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Nurse/physician relationships: are we making any progress?

I recently read an interesting article about nurse/physician relationships. The findings indicate collaboration and communication as the key ingredients to improved nurse/physician relationships. The article defines collaboration as "an essential element of quality health care." Collaborative nurse/ physician relationships are associated with improved patient satisfaction and improved patient care and outcomes. There have been many articles written on nurse/physician relationships and most show that these integral relations affect all aspects of patient care, as well as job satisfaction and job-associated stress for both nurses and physicians. According to the S. Jansky article, The Nurse-Physician Relationship: Is Collaboration the Answer?, the current nursing shortage could be directly affected by nurse/physician relationships. If the relationship is positive, nurses are more likely to be satisfied with the workplace and remain in their current positions.

The central element in nurse/physician relationships is communication, mutual trust, respect and shared decision-making responsibilities. An article by Theodora Sirota, APRN, BC, PhD, identifies communication and collaboration as the key to the development of understanding, respect and trust amongst health care professionals.

Dr. Sirota suggests that nurses can work toward improving working relationships with physicians in two interrelated ways:

* Empowering nurses Feeling secure in their knowledge and clinical expertise empowers nurses. By staying up-to-date with advances in their specialty, nurses can take pride in their expertise. Continuing education, specialty certification, and participation in professional organizations, clinical research and conferences are good ways to stay in touch with developments in your field. Nurses should also establish informal collaborative work groups with other nurses where they can recognize and share their clinical expertise. Participating on interdisciplinary committees also empowers nurses to have an equal say in facility policies and procedures. Simply put, knowledge is power.

* Improving communication with physicians This can be accomplished when nurses feel empowered to approach physicians as equal professional colleagues. This means that nurses must assume responsibility for the quality of their relationships with physicians. Experiencing professional empowerment helps nurses stay focused on approaching all physicians in a collegial, respectful and problem-solving-based manner, no matter how badly an individual may behave. As nurses, we can't let negative behavior push us into angry communication or discourage further efforts to communicate.

It's important to point out that the "old" nurse/ physician dynamic is changing with the times. With new generations of nurses and physicians come new attitudes on how this traditional workplace relationship can develop and mature.

Another example of the importance of communication is found in the book Introduction to Evidence-Based Practice in Nursing and Health Care by Kathy Malloch and Tim Porter-O'Grady. The authors identify teamwork strategies as a key to changing "the culture of the organization from hierarchical and autonomous practice to collaborative practice through a team approach." According to Malloch/Porter-O'Grady, a structured teamwork strategy tool, such as a "time-out" before surgery, can be employed in the workplace to achieve "clear, timely and effective communication." These higher levels of collaboration have been associated with lower predicted death rates, decreased nurse turnover, less fragmentation of patient care and better patient outcomes.

Positive nurse/physician relationships have also been identified as a fundamental characteristic of magnet hospitals. A study of 14 magnet hospitals showed a correlation between the quality of nurse/ physician relationships and the reported quality of care for patients. In fact, positive "interdisciplinary relationships" are identified as one of the 14 "Forces of Magnetism." Hospitals seeking magnet status must possess interdisciplinary relationships characterized as positive, with a sense of mutual respect exhibited among all disciplines. These positive relationships yield results, as magnet hospitals have been shown to have better patient outcomes, including lower mortality rates.

Through research, training workshops, staff meetings, coordination of care, continuing education and other professional development, nurses can continue the effort to enhance the nurse/physician relationship. A part of this solution involves nurses who are professional, confident and know that their input is a key component to patient care. The more involved and empowered the nurse is, the more success he or she will find when it comes to navigating the nurse/physician relationship.



Jansky, S. (2004) The Nurse-Physician Relationship: Is Collaboration the Answer? The Journal of Practical Nursing.

Malloch, K, and Porter-O'Grady, T. (2006). Introduction to Evidence-Based Practice in Nursing and Health Care. Sudbury: Jones and Bartlett.

Sirota, Theodora, APRN, BC, PhD. (2007). Nurse/ Physician Relationships: Improving or Not?

by Dorethea Peters, RN-BC

Dorethea Peters serves on the GNA Governing Board and is Director of Workforce Advocacy.
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Title Annotation:Workplace Advocacy
Author:Peters, Dorethea
Publication:Georgia Nursing
Geographic Code:1USA
Date:Feb 1, 2009
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