The U.S. Registered Nurse: Your Role in the Multidisciplinary Healthcare Team

Nursing in the United States operates within a collaborative, multidisciplinary framework that may differ significantly from healthcare models in other countries. As an international nurse preparing to work in the U.S., understanding your role within this team structure is essential for providing excellent patient care and thriving in your new environment.

Understanding the Multidisciplinary Team

U.S. healthcare delivery is built on the principle that optimal patient outcomes require diverse expertise working in concert. Unlike hierarchical models where nurses primarily execute physician orders, American nurses are viewed as integral team members with unique contributions to patient care. This collaborative approach recognizes that nurses bring critical assessment skills, patient advocacy, care coordination and clinical expertise that complement, but are distinct from, the contributions of physicians and other team members.

The typical multidisciplinary team includes:

Physicians and Advanced Practice Providers: Attending physicians, residents, physician assistants (PAs) and nurse practitioners (NPs) who diagnose, prescribe treatments and oversee medical management

Registered Nurses (RNs): Bedside nurses who provide direct patient care, conduct assessments, administer medications and treatments, coordinate care and serve as patient advocates

Pharmacists: Medication experts who review orders, recommend adjustments, provide drug information and ensure safe medication use

Physical, Occupational, and Speech Therapists: Rehabilitation specialists who assess function, develop treatment plans and work toward patient mobility and independence goals

Social Workers and Case Managers: Professionals who address psychosocial needs, coordinate discharge planning, arrange community resources and support patients and families through transitions

Respiratory Therapists: Specialists in airway management, mechanical ventilation and respiratory treatments

Dietitians: Nutrition experts who assess dietary needs, develop nutrition plans and address metabolic concerns

Other Allied Health Professionals: Lab technicians, radiology technologists, chaplains and various specialists depending on patient needs

Core Responsibilities of the U.S. Registered Nurse

1. Patient Assessment and Monitoring

As the healthcare professional spending the most time with patients, nurses are responsible for continuous assessment and monitoring. This includes:

• Conducting comprehensive head-to-toe assessments at the beginning of each shift and focused assessments throughout the day
• Monitoring vital signs, pain levels and changes in patient condition
• Recognizing early warning signs of deterioration or complications
• Interpreting telemetry strips and monitoring data
• Documenting findings accurately and promptly in the electronic health record

Your assessment skills are critical. Physicians and NPs rely on your clinical judgment to identify changes that warrant intervention. In U.S. nursing culture, you’re expected to use critical thinking and notify providers when you observe concerning findings, not simply wait for orders.

2. Medication Administration and Management

Medication safety is a cornerstone of nursing practice in the U.S. Your responsibilities include:

• Verifying medication orders for accuracy, appropriateness, and potential interactions
• Following the five rights (right patient, medication, dose, route, time) plus additional safety checks
• Understanding drug actions, side effects, and nursing implications
• Questioning orders that seem inappropriate or unsafe
• Monitoring patient response to medications and reporting adverse reactions
• Educating patients about their medications

U.S. nursing emphasizes that you have a professional duty to question orders you believe may harm patients. This is not viewed as insubordination but as essential patient safety practice. Collaborate with pharmacists when you have concerns about medications; they’re valuable allies in ensuring safe medication practices.

3. Care Coordination and Communication

Nurses serve as the central hub of communication within the multidisciplinary team:

Facilitating communication between physicians, specialists, therapists and other team members

• Providing concise, accurate reports during shift handoffs using structured frameworks like SBAR (Situation, Background, Assessment, Recommendation)
• Participating in interdisciplinary rounds and care planning meetings
• Coordinating diagnostic tests, procedures and consultations
• Ensuring seamless care transitions during patient transfers or discharge
• Advocating for patient needs across disciplines

Effective communication is essential. U.S. nursing culture values assertive, professional communication. You’re expected to speak up when you have concerns, ask questions when you need clarification and advocate for your patients’ needs.

4. Patient and Family Education

Patient education is a fundamental nursing responsibility in the U.S., driven by both quality of care goals and regulatory requirements:

• Teaching patients about their conditions, treatments and self-care
• Providing discharge instructions and ensuring patient understanding
• Explaining procedures and obtaining informed consent
• Addressing health literacy barriers and adapting teaching to patient needs
• Supporting families in caregiving roles

Patient education impacts hospital reimbursement and quality metrics, particularly around readmission rates. Documentation of education is equally important as the teaching itself.

