Patients receive better treatment when nurses and physicians work as a team, sharing knowledge, responsibility and mutual respect. But their interaction is often fleeting, and sometimes, the professional relationship is strained.

To improve patient safety and care, the Josiah Macy Jr. Foundation and the Institute for Healthcare Improvement (IHI) Open School for Health Professions recently challenged Case Western Reserve University and five other prominent institutions to train nursing and medical students to work more collaboratively.

The findings of the yearlong initiative, “Retooling for Quality and Safety” were reported in the December issue of Health Affairs.

Participants also included Johns Hopkins University, Penn State University, the University of Colorado, the University of Missouri and the University of Texas Health Science Center in San Antonio.

The universities presented various approaches, ranging from small-group classroom learning and team-building activities, to hands-on seminars with simulated patients.

“The educational setting is the ideal place to start,” said Deborah Lindell, director of the Graduate Entry Nursing Program at the Frances Payne Bolton School of Nursing at Case Western Reserve University, who co-directed the campus activities.

The universities also placed students in situations where they learned about the strengths each individual and section brought to the team, such as the science-based education for medical students, and the breadth of early clinical and hands-on patient care by nursing students.

At CWRU, Lindell and her co-project director, Mamta Singh of the School of Medicine, involved students working toward the Master of Nursing (MN) degree with prior undergraduate degrees and BSN students with extensive clinical experience. The nursing students teamed up with medical students. Singh directed the Patient Based Programs for first- and second-year medical students, exemplifying the need for interprofessional learning to start early in careers, rather than until clerkships are introduced.

“The initiative demonstrated that schools of medicine and nursing can create learning experiences in quality and safety by integrating the content into existing curricula,” wrote Linda Ann Headrick, the lead author and professor of medicine at the University of Missouri School of Medicine. She was a director on the “Retooling” project and a graduate in epidemiology and biostatics at Case Western Reserve.

A subsequent grant from the Josiah Macy Jr. Foundation has enabled Case Western Reserve medical and nursing students to engage in interprofessional activities that have expanded to include dental and social-work students.

When the nurse- and medical-student teams were polled about their in-patient group experience at MetroHealth Medical Center in Cleveland, some of the responses were:

  • “That both medicine and nursing require dedication and passion in order to bring the best care to our patients.”
  • “That it doesn’t take just one profession to achieve quality patient care and with working together, we are better able to look at all aspects of the patient.”
  • “The implementation of inter-professional collaboration is essential to increasing patient outcomes and must be approached from all sides.”
  • “The biggest take away is probably that working closely with the nursing staff seems to provide an avenue to effectively approach patient care in a detailed and ‘whole-person’ focused manner.”

Faculty of the four professional schools have organized interprofessional events for the spring and fall, where 500 students from the various disciplines will meet, discuss and learn how each profession approaches a specific topic, such as obesity.

A hallmark of the collaborative approach is the two-year-old Student Run Free Clinic, directed by medical and MN students, with faculty from both schools and physicians from the Free Clinic of Greater Cleveland serving as advisers. Plans include expanding into public health education and adding nutrition and social work students to the mix.