A first in Quebec: Doctor-to-nurse education to improve patient care

Dr. Gad Friedman reviews aspects of gastroenterology with Endoscopy Nurses Mildred Clement (left) and Joanne Scullion.
Dr. Gad Friedman reviews aspects of gastroenterology with Endoscopy Nurses Mildred Clement (left) and Joanne Scullion.

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 Jewish General Hospital, for physicians to hold rounds for residents or students, having doctors provide ongoing specialized training to nurses has simply not been done—until now.

We are 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.

One physician at the JGH has undertaken to share his knowledge, in keeping with one of the CIUSSS’s key principles: to provide the highest quality of patient care—the more innovative the approach, the better.

Dr. Gad Friedman, a JGH gastroenterologist, proposed to the hospital’s Nursing leadership seven years ago the idea of providing a global education to the nurses in his specialty. “There is a unique aspect to the work of the gastroenterology (GI) team in that they are a bit isolated in a technical world, so there’s a necessity for knowledge,” he says.

From lecture hall to bedside

Once he identified the need for a more specialized, theoretical education for the 16 nurses on the team, Dr. Friedman created a program designed to enhance their clinical training in the form of a series of 37 easily digestible, early-morning lectures. The classes are structured around the different GI 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.

Participants receive the course content by email prior to the class, which is captured on video for viewing and reference afterwards. 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.

“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 about GI conditions and their problems, 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.

Armed with their knowledge from the lectures, the team’s nurses are now also able to discuss a specific disease. 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.”

“We’re also seeing a difference in interaction with physicians,” observes Dr. Friedman. “Nurses with that enhanced training have gained confidence, they are less intimidated to ask questions.” That self-assurance translates into a greater motivation to pursue other avenues of health training in their field.

Nearly a third of JGH endoscopy nurses have taken the gastroenterology nursing exam offered by the Canadian Nurses Association, which unites 45 national associations in specialized areas of nursing. The exam is designed to assess 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.”

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 course reflects a great investment of time spent researching, building and updating the presentations, says Ms. Clement. “The material is all relevant, useful and challenging, which keeps us energized,” she notes. “User-friendly information helps us to better understand why we do certain things. We also learn what we need to know when we approach patients to explain their test findings, and the next step to getting the care they need. For example, if we have a celiac patient, we understand the reasoning behind advising them to continue to consume gluten ahead of testing, instead of eliminating it from their diet. That way, we can get an accurate biopsy.” 

The nurses on the endoscopy team are now more adept at troubleshooting, adds Ms. Clement. “In Endoscopy, we’re all working side by side. The nurses are not simply carrying out tasks. We share our findings and often these are taken into consideration for the better care of the patients.”

As nurses develop these aptitudes, the whole dynamic on the team changes, notes Ms. Clement. “You’ve shown them that you want to continue to learn, that you want to get things done at a gold standard level. Then when physicians and residents talk about patients, they’re more open to you. You have a voice in your specialty that brings you leverage. As nurses, we feel valued when we can contribute in our way, it’s empowering.” It is imperative that nurses have that level of input into patient care, Ms. Clement adds. “We’re the ones beside patients, we see first hand what they want and need. And now, we are even better placed to help deliver focused care.”