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Join us as we host Angel J. Mena, an internal medicine physician and health care executive, along with Ali Morin, a nurse and health care executive. In this episode, we explore the importance of strong nurse-physician relationships in achieving optimal patient outcomes. Our guests discuss challenges such as staffing shortages and burnout rates, while offering insights on improving training and support for nurses. We also delve into leveraging technology to streamline communication and staffing, ensuring efficient collaboration. Tune in for an enlightening conversation on enhancing nurse-physician collaboration and its impact on patient care.

Angel J. Mena is an internal medicine physician and health care executive. Ali Morin is a nurse and health care executive.

They share their stories and discuss the KevinMD article, “Healing the damaged nurse-physician dynamic.”

The Podcast by KevinMD is brought to you by the Nuance Dragon Ambient eXperience.

Ambient intelligence augments human capabilities to make our lives easier. The applications are many, especially in health care. Ambient clinical intelligence is offsetting the most pressing challenges in health care today, such as burnout, physician shortages, physician and patient dissatisfaction, and underperforming financial outcomes, by applying the technology to clinical documentation. 

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Get CME for this episode by clicking on the CME link in the show notes. Today on the show we have Angel Mena and Ali Morin. Angel is an internal medicine physician, and Ali Morin is a nurse. Both of them are health care executives, and together they co-wrote the KevinMD article “Healing the damaged nurse-physician dynamic.” Angel, Ali, welcome to the show.

Angel J. Mena: Thank you very much, Kevin, for having us today.

Kevin Pho: So I’m going to start by just briefly asking you to share your stories and journeys to where you are today. Angel, why don’t you go first?

Angel J. Mena: Of course. Well, I’m a practicing physician, an internist by training. I’m actually originally from the Dominican Republic and came to Cincinnati to train in internal medicine. My journey took a few steps. I was a primary care physician, then joined as a faculty physician for our residency program, where I’m actually a program director for internal medicine.

My technology journey, and part of the reason that we were able to write this piece, started about 10 years ago, when one of my attendings, an oncologist at that time, one of the great oncologists and mentors, had an idea of putting together a communication platform. He invited me to join kind of a think tank on how to put this together, and well, I ended up joining our company, which was later acquired by symplr.

Kevin Pho: All right. Angel, tell me about that blend of your technology background married with your clinical background. I always like to ask physicians this. Did you have any training in terms of managing both those hats?

Angel J. Mena: No, no, I didn’t have any training. In fact, as a company that was getting into the industry of collaboration and communication, we were kind of some of the first ones. I always asked, “Should I train in this?” And we knew we were creating the university for this industry, so we kind of learned as we went. It’s very interesting. It was about being at the right place at the right time, and it’s been such a fantastic journey.

Kevin Pho: All right. Ali, tell me your story and journey to where you are today.

Ali Morin: Yeah, thanks. I’m a pediatric critical care nurse by background. I spent four or five years at the bedside before I was tapped to be a super user. I’m old enough to have charted on paper at the beginning of my career, and we were getting ready to go to the EMR, and I was tapped to be a super user. I immediately fell in love with being the person who could help my nurses understand how technology was going to make their lives better.

I really came to a point where I loved being that great translator. I could go to the IT department and say, “Nurses need to do this.” I could go to the nurses and say, “This is how it can solve your problem.” So I really loved that. I worked in health care systems doing that for about 15 years and then left and went to the vendor side, where I now get to influence and impact how products can help nurses’ lives be better with technology. Right? That’s what we say we do with them. It’s supposed to make better patient outcomes and better outcomes for us, for our staff, as well.

Kevin Pho: So Ali, as you know, within the physician community we have a certain, let’s say, perspective when it comes to health IT solutions. What’s the view of health IT among the nursing community?

Ali Morin: I would say nurses feel like it’s another thing they have to do. No nurse went to school to spend 35 percent of their shift documenting in the EMR. I think we as vendors all think our solution is the best, and we think it’s the one that’s going to make health care better. But we really need to think about it more systematically and programmatically, to say: What are the things that are required of nurses, and what are the things that nurses are being asked to do that aren’t necessarily the nurse’s job, just because they’re there 24/7?

There’s a lot of work going on in the HIMSS community right now around this, the 25 by 5 study and work to try and reduce documentation. There are a lot of industry disruptors who are out there saying, “Let’s put a pause on technology and make sure that it’s the right technology today.”

Kevin Pho: And Ali, one question before we go into the article. So you’ve been in both that clinical space and the health IT space. Now, what are some misperceptions about the health IT space you would like to clear up among your clinical colleagues?

Ali Morin: Technology really is going to be the future. I think we’re not going to go backwards; we’re going to go forwards, and it’s really time to embrace it and come to a position where we, again, define what the right solutions are that we need in place. Certainly the future is AI, ChatGPT, and machine learning. We all know that’s coming.

