There is no single profession which can meet all patients’ needs,
Vasiliki Matziou et al. begin. The authors later explain it’s quite the opposite: when healthcare professionals collaborate, there are better health outcomes, higher patient satisfaction, and lower costs.1, 2
This much is known, but what influences how well nurses and physicians communicate? What exactly does each side feel they bring to each other?
Reading a study like this is interesting for its own results. It’s also worth considering how this dynamic between care providers reflects on provider-patient interactions. If it’s difficult enough to get doctors and nurses in conversation, how much more difficult is it going to be to get doctors, nurses, and the patient all communicating openly?
The authors’ conclusion seems to be a logical one: The
key
for true interprofessional collaboration seems to be the ongoing interprofessional negotiation between individual nurses and physicians and other health professionals.
The word “negotiation” seems intimidating. The authors later cite other works pointing to a solution that sounds less diplomatic: it is the mutual recognition of [the] interdependence of nurses and physicians that will lead the way to interprofessional collaborative clinical practice.
3, 4
This is something a story can do well. As a patient, I can tell stories of doctors and nurses collaborating on my road back to health. I’m sure any provider could tell stories without too much thought on times they relied on professionals in other disciplines.
As usual, this narrative approach isn’t just a feel-good technique. The definition of healthcare collaboration the authors cite is a type of interprofessional work which involves different health and social care professions who regularly come together to solve problems.
Telling a good story involves getting a problem out into the open as early as possible. A story about one profession unable to solve a medical problem without another emphasizes both the importance of communication and that it’s true there’s no single profession which can meet all patients’ needs.
The “Doctor-Nurse Game”
Since the “doctor-nurse game” was first articulated,5 there’s been a lot of debate on whether that “game” is still being played. In other words, do nurses understand themselves as existing simply to carry out doctors orders? Do nurses look to physicians for respect and recognition of their role
?
Certainly, nursing has become more autonomous, and is understood as a profession separate but complimenting medicine. There is still debate, though, about if—and to what extent—the game is afoot. In 1990, Leonard Stein, who first articulated this “game” said that, no, the professions had evolved beyond it.
With this study of doctors and nurses working in Athens, Matziou et al. articulate their answer. The data the authors collected from their surveys indicate that even if the context and the rules of the game may have changed, the dynamic of the game still exists.
Before the study was conducted, the authors were aware of research which pointed to a hierarchy still existing between physicians and nurses. For example, nurses rate “communication difficulties” with physicians as much more stressful than doctors rate difficulties with nurses.6
The “dynamic” that Matziou et al. uncovered in their data has some interesting features. Experience and department size seem to be two of the main drivers for the differences in how physicians and nurses see one another.
In our study, younger physicians with less clinical experience recognized nurses’ administrative skills and tended to accept more easily their opinion about treatment and decision making. On the contrary, less experienced nurses stated lower levels of collaboration and satisfaction from the acknowledgement of their administrative skills. They also felt that physicians did not treat them as equal members of the patient’s care group. These findings illustrate the importance and the effect of informal learning in the interprofessional collaboration…
…
Physicians working in departments with less than 15 patients … hardly approved nurses’ judgments regarding treatment or decision making. On the contrary, nurses working in smaller departments acknowledged the effect of good relation[ships] between physicians and nurses by stating that it was enhancing collaboration during the therapeutic procedure and the decision-making process.
It isn’t surprising that when there are conflicts, physicians and nurses prefer ignoring the conflict rather than engaging in it
. The authors restate their point later, that avoidance [is] the most commonly implemented strategy of dealing with conflict
.7
If collaboration and interprofessional communication improves health outcomes, conflict between nurse and physician is harming the patient’s chances of recovery. Sharing all health professions’ common goals and narratives can help thaw the ice.
Sources
The article reviewed: Matziou, Vasiliki, Efrosyni Vlahioti, Pantelis Perdikaris, Theodora Matziou, Efstathia Megapanou, and Konstantinos Petsios. “Physician and Nursing Perceptions Concerning Interprofessional Communication and Collaboration.” Journal of Interprofessional Care 28, no. 6 (2014): 526–33. https://doi.org/10.3109/13561820.2014.934338.
1 Rosenstein, Alan H. “Original Research: Nurse-Physician Relationships: Impact on Nurse Satisfaction and Retention.” The American Journal of Nursing 102, no. 6 (June 1, 2002): 26–34. ↑
2 Schmid, Ingrid K, and Bonnie L Svarstad. “Nurse–Physician Communication and Quality of Drug Use in Swedish Nursing Homes.” Social Science & Medicine 54, no. 12 (June 1, 2002): 1767–77. https://doi.org/10.1016/S0277-9536(01)00146-0. ↑
3 Fagin, Leonard, and Antony Garelick. “The Doctor–Nurse Relationship.” Advances in Psychiatric Treatment 10, no. 4 (July 2, 2004): 277–86. https://doi.org/10.1192/apt.10.4.277. ↑
4 Miller, Karen-Lee, Scott Reeves, Merrick Zwarenstein, Jennifer D. Beales, Chris Kenaszchuk, and Lesley Gotlib Conn. “Nursing Emotion Work and Interprofessional Collaboration in General Internal Medicine Wards: A Qualitative Study.” Journal of Advanced Nursing 64, no. 4 (November 1, 2008): 332–43. https://doi.org/10.1111/j.1365-2648.2008.04768.x. ↑
5 Stein, Leonard I. “The Doctor-Nurse Game.” Archives of General Psychiatry 16, no. 6 (June 1, 1967): 699–703. https://doi.org/10.1001/archpsyc.1967.01730240055009. ↑
6 Puntillo, Kathleen A, and Jennifer L McAdam. “Communication between Physicians and Nurses as a Target for Improving End-of-Life Care in the Intensive Care Unit: Challenges and Opportunities for Moving Forward.” Critical Care Medicine 34, no. 11 Suppl (November 1, 2006): S332–40. https://doi.org/10.1097/01.CCM.0000237047.31376.28. ↑
7 Kontogianni, Alexandra, Galanis Petros, Olga Siskou, Kostas Tsavalias, Eugenia Kouli, Vasiliki Matziou, and Dafni Kaitelidou. “Conflict Management and Job Satisfaction. Major Challenges for Nursing and Medical Staff in Greek Public Pediatrics Hospitals.” Nosileftiki 50, no. 3 (2011): 320–31. ↑
Featured Image: cropped from “Surgical Operation” from flikr user SALTOnline. To the best of the original poster’s knowledge, this work is in the public domain.