A first in Quebec: Doctor-to-nurse education to improve patient care
The evolution of the professional relationship between doctors and nurses is surging ahead in CIUSSS West-Central Montreal in an initiative—the first of its kind in Quebec—in which a gastroenterologist is teaching nurses more about their specialty to improve the quality of patient care.
While it’s common, especially in a teaching hospital like the JGH, for physicians to hold rounds for residents or students, having doctors provide ongoing specialized training to nurses has simply not been done—until now.
This a far cry from decades past, when nurses and allied health professionals were often considered to be subservient to physicians. Today, doctors still command the greatest medical expertise, but they are seen as members of a multi-disciplinary healthcare team, each of whose members make a unique and valuable contribution to the patient’s well-being.
Dr. Gad Friedman, a JGH gastroenterologist, proposed to the hospital’s Nursing leadership the idea of providing a global education to the nurses in his specialty. “There is a unique aspect to the work of the gastroenterology team, in that they are a bit isolated in a technical world, so there’s a need for knowledge,” he says.
Once he identified the need for a more specialized, theoretical education for the 16 nurses on the team, Dr. Friedman created a program to enhance their clinical training in a series of 37 easily digestible, early-morning lectures.
The classes are structured around the various organs—for example the esophagus. They begin with the study of a specific organ’s physiology and anatomy, and then review related diseases, from the more benign (such as acid reflux) to the more grave (such as cancer).
The cycle of the program spans four years, with Dr. Friedman lecturing eight times a year at the JGH. The course is now accredited, culminating in a jeopardy-style game show to test the nurses’ knowledge, as well as a standard post-lecture participant evaluation quiz.
Cooperating to deliver gold-standard care
One of the first nurses on the endoscopy team to take the gastroenterology certification exam, Mildred Clement, developed an interest in research while working in endoscopy at a private clinic early in her nursing career.
She found, however, that she felt more fulfilled as a nurse in a hospital setting because she was caring for a far broader range of GI patients.
Ms. Clement returned to the JGH, where she had begun her career in health care, but retained her taste for studies. “I wanted to get in underneath all the thinking behind what I do,” she says.
One year after Dr. Friedman began his lectures, she received her GI certification. Ms. Clement says that when her colleagues saw her studying for her exam, they wanted to become certified as well.
She credits Dr. Friedman for supporting that interest in more specialized education. “His model of physician-to-nurse practice is pioneering and innovative.”
“The nurses are highly trained in techniques to assist the physician, as in an endoscopic procedure using a scope, but they were not necessarily informed about the diseases themselves,” says Dr. Friedman.
“By transferring a physician’s knowledge, nurses attain a level of expertise that has a direct impact on patients.”
He has witnessed the team responding more effectively to complications that arise when a patient is undergoing a procedure. He cites as an example a nurse’s ability to handle a patient who is experiencing pain during a colonoscopy, or to intervene if a patient loses consciousness.
Before the course was offered, nurses were on the receiving end of patients’ questions but did not always have the answers, says Dr. Friedman. What are the symptoms of inflammatory bowel disease, for instance? Or what does a colon polyp mean to my health?
“It’s really important that they feel more comfortable in responding to patient queries, in directing patients in their care, because some patients are far more likely to turn to a nurse for information about their disorder or a procedure, they may not ask a doctor.”
Nearly a third of JGH endoscopy nurses have also taken the gastroenterology nursing exam offered by the Canadian Nurses Association, which unites 45 national associations in specialized areas of nursing. The exam assesses the ability to practise safely and ethically in a given nursing specialty.
“They opted to take the exam by their own initiative, it’s not required and doesn’t directly promote their career,” says Dr. Friedman. “The incentive is purely one of interest in expanding their knowledge in their specialty so that they can become more proactive in patient care.”