A Guide To All The People You May Encounter On The Wards
As the field of medicine has become increasingly complex, patient care responsibilities have been divvied up across an ever growing number of providers and support staff. Over 13 million Americans are now employed in the healthcare sector, and the Bureau of Labor Statistics projects that the field will grow quickly in coming years. The field’s sheer size may pose a challenge to young physicians-in-training, who may find it difficult to learn the roles and capabilities of every member of the medical care team. However, having a clear understanding of the roles of each member of the team and how they interact with one another is essential to understanding how medical care is delivered in America. In this article, we will go over the roles of some of the healthcare workers you will encounter on the inpatient wards.
Attending physicians supervise fellows, residents, and medical students as they provide medical care to patients. Attending physicians have, at a minimum, completed medical school and residency, and some have completed a fellowship as well. They are ultimately responsible for the medical decisions made on their services.
Fellows have completed medical school and residency and are pursuing training in an advanced subspecialty, like cardiology or rheumatology. They are still under the tutelage of attending physicians. Fellows can oversee residents in the provision of medical care.
Residents have completed medical school and are pursuing medical training in their chosen specialty (residency). Residents provide medical care, in the form of medications and services, to patients under the supervision of attendings and fellows.
Medical students are in the process of completing medical school and deciding which specialty to pursue. They generally work directly under the supervision of residents when taking care of patients. They cannot prescribe medications on their own.
Physician assistants (PAs) have completed a PA post-graduate training program. They have their own licenses and can provide medical care to patients under the supervision of a licensed physician. They are able to prescribe a variety of medications to patients.
Nurse practitioners (NPs) are registered nurses (see below) who have received additional graduate-level training in the care of patients. They may order diagnostic and laboratory tests, medications, and patient services. Depending on the state, NPs may care for patients on their own or under the direct supervision of a licensed physician.
Registered nurses (RNs) work with medical students, residents, fellows, and attending physicians to implement medical care plans. While their exact responsibilities vary by hospital, nurses generally help take patients’ vital signs, dispense medications, assist patients in their activities of daily living (e.g. helping with bathing and toileting), guide medical students, and facilitate communication between patients, their families, and physicians.
Nursing assistants work under the supervision of registered nurses to help implement medical care plans. Among many other roles, they assist nurses in helping patients complete their activities of daily living and taking patients’ vital signs.
Nutritionists help optimize patients’ diets to ensure they are receiving enough calories and the appropriate nutrients for their medical conditions. They review daily nutrient consumption and provide personalized diet recommendations.
Pharmacists dispense medications and directly educate patients on the proper use of their medications. Pharmacists often participate in rounds with medical students, residents, fellows, and attending physicians.
Occupational and Physical Therapists
Occupational therapists help patients maintain and regain their abilities to complete tasks required for daily living and work, while physical therapists help patients recover their mobility. The recommendations of occupational and/or physical therapists play a crucial role in determining which patients require continued therapy in acute rehabilitation, sub-acute rehabilitation, a skilled nursing facility, or at home on discharge.
Phlebotomists draw blood from patients for analysis. In their absence, nurses, nurse assistants, and residents may fulfill this task.
Radiologic technicians perform diagnostic imaging examinations, such as X-rays, CT scans, and MRIs. They often come to the wards to administer portable X-rays.
Respiratory therapists manage life-saving ventilation systems and artificial airways, help collect sputum samples for analysis, and administer pulmonary rehabilitation. They play an especially crucial role in managing intubated patients in intensive care units.
Speech-language pathologists diagnose disorders of swallowing and assist the primary medical care team in determining personalized treatment plans for individual patients. Evaluations of post-stroke patients by speech-language pathologists, for example, help determine when it is safe for these patients to start eating again.
How The Medical Team Works Together
As is clear from the list above, you will come across many different health workers while on the wards. To see how they all interact, let’s consider the hypothetical example of patient X, an emaciated, 70-year-old man who presents to the emergency department with altered mental status and shortness of breath. The emergency room attending determines that he requires an inpatient admission and calls the admitting resident, who, along with the medical student rotating on his service, takes the patient’s history, performs a physical exam, and places orders for medications and laboratory and imaging studies.
Upon the patient’s arrival on the wards, his registered nurse places an IV and administers medications, while the nursing assistant takes the patient’s vital signs. A phlebotomist draws blood to send for laboratory analysis. A respiratory therapist helps suction his excessive secretions. A radiologic technician comes by to perform a portable X-ray, and a speech-language pathologist evaluates the patient’s ability to swallow.
The next morning, the patient is discussed on teaching rounds run by an attending physician. Residents, medical students, pharmacists, PAs, and NPs all participate in rounds. Over the next several days, the patient improves. Given his cachectic frame, the medical team calls a nutrition consult, and a nutritionist creates a personalized nutrition plan for the patient. A physical therapist evaluates the patient and determines that he would benefit from sub-acute rehabilitation given his limited mobility as a result of physical deconditioning. A few days later, now back to baseline, the patient is discharged from the hospital to sub-acute rehabilitation.
While the inpatient care team may seem complex, the roles of each member will become clear with experience. Stick with it–soon enough you will learn how to utilize the skills of every healthcare worker to provide your patients the best care.