How do we make sure that vendors are supportive of the staff? Because there is a definite feeling at the bedside today of technology as a burden. We know it’s a burden. We know that nurse managers are spending four to six hours of their shift, or of their day, creating staffing and scheduling so that we have enough nurses at the bedside. We need those technologies to be simpler, no pun intended, for our end users to leverage. I think the bedside staff feel the burden of technology, and we need to solve that.

Kevin Pho: All right, let’s talk about the KevinMD article that both of you wrote. It’s titled “Healing the damaged nurse-physician dynamic.” Angel, tell us, how did this article come together?

Angel J. Mena: That’s a good question. So throughout COVID, so basically between 2020 and 2022, I started noticing an increased number of incident reports in our hospital, in our practice. They were not necessarily true patient outcome issues, but more communication issues. We started thinking, and I poked Ali on this, like, “What’s going on?” And the question was, if we look at what was going on in health care as a whole, we noticed that there’s a lot of attrition in nursing. In the physician world it was about the same; it was with training residents. That’s where I noticed the pattern. But we noticed that the new nurses coming in needed to adapt, and they didn’t have the support that they used to have before. So we started kind of looking into what was going on, and that’s how we put together the article.

And then there were stories. I’m a big believer in the stories, and one of those was a code blue. One of the worst situations a resident in training can encounter is the code blue, right? We all know what a code blue is. But then what if there are two code blues or three code blues at the same time? That’s a worse situation. We have a good process in place and a system for supervision of our interns, right? But when you have to split that team, that’s a daunting experience. But when you go to that bedside and you’re running a code blue and you feel that you have the support from the team that’s there, the nurse leader, the respiratory therapist, whoever is there supporting you, that’s something that I felt was lost. And that was kind of the point of the article: We needed to feel that relationship between nursing and physicians.

For me, I live in the internal medicine world. I worked in the ICU for a while after I trained, and it was so important to have a great team of nurses and other clinicians around me. Ali has experience in trauma. I can’t imagine how you can collaborate when you don’t know each other, when that relationship doesn’t exist there. So that’s kind of how the article came about.

Kevin Pho: And Ali, Angel mentioned that during COVID there was an increased number of incident reports that may have had roots in communication issues. So talk more about that from your perspective. What were some examples of stories that you’ve heard that led to these incident reports?

Ali Morin: Yeah, I mean, certainly you think about the journey in time, and I’m going to date myself, but back in the day, when we were on paper, to know what was going on with the patient, the doctor had to come up and read the notes. You had to see the doctor; the nurse and the doctor spoke together. The EMR got implemented, and lots of that got decentralized, because you could access the chart anywhere you wanted to be. Then compound that with COVID, compound that with people being even physically further apart and socially further apart from each other, and there was less and less ability for people to communicate.

You also put people in physical units that they’re not familiar with working in. They don’t know how to get a hold of the right doctor. They don’t have a technology solution where they can easily communicate, and vice versa. Things are falling through the cracks, because if we don’t have our nurses qualified and certified to take care of patients across the whole care continuum, there’s just inherently going to be an unfortunate outcome, because “I’m not prepared to take care of this patient.” I would self-report, “I’m not prepared to take care of this patient.”

And as we know, we were turning closets into hospital beds because we needed space to put patients, and so it was an unsafe environment to start with. Then you add to it the inability to communicate effectively, and it was just a recipe for a disaster. And so, really, we pulled this article together to remind everybody that patient outcomes are the reason why we do what we do, but there are also our own outcomes. How do we improve our own outcomes? It’s really by communicating and collaborating better and making sure that you have the ability to reduce those misses, right, and kind of fill the Swiss cheese back in.

Kevin Pho: So Ali, of course, in this environment where you just have a shortage of nurses and there has been attrition secondary to burnout from COVID, in that environment, what’s the path forward in terms of improving that communication?

Ali Morin: Well, what are some options that we have? I mean, certainly I’m going to say technology, right? So find the right technology that’s enterprise-deployed, that makes sure that you have the ability to put all care providers on the same team, so that I don’t have to look up one doctor on one solution, one pharmacist on another solution, and use the EMR as a third option. I think technology plays a big piece in making sure that communication and collaboration improve. I think there are a lot of great solutions out there. Our clinical communications solution is by far, in my opinion, the best.

But then you also have to put together: What else are we doing to decrease that burnout? From a nursing perspective, I can’t say enough about the DAISY Foundation and the recognition that comes along with nurse gratitude and nurse manager gratitude, and ensuring that we are continuing to support and grow those nurses who are, to Angel’s point, the new grad nurses who are walking into health care with this great idea that “I’m here to save patients’ lives,” and quickly feel the pressure, and don’t have the support, don’t have the seniority around them that I once had the benefit of having, the luxury of a lot of great mentors around me. It’s kind of baptism by fire on the nursing side.

And I think there are technologies around that too. There’s a lot of simulation technology. There’s the ability to train in a way and onboard in a way where we’re being effective in how we’re positioning those nurses to succeed, because that’s what we have to do. We cannot continue to bleed nurses. There’s not going to be anybody to take care of us, right, when we get there.

