At the Johns Hopkins School of Medicine Division of Rheumatology, Baltimore, registered nurses (RNs) are an integral aspect of the rheumatology fellowship program. This gives the fellows information and insight into areas of practice they might not otherwise receive.
“This [practice] is a result of our very strong belief that an integrated and interdisciplinary approach, including the participation of nurses, is critical to provide the best care for patients with rheumatic disease,” says Clifton Bingham, MD, director of the Johns Hopkins Arthritis Center. “The RNs play a critical role in educating patients about their diseases and instructing them on treatment options and their various risks and benefits.”
Dr. Bingham says medical training is traditionally centered on what physicians can assess through clinical evaluations and less so on more difficult to measure factors and health-related quality of life. Yet these other inputs are important in terms of how patients feel, function and survive.
“The nursing perspective is very different from the physician’s; nursing looks more at how interactions take place with patients and what the patients see as important,” says Victoria Ruffing, RN-BC, director of patient education at Johns Hopkins and one of the lecturers in the program. “What are the unique barriers a particular patient faces that might impede adherence to a particular regimen? What are the psychosocial factors, environmental influences and family support issues that influence a patient’s decisions?”
The RNs’ interaction with fellows begins in orientation and continues throughout the year. The topics nurses address are varied, covering issues of patient teaching, medication administration and certain kinds of patient-specific paperwork.
The nurses deliver hands-on training in aspects of treatment to which physicians are not normally exposed. For example, nurses are a fount of information on how biologic medicines work and possible drug interactions, how to counsel patients on injection techniques, possible reactions and how patients should respond to adverse events.
Another perspective that nursing provides is in the area of interactions with patients and what they see as important. Often, physicians are not well trained in assessing and addressing areas of a patient’s life, such as their personal beliefs, and then integrating care into the patient’s individual environment and circumstances.
“Interacting with the nurses gives us a better understanding of the application of what we learn to where the rubber meets the road,” says Jason Liebowitz, MD, a graduate of the rheumatology fellowship program at Johns Hopkins and now a practicing rheumatologist in New Jersey. “It helps us put into process many of the important parts of medical management that you really can’t get just by reading textbooks or attending lectures.”
With regard to biologics, nurses are often more knowledgeable than physicians about the action, side effects and what is important to teach the patients about these drugs.