or not, etc.). Multiply these steps by five patients and many medications at different hours throughout the day, and the work did not seem to stop throughout an entire 12-hour shift.

A recurring theme the medical student heard nurses discuss during the elective was a perceived increase in acuity and severity of illness amongst the patients on the floor. When a patient is very sick, they often need more physical and emotional support. This support entails more frequent medication administration, vitals checks, hygiene maintenance, changes in position, skin care, and an overall increase in the need to continue to be present at the patient’s bedside. Though the nurses the medical student worked with always want to provide this level of care for their patients, the nurses found that as the acuity of patients has increased over time, they have far too many responsibilities to complete during a given shift. Without any changes made in the nursing-to-patient ratios, this places greater stress on all the additional tasks that need to be completed during their shift.

During this elective, the medical student also observed that given nurses spend a significant amount of time at the patient’s bedside for some of the reasons described above, there were many instances when nurses were able to make observations that were crucial to the care of their patients. It also allowed them to be better advocates for their patients in situations when the team seemed to believe the patient understood the plan, but time with the nurse in the room revealed otherwise. For example, they recognized one patient had not understood her cancer diagnosis and another patient did not want to proceed with a scheduled BKA when the team initially believed otherwise. When nurses express concern or questions about a patient, the medical student found it was coming from an informed place of spending time at the patient’s bedside, and the team functioned better when observations were received with appreciation and given appropriate attention.

Leveraging Observations to Facilitate Positive Change

When this elective was created, we anticipated medical students would learn a significant amount about the procedural and technical aspects of a nurse’s job. We did not realize the extent to which they would reflect on deeply important lessons around communication and teamwork. Though students observed many examples of productive communication in the hospital, they also identified areas where communication between nurses and physicians could be improved.

One of these areas was the communication that takes place when physicians place orders for their patients. On several occasions, the student noted that physicians asked questions of the nurses about why tasks were not completed in a certain way or by a certain time. Working with the nurse during the entirety of their shift, the student was better able to appreciate the multitude of reasons why this may have occurred. After participating in the elective, they believe that physicians taking ownership of how orders are written and subsequently communicating about orders with gratitude could lead to smoother communication and more effective teamwork.

While we are actively collecting data to identify concrete next steps and potential changes to improve communication, we believe electives like this one could have a significant impact on medical students’ practice. Moving forward, there may be additional topics to incorporate into nursing electives for medical students, such as teaching on the practical aspects of medication administration (for example, how long electrolytes need to run or if certain medications cannot run at the same time through the IV). We believe incorporating interprofessional training experiences, similar to this elective, for students, residents, and attendings could lead to greater support and understanding among team members and better equip trainees to continue to have ongoing constructive conversations about how to optimize team communication. Our hope is that they will learn the skills of thoughtful and grateful communication with nurses from such experiences during medical school. Nursing is a difficult field, both physically and emotionally. We, the physicians, should be lifting our teams up, appreciating them, and asking them what they need to do their jobs and provide the best possible patient care — our common and shared goal.