Nurse-Physician Relations: What Has Changed and What Hasn't
Much has been published on the nature and current state of the relationship between nurses and physicians. It's a debate at least as old as organized medical care itself and it continues to occupy the thoughts of nurse managers everywhere. Given the topic's often controversial character and the sometimes highly charged tone, it is always welcome to have some balanced research available to inform our thinking about it.
A current article in Nursing2007 (Sirota T, "Nurse/Physician Relationships: Improving or Not?" Nursing2007, January, 37 (1): 52-55. You can download the article for free here) discusses the current state of nurse-physician relationships, noting some significant improvements yet also persistent problems. The article draws on research begun sixteen years ago, surveying the attitudes of nurses and physicians about their relationship. Back then, both constituencies worked in a "rigid hierarchy that placed physicians firmly in charge" and nurses were clearly expected to defer to physicians, leading to less than open channels of communication, quiet resentments and persistent misperceptions about each other.
According to the article, much has changed since then in the health care environment. Health care professionals now recognize that interdisciplinary collaboration and good communication are crucial to patient safety. In fact, agencies such as the Centers for Medicare and Medicaid Services, Joint Commission on Accreditation of Healthcare Organizations (JCAHO), and Institute for Healthcare Improvement expect health care facilities to promote good communication and teamwork to prevent errors and improve patient outcomes. These changes are cited as contributors to better relationships in the OR and in intensive care settings where teamwork is crucial and which have been the beneficiaries of many intensive training projects aimed at improving collaboration and communication.
Support from CMS and the Joint Commission has helped break down the "rigid hierarchy that placed physicians firmly in charge" and build a foundation for nurses to stand on an equal footing. Moreover, nurses report that disruptive physician behavior-such as acting rude, belittling, or intimidating-is less prevalent among younger physicians, who are now being "reared in a more egalitarian social climate."
However, the national survey of nurses and other current research indicate that nurses' daily interactions with physicians tend to still involve poor communication that can lead to conflict, work dissatisfaction, and even sentinel events. According to the article, communication problems often occur when physicians have dismissive attitudes toward nurses and buy into traditional power/gender roles.
The role of the nurse leader in addressing these issues is clear and can be summed up in one phrase: Knowledge is Power! Any investment in nurses' clinical excellence, communication skills, and knowledge of evidence-based practice is also a direct boost to nurse-physician relations. To improve working relationships with physicians-and promote job satisfaction among nurses-the article suggests that nurse leaders empower nurses by leveraging their expertise. This means that nurse leaders should heavily promote continuing education and certification; encourage participation in professional nursing organizations, conferences, and clinical research; and keep staff up-to-date with advances in their specialty by organizing dedicated nursing work groups ad generally highlight and support all efforts by nurses to grow and develop professionally.
When nurses bring crucial skills and knowledge to committees and interdisciplinary meetings, then increased interaction and collaboration will ultimately erase old stereotypes and attitudes on both sides.
If you are interested in more information on this topic, please get in touch with us. You might also be interested to know that there is a Nursing Leadership Institute course on Strengthening Nurse-Physician Relationships . Contact your regional NLI resource to find out if this course is being offered somewhere near you.
Any attempt to seriously address the issue of nurse-physician communications on the unit and facility-level has to begin with an assessment of its current state. If you would like to take the pulse of what both your nurses and the physicians they work with really think about their interactions, you can do so using a confidential survey. Click here to download the survey for
nurses and here for the physician survey.