Last week, hospitals across the US celebrated National Nurses Week, which led me to recall with gratitude nurses who made a difference in my training and kept me from harming patients. What better place to start than internship?

I salute Nikki, a nurse on the 7PM to 7AM shift in the Emergency Department of a community hospital in Cambridge, MA, who had a wry sense of humor and a knack for being in the right place at the right time. During an unusually busy Sunday evening shift, I saw eight patients with sprained ankles in just one hour. People complimented me for my organizational skills and ability to minimize waiting time. I was proud to be up to the task.

Nikki surprised me by taking me aside and telling me, “Just because that was your eighth patient with the same condition doesn’t mean that it was her eighth sprain,” and just as quickly, turned away to do her next task. My ears burned with embarrassment. I was angry for moving patients through the system and getting called on it. Only later did I realize that she thought that I was trainable, and I took her advice as a compliment. I feel that she still hovers over my left shoulder at times when I am time-pressured.

Later, I relearned the lesson as I analyzed the results of a survey that I conducted as an attending surgeon. The principal question asked, “What should be the aims of a residency program in general surgery?” All 43 residents and attending surgeons cited technical competence as the primary aim. The 20 participating attending surgeons also cited judgment, compassionate patient care, and research as additional aims. However, all 10 participating nurses listed communication skills as the principal aim, followed by technical competence, holistic care, and knowledge-building. Each nurse asserted that the current system of residency training was inadequate for preparing residents to care for patients in a multidisciplinary, collaborative setting and welcomed ways in which they could reduce residents’ burden of care (Cohn K, Batalden P, Nelson E, Farrell T, Walsh D, Dow R, Mohr J, Barthold J, Crichlow R. “The odyssey of residency education in surgery: Experience with a total quality management approach.” Current Surgery, 1997; 54:218-224).

As I wrote subsequently, (Cohn KH, Algeo S. Stackpoole K, Bowkley CW. Overcoming abrasive interfaces: Implications for nurses in leadership positions Nurse Leader. 2005; 3(4):53-56), lifetime continuing education may be necessary to meet patients’ and caregivers’ needs in a way that promotes safe, effective, timely, efficient, equitable care and that provides a fulfilling practice environment.

What do you think:

• Are we managing the process of healthcare change effectively
• Are we establishing our facilities as safe environments for learning as well as safe environments for receiving and providing care
• What synergy results when physicians and nurses truly work collaboratively

As always, I welcome your input.

Kenneth H. Cohn