Implementing a Pediatric Resident Physician/Bedside Nurse Shadow Program to Improve Interprofessional Collaboration and Understanding, and to Transform Practice

Abstract

INTRODUCTION Resident physician/nurse collaboration is essential for patient safety and optimal clinical outcomes. Interprofessional shadowing experiences can facilitate understanding of team roles; however, enhanced understanding may not transform individual practices leading to workplace improvement. This educational innovation utilized a resident/nurse shadow program to raise awareness of interprofessional roles and as a needs assessment to identify and educate about specific system-wide standards that can lead residents to transform their practices to improve nurse workflow. METHODS From 2018-2020, 44 first-year pediatric residents at a free-standing children’s hospital shadowed nine nurse preceptors. Each nurse received an orientation and checklist of topics to cover. Residents observed nursing responsibilities including admissions, line placement and medication administration. All participants completed pre-post surveys. RESULTS Post-surveys demonstrated a statistically significant improvement (p<.00001) in Likert scores of residents’ self-rated understanding of nursing cares and workflow. The experience uncovered three system-wide scheduling standards where resident modification of ordering practices could optimize nursing workflow: timing of morning lab draws, new medication administration, and delivery of dietary formula. The shadow program was modified to include education in these three areas and participants had statistically significant (p<.01) increased knowledge of timing of morning labs and new medication administration (35% and 39% improvement, respectively). Nurse understanding of resident workflow was not measured due to limited data.DISCUSSION A resident/nurse shadow program successfully improved resident awareness of nursing roles and was an innovative way to identify specific areas of workflow improvement. Program modifications are required to create a true, bidirectional, resident/nurse interprofessional shadow experience.