Multidisciplinary Teams on my First Travel Nurse Assignment
- Patrick Callang
- Apr 17, 2023
- 5 min read
Welcome back! In my last post, I wrote about my first few night shifts on my first travel nurse assignment. You can check out that post and others here!
The Multidisciplinary Healthcare Team
My first travel assignment was at a level 1, trauma and academic hospital in Portland, Oregon. There, I had the opportunity to work with a multitude of healthcare workers. Not that I didn’t have that opportunity at my old hospital, but the difference was that I was able to experience working alongside new medical doctors (MDs). If you aren’t familiar with the hierarchy of doctors at a university hospital, let me give a quick breakdown.
Medical Students
These are individuals who are pursuing a degree in medicine. Medical students are typically in their first two years of medical school and are learning the basics of medicine, such as anatomy, physiology, and pharmacology. They aren’t licensed to practice medicine and don’t have the authority to make medical decisions or write orders for patients.
I had the unique opportunity to have a few medical students shadow me during some shifts. It was a great opportunity to have them learn about my role as a nurse and how I contribute to the multidisciplinary healthcare team.
Interns
After completing their medical degree, graduates have to complete a one-year internship, also known as a "PGY-1" (post-graduate year 1) program. During this time, interns work under the supervision of more experienced doctors and gain hands-on experience in the medical field. They are responsible for tasks such as taking patient histories, conducting physical exams, and performing basic medical procedures. It is definitely a different dynamic working with interns.
Although they are considered doctors, they aren’t as experienced as the doctors I was used to working with. They wouldn’t just rely on their senior doctors to help them, they often would also rely on us, the nurses, to help them. Coming from a critical care background, I found myself being seen as an expert, especially when the interns had little critical care exposure. However, their experiences in other specialties brought a different perspective to each patient I took care of and I always appreciated their unique input.
Residents
Following their internship, doctors typically complete a residency program, which can last anywhere from 2-7 years depending on their specialty. During this time, they work under the guidance of attending physicians and gain more advanced clinical experience. They may also participate in research and other scholarly activities.
From my experience, the residents I worked with had critical care experience as interns and decided to further pursue critical care. These doctors were proficient and often operated pretty independently from their fellows and attendings. The times that they really consulted with their senior doctors would be in regards to higher acuity critically ill patients. Outside of the MICU, I also met some residents who were involved with unique research projects. One, in particular, was focused on using VR technology as a distraction method for patients in pain.
Fellows
After completing their residency, some doctors choose to pursue additional training in a specialized area of medicine through a fellowship program. Fellows work under the supervision of attending physicians and are often involved in research and teaching activities. At the MICU, the fellows often worked closely with the residents and would try their best to be independent of the attending.
Some fellows specialized in critical care, others specialized in pulmonary critical care. Their different experiences and specialties often brought interesting perspectives to caring for our patients. One challenge that I had with working with fellows was having to adapt to each individual doctor's preferences on how to manage a patient. In retrospect, I can see this as a great learning opportunity to see how medicine is rarely just a “one-size fits all” science and that it can be an art to individualize the care of each patient.
Attending Physicians
These are fully licensed physicians who are responsible for overseeing the care of patients and supervising medical students, interns, residents, and fellows. They have completed their medical training and have years of experience in their field. They are responsible for making medical decisions, writing orders, and ensuring that patients receive the best possible care.
Working on nights, I would only really see the attending doctor from 7 pm to midnight. If the patients were generally stable and they agreed with the management plan from the fellows and residents, they would leave for the evening. The only times they would come back would be in emergencies. These were the types of doctors I was used to working with. Whenever I had the opportunity, I would pick their brains about certain patients, especially if they had diseases or diagnoses that I wasn’t completely familiar with.
On top of working with MDs and doctors of osteopathic medicine (DOs), I also worked with nurse practitioners (NPs) and physician assistants (PAs). If you aren’t familiar with these types of healthcare workers, here’s a quick breakdown.
Nurse Practitioners
Nurse practitioners are registered nurses (RNs) who have completed advanced education and training in nursing. NPs work in a variety of settings, including hospitals, clinics, and private practices. Some nurse practitioners specialize in specific areas of medicine, such as family practice, pediatrics, or cardiology.
Nurse practitioners are licensed to diagnose and treat medical conditions, order diagnostic tests, and prescribe medications. They can also provide health education and counseling to patients and their families. In some states, nurse practitioners have full practice authority, which means they can practice independently without physician supervision.
Physician Assistants
Physician assistants are medical professionals who work under the supervision of a licensed physician. Like NPs, they work in a variety of settings, including hospitals, clinics, and private practices. PAs can specialize in specific areas of medicine, such as emergency medicine, surgery, or cardiology.
Physician assistants are licensed to diagnose and treat medical conditions, order diagnostic tests, and prescribe medications. They can also perform medical procedures such as suturing, casting, and splinting. However, their practice must be supervised by a licensed physician, and they must consult with the physician regularly.
Throughout my assignment, I collaborated with NPs and PAs in the neuroscience ICU and cardiovascular ICU (CVICU). At times they were the primary provider for my patients and they would be the ones I would speak to during rounds or if I needed orders or simply wanted to consult them. During one shift in the CVICU, I assisted a PA with inserting a Swan-Ganz, or pulmonary artery, catheter. Luckily, I didn’t have to fully manage using the PA catheter. The CVICU had resource nurses that could help with troubleshooting and running the numbers and interpreting them.
Having spent roughly 6 months working at this hospital, I learned a lot from everyone that I met. Some special mentions and shoutouts to all the respiratory therapists, pharmacists, patient mobility techs, certified nursing assistants, social workers, and so much more! One of the most important lessons that I learned from this assignment is that you have to put yourself out there and get to know the team you are working with in order to learn as much as you can to be a successful and proficient travel nurse!
I know I mentioned in my last blog post that I would talk about the night shift routine for nurses at this MICU, but you’ll have to come back next week for that!
Until next time! Salamat and si yu’us ma’ase!
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