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I just took a job at a teaching hospital connected to a medical school and residency program. Although the hospital has a great reputation, it seems stuck in the dark ages in terms of multidisciplinary cooperation. Even though members of the patient-care team-nurses, physicians, social workers, chaplains-meet regularly, nurses are never asked to share information about things I think are important, such as family issues, ethical problems, nutrition, and wound healing. Most of the time is spent discussing complex diagnoses and other medical dilemmas. Similarly, when physicians make rounds with medical students, they talk to one another around the patient's bed, shutting out the nurse and the family.


I think this is an ethical issue because the hospital isn't using a team approach to patient care and the quality of care suffers. What can I do to promote change?-C.B., TEX.


Jump-starting a culture change isn't easy when a hospital is stuck in an old paradigm, such as the medical model of care. That's because most people can't imagine another way of doing things. Bravo to you for seeking a change for the better!!

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Start with education. Before people become open to change, they need to see and hear real-life examples of different options and recognize them as better. So, for example, find a DVD that shows the kind of interdisciplinary, interactive team meeting that works to benefit patients.


Research has shown that multidisciplinary rounds and good communication among professional caregivers improve patient care and reduce errors and other adverse events. Some hospitals have promoted better communication and collegiality by developing a documentation system that incorporates interdisciplinary progress notes. For more details on these issues, see the "Nursing2006 Patient-Safety Survey Report" in the May issue.


As you advocate for change, use your hospital ethics committee as a resource; members should be skilled at interdisciplinary communication and decision making. And investigate hospice, a caregiving model that's traditionally interactive and that puts the patient and family at the center of the team process. Your hospital's quality improvement system should also play a major role in promoting change because interdisciplinary patient-centered practice reduces errors and improves patient care.


Brainstorm with your nurse-manager about how nurses can work more collegially with physicians. Talk with physicians too. You may be surprised to learn that some would like more input from nurses.


Kudos to you for helping to move your new hospital out of the dark ages-it's the right thing to do.