5. Patient Advocacy

• U.S. nursing strongly emphasizes the nurse’s role as patient advocate:
• Ensuring patient preferences and values are respected in care decisions
• Speaking up when you observe potential safety issues or quality concerns
• Supporting patients’ rights to informed consent and refusal of treatment
• Facilitating access to resources and support services
• Protecting vulnerable patients from abuse or neglect

Patient advocacy is considered a professional obligation, protected by workplace policies and nursing regulations. You should never fear retaliation for advocating appropriately for patient safety and wellbeing.

6. Technical Skills and Procedural Competency

U.S. nurses perform a wide range of technical procedures:

• IV insertion and management of central lines, PICCs and other vascular access
• Wound care and dressing changes
• Urinary catheter insertion and care
• Nasogastric tube insertion and management
• Specimen collection (blood, urine, sputum)
• Operating specialized equipment (IV pumps, feeding pumps, sequential compression devices)
• Emergency response (CPR, code team participation)

Hospitals provide competency validation for procedures but prior acute care experience with these skills is highly valued.

Collaborative Practice in Action

Let’s examine how multidisciplinary collaboration works in practice:

Example: Post-Surgical Med-Surg Patient

A 68-year-old patient is recovering from hip replacement surgery:

• The surgeon manages the surgical site, prescribes medications and determines medical clearance for therapy
• You (the RN) assess pain, administer medications, monitor for complications (infection, DVT, bleeding), provide wound care, educate the patient about hip precautions, coordinate care activities and serve as the communication hub
• The physical therapist assesses mobility, provides gait training and works toward discharge goals
• The occupational therapist evaluates the patient’s ability to perform activities of daily living and recommends adaptive equipment
• The pharmacist reviews pain management and anticoagulation therapy, making recommendations to optimize safety
• The case manager plans for discharge, arranging home health services or rehabilitation facility placement
• The dietitian ensures adequate nutrition to support healing

During interdisciplinary rounds, you report the patient’s current status: pain control is adequate with current medication regimen, the surgical site shows no signs of infection, the patient is anxious about going home alone and may benefit from extended care placement. The physical therapist reports the patient is progressing but needs additional therapy before safe discharge. The case manager notes this feedback and begins exploring options. The pharmacist suggests a simplified medication schedule to improve adherence post-discharge. The surgeon agrees with the plan.

This scenario illustrates true collaboration; each team member contributes unique expertise and decisions are made collectively with the patient’s best interests at the center.

Cultural Considerations for International Nurses

International nurses sometimes find U.S. collaborative practice culture requires adjustment:

• Speak up and ask questions: Silence is not valued in U.S. healthcare. If you don’t understand something or have concerns, you’re expected to voice them.
• Professional equality: While each team member has distinct roles, there’s an expectation of mutual respect and professional equality. Nurses are not subordinate to physicians but rather partners in care.
• Direct communication: U.S. professional communication tends to be direct. When calling a provider about a patient concern, be clear, concise and assertive.
• Use of first names: U.S. workplace culture is often informal, with team members addressing each other by first names regardless of title. This doesn’t indicate disrespect but rather a culture of collegiality.
• Critical thinking is expected: You won’t simply execute orders without thinking. You’re expected to understand the why behind interventions and recognize when something doesn’t seem right.

Your Value to the Team

As a registered nurse in the U.S., you’re not just a pair of hands executing orders; you’re a critical thinker, patient advocate, care coordinator, educator and clinical expert. The multidisciplinary team relies on your observations, assessments and insights to provide safe, high quality patient care.

Understanding your role and embracing your professional responsibility within this collaborative framework is key to success in American healthcare. You bring valuable skills and perspectives from your education and experience in your home country. Combined with understanding of U.S. healthcare culture and expectations, you’re positioned to make meaningful contributions to patient care and earn the respect of your colleagues.

At Conexus MedStaff, we prepare international nurses not just for the technical aspects of U.S. nursing, but for the collaborative, autonomous practice culture you’ll encounter. We’re here to support your transition and help you thrive as a valued member of the American healthcare team.