The two Vietnamese health care providers sat quietly, absorbing the discussion among UCHealth’s providers on the diagnosis and care of patients. But they weren’t observing simulation training at the UCHealth Clinical Education and Innovation Center in Windsor to find out how to diagnose and treat patients — though they were soaking in that information as well. Instead, they were there to learn about the teamwork of doctors and nurses in America.
In the United States, nurses often make decisions based on their observations and communication with patients and their family members. They also discuss treatment plans with doctors. In Vietnam, nurses are prohibited from looking at patients’ test results, responding to acute symptoms or even expressing an opinion. They must always consult a doctor.
Registered nurse Ms. Trinh Le Lam and Dr. Ban Ha Ngoc hope to change that.
Dr. Ban is the chief cardiac intensivist and assistant director of the Heart Institute of Ho Chi Minh City, Vietnam. Ms. Trinh is a faculty member and lecturer of nursing at the University of Medicine and Pharmacy and also teaches with volunteer nursing professors in the Master of Science in Nursing program at the University of Medicine and Pharmacy.
The latter program — the first in Vietnam — was developed and implemented at the University in Vietnam in 2007 in collaboration with Friendship Bridge Nurses Group, of which retired UCHealth nurse Ann Henderson and University of Northern Colorado Associate Professor Alison Merrill are volunteers. Henderson and Merrill encouraged Dr. Ban and Ms. Trinh to visit northern Colorado to learn more about coordination between doctors and nurses, with the goal of improving practice and enhancing patient outcomes in Vietnam.
During their two-week stay, Dr. Ban and Ms. Trinh spent a majority of their time at Medical Center of the Rockies in Loveland, and the University of Northern Colorado’s School of Nursing in Greeley. Dr. Ban and Ms. Trinh also took a trip to UCHealth’s University of Colorado Hospital in Aurora.
Focus on relationships
Dr. Ban said his visit had two purposes. First, he wanted to learn how to improve collaboration between physicians and nurses, especially in the emergency department and intensive care unit.
“At present, the nurses [in Vietnam] just do according to the order of the physicians,” he explained. “They wait and call on the doctor to come and see the patient. Sometimes the physician is not easy to reach and delayed, so it’s really difficult. It puts patients at risk.”
Vietnamese doctors also expect complete obedience to their orders — no questions asked, Dr. Ban said.
Except for his nurses.
“When I train the nurses in my unit during the night shift, they have to work without a physician, so [other doctors are] shocked to see what the nurses do. The following morning, a nurse tells me about the conflict over the night with each patient,” Dr. Ban said. “I was surprised when I saw the MCR team had fewer physicians and more nurses. [The] nurses are very well trained and can help physicians more, especially in the catheter lab.”
Second, Dr. Ban wanted to learn how to teach and organize staff trainings for new procedures, such as treatment for patients experiencing cardiogenic shock after myocardial heart failure. Collaboration between nurses and doctors is important during the performance of such complicated procedures, he said.
More respect, responsibility
Ms. Trinh’s focus was similar.
“I would like to know how nurses here show their confidence and professionalism in their career,” she said. “In Vietnam, I just see how nurses have less confidence. They may be very skillful, but they have so much work to care for patients, [it] makes them tired.”
Merrill explained that Vietnamese nurses may care for as many as 20 patients at one time, compared with the five or six patients for which U.S. nurses are usually responsible.
Ms. Trinh added that nurses in Vietnam have no computers, so everything is documented in writing, and they work three 12-hour day shifts and one 12-hour night shift before having just one day off.
“University provides many skills like communication, partnership or leadership in nursing, but when they become a nurse, they don’t have a chance to provide what they learn at school because they work so hard,” she said.
Ms. Trinh noted she is concerned about patient satisfaction and the value of nurses in her country as well as how nurses can contribute more to the process of patient healing, communicate better with physicians and gain the respect of doctors.
Dr. Ban said those changes could take some time, but they’re possible.
“It really needs to change in the system of education,” he said, noting he is the only doctor at his hospital giving nurses more responsibility and respect. “It costs a lot of money.”
Change on the horizon
Dr. Ban believes hospital physicians need to train nurses, and knowing how to set up simulations like those they observed in northern Colorado will allow him to share that point of view with other doctors and facilities. Incorporating doctor-nurse collaboration into medical school training also will change attitudes, he said.
Giving nurses more responsibility will not only benefit patients and ensure optimal outcomes, it will also relieve some of the stress and pressure that physicians experience, he added.
“Doctors and nurses have the same purpose, want the same outcome,” Ms. Trinh said of what she observed while visiting UCHealth. “Nurses are specialized — IV team, wound care team, palliative care. I’m very impressed.”
Teaching the teachers
But the pair also impressed their American cohorts.
“I commend you for what you’re attempting to do — getting the communication between the nurse and the physician,” Marilyn Schock, chief operations officer for Poudre Valley Hospital and MCR, told them. “You’ll be able to achieve results because of that partnership. I can’t stress that partnership enough.”
Registered nurse Faye Hummel, director and professor of the UNC School of Nursing, said the visit was a benefit to all involved.
“It really isn’t about us helping them improve,” she said. “We take away so much more than what we give. I’m always so taken by their deep desire to learn and to capture every opportunity that comes their way. They don’t ever minimize their opportunities.
“They are able to do so much with so little,” Hummel added. “It is remarkable and it is beyond compare. Just the fact that they can take tidbits of knowledge you impart to them in one day and explode them into something much more is remarkable. …They take nothing for granted.”