Abstract

Purpose/Aims

This DNP project aims to improve communication and collaboration between physicians (MDs) and registered nurses (RNs) on medical units by implementing a structured three-step communication-rounding model integrated into the daily workflow and leveraging existing communication tools. As patients’ conditions become more complex and healthcare demands increase, it is crucial to foster an environment where communication among providers and staff is clear, transparent, respectful, and collaborative. By leveraging information technology and evidence-based strategies, the project seeks to strengthen interprofessional collaboration and improve patient satisfaction and the quality of care. The project includes educational sessions for both MDs and RNs to facilitate adoption of the model. The Johns Hopkins Evidence-Based Practice (JHEBP) PET model and Kolb’s Experiential Learning Theory provide a framework to support practice change.

Background

According to the World Health Organization (2023), about one in ten patients experiences harm in healthcare, leading to more than three million deaths worldwide each year from patient safety incidents. In inpatient settings across the United States, communication failures have caused medical errors, treatment delays, and inadequate patient education. Poor communication between healthcare providers and patients leads to higher readmission rates, which can negatively affect a hospital's HCAHPS score and result in reduced Medicare and Medicaid reimbursements. In medicine units, nurses are often excluded from interdisciplinary rounds (IDR), creating variability in patient care that can jeopardize patient safety and outcomes. Nurses and physicians continue to face challenges with fragmented communication, which affects patient outcomes and prolongs hospital stays (Tan et al., 2017). Hospital systems have implemented standardized approaches to improve IDR, especially in medicine units, to strengthen interprofessional collaboration and promote patient- and family-centered care.

Methods

A six-question pre-assessment survey was administered to evaluate registered nurses’ perceptions of current rounding practices, participation, communication, and awareness of care plans. Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores from July 2023 to February 2025 at Ronald Reagan UCLA Medical Center (RRUCLA) were reviewed to assess MD-RN rounding compliance and patient satisfaction with communication. In the winter quarter of 2026, physicians, NPs, and nurses were invited to complete a demographic survey and the Baggs Collaboration and Satisfaction about Care Decisions (CSACD) survey to establish a baseline understanding of their perceptions of interprofessional collaboration. Staff participated in educational sessions introducing a three-step structured communication rounding model, delivered via a PowerPoint presentation. After the sessions, participants completed the CSACD and the CDC Post-Course Evaluation survey to assess their knowledge and perceived training effectiveness. Additionally, tip sheets were posted around the unit to encourage adherence to the ongoing DNP project. Four weeks post-training, the CDC Delayed Evaluation Survey was administered to assess the use of the education and the integration of the intervention into practice. HCAHPS scores will be reviewed after education to evaluate patient satisfaction at discharge.

Results

The results for Aim 1 highlighted significant improvements in interprofessional collaboration and communication, particularly in shared decision-making and open communication, following education. Staff satisfaction and perceived collaboration also increased, with the most notable improvement in collaboration between physicians and nurses. The results for Aim 2 showed that education increased staff confidence and perceived competence in interprofessional communication and collaboration. Participants noted that the educational intervention was relevant to their current role and that they intended to continue using it. The results for Aim 3 demonstrated that the majority of participants used the education provided 4 weeks post-implementation and reported opportunities to apply the content in their work. The results for Aim 4 showed improvement across all three HCAHPS communication domains following education implementation. Overall, the findings showed that implementing the structured MD-RN rounding model, with targeted education, led to several notable improvements and positive outcomes across all four aims.

Conclusion


Implementing a structured rounding model improved communication and satisfaction among healthcare staff and patients. Even when nurses miss bedside rounds, tools like Secure Chat keep them informed and engaged. The project aimed to demonstrate its impact on patient outcomes and teamwork, underscoring its importance. Continuing the three-step rounding model promotes safer, collaborative IDRs. Attending physicians should enforce and encourage its use among residents and interns to shift the culture. To support long-term success and impact, it is recommended that structured rounding be integrated into daily workflows, staff training be increased, best practices be reinforced through leadership engagement, and, if feasible, implementation be expanded to additional units.

Keywords: Physicians, Registered Nurses, Patient, Interprofessional, Communication, Collaboration, Rounding, Model, Medicine, Unit

LLU Discipline

Nursing

School

School of Nursing

First Advisor

Robin Dudley Pueschel

Second Advisor

Salem Dehom

Degree Name

Doctor of Nursing Practice (DNP)

Year Degree Awarded

2026

Date (Title Page)

Spring 2026

Language

English

Type

Doctoral Project

Page Count

99 p., 1 p.

Digital Format

PDF

Digital Publisher

Loma Linda University Libraries

Usage Rights

This title appears here courtesy of the author, who has granted Loma Linda University a limited, non-exclusive right to make this publication available to the public. The author retains all other copyrights.

Collection

Loma Linda University Electronic Theses and Dissertations

Collection Website

http://scholarsrepository.llu.edu/etd/

Repository

Loma Linda University. Del E. Webb Memorial Library. University Archives

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