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All the Health Care World’s a Stage
Led by professional actors, nurses use improvisational exercises to improve relations.

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Nursing leaders Tina Tolson (left), Karen Davis and Dave Cummings hoped that acting exercises would help nurses to better handle unexpected situations and friction between units.

When dealings between two key nursing units at Hopkins Hospital began to fray, Karen Davis, nursing director for Medicine, knew it was time for an intervention.

Nurses in the Emergency Department, it seemed, became flustered when their counterparts in Medicine couldn’t find beds for new admissions, while the ED would routinely have 20 or more patients in the waiting room. The Medicine nurses, on the other hand, were overloaded with layers of duties on the unit and couldn’t fathom why the ED nurses didn’t understand that. The exchanges between the two groups were sometimes abrupt, as frustrated ED and Medicine nurses were tempted to drop any pretense of diplomacy: “Hey, I need that bed!” 

Looking for help, leaders from the two departments tapped a New York-based firm with a novel team-building approach. The Performance of a Lifetime tackles workplace frictions by persuading co-workers to act out scenarios in loosely structured theatrical skits. “The training group’s philosophy is that we’re all actors and players,” says Davis. “Their approach is for us to learn the skills of the improviser in a safe environment.”

After several discussions in which the group’s director joined Davis in tailoring the skits for nurses here, the daylong retreat unfolded for 60-some nurses on a September day in Turner Auditorium.

Over the course of eight hours, training group director Maureen Kelly and three theater professionals guided the nurses through exercises geared to detect the underlying causes of communication breakdowns in large groups.

As an icebreaker, some nurses were asked to stand before their peers and act out the story of their lives in two minutes. One, for example, addressed the death of her mother. The personal life stories were aimed at encouraging everyone in the auditorium to sense that they would all be feeling “vulnerable together,” says Davis.

In one memorable exercise, Kelly and her fellow trainers directed all 60 nurses to identify two others in the room with whom they could form a three-person triangle. The trick was that they had to spot the two partners and then face each other in a triangle without using any verbal cues. And they had to achieve the goal within five minutes.

“You couldn’t know who else from across the room had picked you,” laughs Tina Tolson, the ED’s nurse manager. The lesson, she explained, was to gain insight into how your own actions affected others in your environment—and to show that not communicating made seemingly simple tasks vastly more difficult.

The Hopkins nurses could see that, when they all shared a common objective, they had to find ways to cooperate and communicate in order to pull it off. A group of mimes, in other words, was impaired when compared with actors who could talk to one another.

In another improvisational drill, nurses who didn’t know one another paired off, faced each other, and went through a mock gift exchange. The recipients had no idea what imaginary item they’d receive—it could be a ball and chain, a kitten, an empty bird cage or anything else—but they had to accept it without going negative. The exercise, Davis says, “is about not knowing what’s coming at you and dealing with it in the right way—which we often have to do as nurses.” The exercise translates to such unexpected scenarios as when a patient is admitted to the unit in far worse shape than he was when a Medicine nurse took a report from the ED.

“Nearly every nurse said they walked away with something they could use in
their practice immediately,” says Dave Cummings, the Emergency Department’s lead nurse coordinator, who surveyed fellow nurses after the retreat. 

In Cummings’ post-retreat survey, 73 percent of ED nurse participants perceived an improvement in relationships as a result of the exercise series, while Medicine nurses perceived an 86 percent boost. In a separate intra-Hopkins survey, the ED nurses reported a 30 percent increase in patient reports taken by Medicine nurses on the first call.  

Survey results also showed improvement in handoff communications. Eighty percent of ED nurses reported that Medicine nurses ask appropriate questions on report.

It was important that the retreat target the units’ most senior nurses who are “leading the floors,” says Cummings, because they can convey their new mastery of group dynamics to junior nurses. The nurses will continue to get together every six months to review the quality of their interdepartmental coordination, he says.                       

—Ramsey Flynn



Johns Hopkins Medicine

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