Kevin Pho: So Angel, give me a before and after picture. Ali mentioned technology solutions. What would the picture be like before these solutions were implemented? And give us your ideal scenario, where an institution would use some of these technology solutions.

Angel J. Mena: Yeah, if I can go a little bit back and just also add to Ali’s answer, which I completely agree with. When we published this article, pieces of it were published in some other publications, and one of the respondents, or one of the comments, was, “Well, you kind of missed kindness in how you fix this relationship.” And I was like, “Well, you’re right, kindness is the first step, but unfortunately you missed the whole background of the story, where a nurse and a physician were working together in kindness to heal a patient who was in a code. So I’m sorry you missed that part.”

And I think that’s true. We have to be kind. We have to be compassionate. That’s a given, right? We hold this relationship. But then what else can we do to heal this relationship? We need to get to know each other. Then there’s co-training. I’m very humbled and lucky that I work at a health system that supports the physician, nursing, and other clinician interactions that really support our growth professionally and personally. We put together code training between physicians and nurses, because if we’re doing a code, why do I have to train as a physician separately from the nurses? We’re doing it together, so we might as well train together. I did the same for other types of events that happen in the hospital.

Then you have the technology. And when we say technology, yes, you have to choose the right technology, but we all know that any technology that you implement is going to disrupt workflows. So you have to have a partner in place, someone that really has the background in implementing the technology, so you have the right adoption. I think that’s essential: people that have clinical backgrounds, that understand health care, not people that come from technology backgrounds and now want to dabble in health care. So I think that’s essential.

What I see before and after is that it’s about knowing who’s taking care of the patient. So if I’m starting a conversation with someone and it takes me five minutes to figure out who’s the doctor or the nurse or the respiratory therapist taking care of a patient, I’m going to start that conversation with a certain level of frustration. But when in just one click I know who’s taking care of the patient, I can easily communicate and switch from text to voice to virtual, to this and that. Embrace technology to facilitate that communication. But at the end of the day, this is just facilitating. If you have to take the phone and call someone, “Let’s meet by the bedside and take care of this patient,” we have to do it.

And that’s what I hope the after is: that we figure out a way that this collaboration really improves not just patient outcomes, but really improves well-being. I am a believer in burnout. I know; I’ve seen it, and I’ve lived through it. And I think whatever technology solution we implement, people need to monitor for burnout.

Kevin Pho: And just a follow-up on that: What are some obstacles that would prevent us from going from where we are now to your ideal scenario?

Angel J. Mena: So we need to organize ourselves. Health care is a mesh of people, roles, and leadership that sometimes don’t talk. The right hand doesn’t know what the left hand is doing. It’s very departmental. So in the journey of digital transformation, it’s about finding that group of people. It’s enterprise. You have to think enterprise. You need to think outcomes, big, and then make sure that all the solutions that you have talk to each other. I can’t be teaching five or 10 solutions every year to everyone that onboards in my system. I have to figure out how to create one that talks to all the others and really drives the outcomes that I’m looking for, whether they are operational or clinical. But at the end of the day, what you’re doing is making sure that your people, your employees, your team members, are working together and collaborating more.

Kevin Pho: Now I’m going to ask each of you one last question: your take-home messages to the KevinMD audience. Ali, why don’t you go first?

Ali Morin: I’ll go first. Thanks, Kevin. I would say better outcomes are because of better communication. We’re all talking about reducing falls, we’re talking about population health, and we’re talking about decreasing length of stay. All of those things are tied to better communication. There’s no better way to improve outcomes, in my opinion, than better communication.

Secondarily, I will say we are at a precipice in health care right now. We have the ability to change health care. The pandemic was terrible, but it has given us a reason to change, and I think now is the time for everyone to be an innovator, everyone to be a disrupter, and everyone to be an entrepreneur. Think about how you want it to be different, and go speak it, say it, and tell it to whoever you need to tell it to, because people are listening, everyone. CEOs know that the workforce is their number-one challenge. We need to figure out how to get that voice elevated, to know we have ideas and we have suggestions. Be your own advocate. Thank you.

Kevin Pho: And Angel, tell us some of your take-home messages to the KevinMD audience.

Angel J. Mena: Yeah, well, this is always a tough question. I’m super excited about the next 10, 15, 20 years in health care, to be honest. There are a lot of challenges; there are a lot of opportunities. As a program director, I get to interview applicants every year, and there’s kind of a pattern of reasons why we joined health care and became physicians, nurses, and so forth. Many times, you had an experience in your life that kind of made you go into health care, a personal or family experience, and one that’s very common is that you want to change the world, right?

And I think this is the time. Big data, technology, there’s so much. I’m fearful, but I’m excited about the machine learning, right? It’s going to be great. So this is a time to change the world. For anyone who wants to join health care and has the passion, come and join us, because this is going to be fantastic.

Kevin Pho: Angel, Ali, thank you so much for joining the show and sharing your time and insight.

Angel J. Mena: Thank you very much.