Improving Resident and Nurse Communication Practices: Results of a Collaborative Culture Initiative

Paging is a critical modality for urgent hospital communication. We sought to improve overnight nurse paging practices to reduce noncritical pages, improve resident sleep practices and create a team approach to patient care between residents and overnight nursing staff.

Residents, overnight urology nurses and a communications liaison met during 2 overnight sessions in October 2014 to develop a training curriculum for overnight paging, which consisted of a paging protocol based on page urgency, and batching nonurgent communication into a cluster page. Overnight (11 p.m. to 7 a.m.) pages per night were assessed from March 2014 to March 2015. Nurses and residents categorized page messages for perceived urgency. Pre-training and post-training surveys examined physician-nurse opinion after collaboration.

Before training the nurses and residents had variable agreement across all urgency categories (Cohen's kappa=0.25 indicating poor agreement, sample size 132 pages). On trained floors average nightly pages decreased from 2.6 during training to 1.6 after training (November to January, Mann-Whitney p=0.007). This reduction was stable 5 months after training (1.8 pages per night, p=0.994 compared to after training). There was also a paging decrease on untrained floors (7.9 from 9.8 pages per night, p=0.005) but the decrease was lost at 5 months (6.29 pages per night, p=0.0493). Paging frequency from trained floors was proportionally lower (50% reduction) than from untrained floors (29% reduction). The post-training survey demonstrated that new paging practices improved overnight communication, physician response and mutual respect.

This nurse-physician training collaborative produced a lasting reduction in overnight pages, an improved resident response to urgent pages and an enhanced culture of mutual respect.