Hey, doc, can we talk?
Improving nurse/physician communication within the shifting culture
The sticky aspects of communication between nurses and physicians have existed for
decades, and the problems seem ingrained in hospital culture. However, generational
shifts and respectful attitudes being emphasized by new, fresh-faced physicians may
be changing the dynamic of perhaps the most troublesome area of healthcare
interactions. “It’s an age-old problem that’s been around for a very long time,” says
Marjorie Chavez, BS, RN, director of learning and development for CHRISTUS
Spohn Health System in Corpus Christi, TX. “Historically, you have the doctor as kind
of the boss, and the worker as subordinate. But I think it’s much improved [from] a
few years ago. Any culture change within a hospital will take a good long while.”
As medical schools emphasize the development of collegial relationships across the
board and turn out physicians who believe in mutual respect, educators can take
action at their facilities to help this new development grow, says Cathy Colley,
MEd, BSN, RN, director of nursing education for CHRISTUS.
“Educators can take many steps to model good behavior and improve the
nurse/physician dynamic,” says Colley.
The good, the bad, and the ugly
Although improvements are definitely taking place, the ugly aspects of
nurse/physician communication are still rearing their ugly heads at facilities
nationwide, says Chavez.
“The nurse is already afraid to call a physician,” she says. “So poor communication
and poor relationships will result in poor patient outcomes.”
Colley recalls a situation at her facility where nurses refused to work on certain units
simply due to the fact that particular physicians were placed there. Such issues and
the development of hostile environments have huge consequences within areas such
as patient safety, staff retention, job satisfaction, and work environment, and can
result in unwanted conclusions, including high turnover rates.
The research backs up Colley’s assertions and shows grim prospects if poor
communication is in place. According to an article in the AORN Journal, “The different
emphases that physicians and nurses have toward patient care may lead to strained
physician-nurse relationships, which may in turn compromise patient safety, unless
the physicians and nurses develop collaborative relationships.”
Fortunately, things are looking up. The changing face of the physician’s role plays a
large part in improved communication. “Medical schools are trying to be more
proactive,” says Chavez. “I think the younger doctors are not coming out with that
same attitude.”
Opening up the lines at your facility
There are many steps educators can take to foster positive nurse/physician
relationships, says Chavez, the most important being to establish a zero-tolerance
policy. “I think one of the most important things for nurses to do is to hold
physicians responsible,” she says. “Sometimes administration needs to be tough on
them. When it comes to zero tolerance, administrators have to be behind that
100%.”
Helping nurses build congenial and collaborative relationships with doctors is another
key element to achieving success, says Colley. “Have the nurse get to know the
doctors and do rounds with them,” she says. “Then the nurse knows what the
doctors want, and the doctor knows how to work effectively with the nurse. It will
help build a team, not nurses against doctors.”
Also make sure to foster critical thinking skills, advises Chavez, as perhaps the
biggest influencing factors for a nurse to demonstrate to physicians are confidence
and competence. “Spend a lot of time with new hires and coach them on critical
thinking if they didn’t do well on the initial assessment,” she says. “If you have a
competent nursing staff, you build a relationship with the physicians. Let the doctors
know that they are highly skilled, competent nurses.”
Nurses should use their critical thinking skills when talking to physicians and ask
questions to build a healthy relationship. “The nurse should say to the physician,
‘This is what I think you want to hear.’ And the physician can say, ‘No, this is what I
want to hear, especially at 4 in the morning.’ ”
The end result, says Colley, is improved patient outcomes and better working
conditions.
“Once you have happy employees, you have happy patients,” she says. “Work
toward good relationships and positive conflict resolution.”
Reference
Sterchi, L.S. (2007). “Perceptions that affect physician-nurse collaboration in the
perioperative setting,” AORN Journal 86(1): 45–57.
Source: The Staff Educator, an HCPro, Inc., publication.