Blog post by Irene Andress, Dr Rajiv Singal, Sarah Coppinger, Sharon Navarro of Toronto East General Hospital
Over the last four decades, an enlightenment has taken hold of the healthcare culture. Today’s nurses are seen as “knowledge workers” by physicians and interprofessional practitioners alike. It is a sharp contrast to a century ago when nurses were described as “only the instrument by whom the doctor gets his instructions carried out.”
According to an article by American Sentinel, a new emphasis on interprofessional collaboration and an evolution of standards and clear guidelines that promote healthy work environments should theoretically bring nurses and physicians closer together in hospital hierarchy.
But is this the case?
A 2013 survey commissioned by the Advisory Board Company indicated that the majority of those polled felt that relations between the two professions was “poor” or, at best, just “okay.”
Another story on nurse-physician communication published in a 2012 edition of Canadian Nurse revealed that many nurses in Canada still report conflicts with doctors.
Therefore despite the advances made to bring collaboration to the two professions, a pervasive perception still exists: doctors are in charge, giving orders to both nurses and patients. Many factors contribute to this perception including the historical notion of “the doctor’s order” as well as power imbalances related to gender and education.
Doctors and nurses both agree, a consistent, standardized communication template or framework will not only improve the quality of information collected about a patient, but also help to reduce the power balance between the professions.
“SBAR,” which stands for Situation, Background, Assessment, Recommendation is a recognized framework of communication that many healthcare settings use. Using SBAR helps foster communication by prompting clinicians for useful points of information about a patient’s condition. Nurses have considerable technical expertise and skills. When physicians ask for their assessment, using techniques like SBAR and other standardized communication approaches will provide both docs and nurses the quality information they need to formulate a plan together.
Interprofessional Collaboration and Communication are Key
It is no secret, interprofessional collaboration and good communication contribute to the safest patient care. In fact, the Joint Commission, an independent organization that evaluates and accredits health care organizations, found that in U.S. healthcare organizations, “63 per cent of cases resulting in patients’ unanticipated death or permanent disability can be traced back to a communications failure.”
Though rapid technological advances have eased connectivity between nurses and doctors, email and computerized order entry have reduced vital face-to-face interaction, further increasing confusion and miscommunication.
Conflicts exist in every profession, field and sector. In healthcare experts overwhelmingly agree: increasing nurse-physician collaboration and reducing “intimidating and disruptive behaviours” can lessen medical errors, burnout and negative patient outcomes.
Let’s consider and discuss why this issue still persists in today’s health care system and more importantly, what the #hcldr community of professionals, patients, clinicians, administrators and advocates can do to improve the nurse-physician relationship.
Please join us on Tuesday, May 12, 2015 at 8:30pm Eastern (for your local time click here) with the following special guests from Toronto East General Hospital (TEGH):
- Irene Andress, @IreneAndress, Chief Nurse Executive at TEGH
- Dr. Rajiv Singal, @DrRKSingal, Endourology, Urologic Cancer & Robotics Lead at TEGH and Assistant Professor at the Department of Surgery, University of Toronto
- Sarah Coppinger, @1SARAHCoppinger, Nurse Manager at TEGH
- Sharon Navarro, @EastGeneral and Sharon Navarro, Senior Consultant Corporate Communications at TEGH
Together we will discuss the following topics:
- T1 Has the modern focus on “healthy workplaces” & collaboration made a difference for nurse-doc relationships?
- T2 What do docs & nurses need to do to create a more collaborative environment? SBAR is one model, others you’ve used?
- T3 How has technology impacted nurse-doc communication and their relationship?
- T4 What can healthcare orgs do to improve relationships with nurses? What is the role of nursing vs physician/surgeon governing bodies?
“How to Improve the Nurse-Physician Relationship”, American Sentinel, November 20 2014, http://www.nursetogether.com/how-to-improve-nurse-doctor-relationship, accessed May 5 2015
“Another look at the ‘hospital hierarchy’: Are nurse-doctor relationships truly that strained?”, Dan Diamond, The Advisory Board Daily Briefing, March 19 2013, http://www.advisory.com/daily-briefing/2013/03/19/the-state-of-nurse-doctor-relations-isnt-strong, accessed May 5 2015
“On the Same Team? Nurse-Physician Communication”, Laura Eggerston, Canadian Nurse, May 2012, http://www.canadian-nurse.com/en/articles/issues/2012/may-2012/on-the-same-team-nurse-physician-communication, access May 5 2015
“Doctors Throwing Fits” Alexandra Robbins, Slate.com, April 29 2015, http://www.slate.com/articles/health_and_science/medical_examiner/2015/04/doctors_bully_nurses_hospital_mistreatment_is_a_danger_to_patient_health.html, accessed May 5 2015
“Ways of Knowing: A Nurse and a Physician Discuss Clinical Decisions, Actions and Lessons”, Potter, Teddie M. & Savett, Laurence A, Creative Nursing, Volume 20, (1) 59-66, http://www.ncbi.nlm.nih.gov/pubmed/24730193, accessed May 5 2015
“Physician-Nurse Collaboration and Patient Safety”, Debora LaValley, CRICO/RMF Forum, May 2008, https://www.rmf.harvard.edu/~/media/Files/_Global/KC/Forums/2008/forumMay2008.pdf, accessed May 5 2015
I think this interprofessional divide persists for two main reasons: 1) the structure of medical education reinforces a type of elitism and 2) strict hierarchies remain pervasive.
1) I acknowledge the great strides that have been made to include interprofessional education in the typical MD curriculum. However when you spend close to two decades training for a profession one must believe that the time and effort invested afford some sort of differentiation – or individuals simply wouldn’t do it.
2) The hierarchies in medicine are palpable. Take a look at most operating rooms in academic centers around the country and it is clear that the staff surgeon is the top dog while residents and the nursing staff resides somewhere in the space below.
When you combine these two factors they make for a very complicated problem. Simply adding another course in medical school is not going to have a lasting impact.and there is much at stake. Many studies have demonstrated how a lack of collaboration and communication leads to medical errors. More must be done to ensure better relationships between physicians and nurses, if not for a more positive work environment then at the very least for the safety of our patients.
Interesting topic! It is good to see that the relationship between nurses and physicians is improving. This is a great discussion to discover what nurses and physicians can do to improve. Thanks for sharing.
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