First-person accounts of clinical experiences help MGH nurses reflect on and apply new knowledge to their clinical practice. The hospital even includes written clinical narratives in employees' annual performance evaluations.
Nursing is often called an art and a science. But what, specifically, makes nursing an art? If you ask a few nurses they'd likely say that the art lies in the use of soft skills like interpersonal communication, empathy, and active listening, while the application of clinical knowledge makes it a science.
When I was in nursing school two decades ago, I learned it was important to find a balance between those two sides of the caregiving coin. Nursing has evolved since then, and today there's a much greater emphasis on evidence-based practice, tracking clinical outcomes, and synthesizing data into patient care. Throw in the increased use of technology and it can seem like the science of nursing has trumped its art.
But at Massachusetts General Hospital in Boston it's a different story—literally. Clinicians there have been practicing the art of storytelling since 1996. That's when Jeanette Ives Erickson, DNP, RN, FAAN, senior vice president for patient care services and chief nurse at MGH, spearheaded the use of clinical narratives as a way to help clinicians in nursing, occupational therapy, physical therapy, respiratory therapy, social work, and speech-language pathology articulate their contributions to their patients, their colleagues, and the organization.
Twenty years later, storytelling through clinical narratives has become an essential part of the culture at MGH. In a new book, Fostering Clinical Success: Using Clinical Narratives for Interprofessional Team Partnerships from Massachusetts General Hospital, Ives Erickson, along with co-authors Marianne Ditomassi, DNP, RN, MBA; Susan Sabia, BA; and Mary Ellin Smith, RN, MS, share how MGH's narrative culture has helped elevate the science of nursing through reflective practice.
Ditomassi, executive director of patient care and Magnet recognition at MGH, and Smith, professional development manager at MGH in the Institute for Patient Care, explained to me how they use clinical narratives to enhance nurses' clinical skills and further their professional development.
Details bring clinical situations to life
"A clinical narrative is a first-person story from a clinician regarding a patient situation that has meaning to them," says Ditomassi. Recognizing the right story to tell is easy, as a rule. "It's usually the [one] that stays with you no matter what."
Struggles and triumphs alike can present opportunities for deep learning about the clinical process.
"We ask [clinicians] to tell us about what was happening, what they were thinking, and what stood out to them," she says. "When you engage them in what happened by asking questions, the story moves to become something larger and much more involved."
Small details bring the big picture into focus and help the manager and clinician understand the nuances of the situation.
Jennifer Thew, RN, is the senior nursing editor at HealthLeaders.