Physicians and nurses have had to interact since nursing became a profession. The act of communication between nurses and physicians is a central activity in health care, and a failure to communicate has been linked with poor quality and patient errors. During the history of nursing, these interactions have been as different as each individual physician and nurse is different. The two professions have had to form relationships to accomplish their common goal: quality patient care (Manojlovich & DeCicco, 2007). The relationships between the professions have changed throughout the years, for the most part; evolving from the traditional “superiority” of the physician/nurse as a “handmaiden” relationship to one of collegial respect between nurse-physician (Schmalenberg & Kramer, 2009). Disruptive communication occurs with alarming frequency in both nurses and physicians, and both sets of professionals agree that such ways of communicating decreases patient safety.
Physician-nurse relationship and communication is something that has drawn interest for some time. In 1967, Stein reported that nurses’ relationships with physicians were based on a “game playing” model, in which nurses gave recommendations regarding care without appearing to direct or disagree with the physician (Sterchi, 2007). By the 1990’s the physician-nurse interactions had evolved into a model in which nurses used informal, overt strategies to involve themselves with physicians in the decision making process. Nurses used negotiation skills to convey their ideas and opinions to physicians, who in turn listened to the nurses (Sterchi, 2007). These changes in relationship increased nurses’ influence on patient-care decisions made by physicians. Miller and Thomas found that physicians perceived there to be higher levels of collaboration between physicians and nurses than did nurses (Sterchi, 2007).
It has also been found that communication between nurses and physicians tends to be better in areas where there is nursing specialization such as in an intensive care unit, Obstetrical department or in the Emergency department. The very nature of a specialty unit promotes teamwork and demands greater communication due to the acuity of the patient. In fact, Chaboyer and Patterson did a study and found that nurses who specialized in a certain area perceived greater levels of physician-nurse communication than did hospital generalist nurses (Sterchi, 2007).
Unfortunately, not every member of these professions has come around to this new way of thinking. A number of physicians still feel that nurses should stand up when they come through the nurses’ station, and be seen not heard when it comes to patient care. These tend to be the physicians that allow their attitude and arrogance to become disruptive and abusive, often times sacrificing quality care to prove the point (Sirota, 2007). Gender-related power issues still create problems, especially for female nurses in their working relationships with both male and female physicians. Nurses report that male physicians continue to exercise control over the largely female nurse group (Sirota, 2007).
Class can also play a factor in the Doctor-Nurse communication. Traditionally, most nurses came from lower social classes than most physicians and a difference in educational level is a factor affecting the balance of power. Dysfunctional relations impact job satisfaction, nurse retention, the nursing shortage, and the profession of nursing as a whole. Some nurses would rather leave the profession than deal with disruptive/abusive physicians and circumstances that lead them to feel helpless and victimized. Feelings of inferiority can lead to nurses not speaking up or giving their opinion about a specific problem with a patient, which can lead to poor patient outcome (Sirota, 2007).
Statistics show 70% of medical errors can be attributed to poor...
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