Thursday, May 11, 2006

Surgical Teamwork

The New York Times reports on a study of operating room communications:
"nurses often describe good collaboration as having their input respected, and physicians often describe good collaboration as having nurses who anticipate their needs and follow instructions."
There is a bit of a culture clash; nurses want respect, and surgeons want submissive, helpful nurses.

1 comment:

yvette77 said...

Disruptive Professional Relationships

Now and tomorrow our nursing shortage will continue to increase. One issue, impacting our shortage, not often looked at, is nurse-physician relationships. Mutual respect and communication plays a vital role in providing positive patient outcomes. When these essentials are not met, and when the barriers between nurses and physicians are put up, in due course the patients loose. Negative nurse-physician relationships can strain the role of the nurse, resulting in job dissatisfaction, and more nurses leaving the profession. Negative patient outcomes, related to the decrease in nursing staff and/or lack of collaboration between nurses and physicians, ultimately result.
In the article, Disruptive Behavior & Clinical Outcomes: Perceptions of Nurses & Physicians, surveys were distributed to hospitals across the country, and results from more than 1,500 survey participants were evaluated. Nurses, physicians, and administers all participated in this study. Some of the survey questions asked were Have you ever witnessed disruptive behavior of a physician or a nurse at your hospital? From your perspective do you think disruptive behavior could potentially have a negative effect on patient outcomes? Are you aware of any specific adverse events that did occur as a result of disruptive behavior?. Participants responded with findings that suggest the disruptive behavior had negative effects on all involved, increased frustration and stress, and decreased communication and concentration. These factors negatively affected medical errors, patient safety, patient mortality, the quality of care and patient satisfaction. (Rosenstein, O’Daniel, 2005, pp. 54-63) Such disruptive behavior can undermine the morale of individual staff members, weaken the effectiveness of the medical team in delivering care to patients, spark lawsuits, make it difficult to hire and retain good staff, and negatively affect the reputation of the institution as well as each profession.
Results of a survey of 1,200 nurses and physicians, reflected in Ongoing Research: Nurse-Physician Relationships: Impact on Nurse Satisfaction and Retention, provide evidence that interactions between nurses and physicians strongly influences nurses’ morale. Although all participants saw a direct link between disruptive physician behavior and nurse satisfaction and retention, the groups differed in their beliefs about responsibility. The findings imply the quality of nurse-physician relationships is an issue that concerns all. (Rosenstein, 2002) Results confirm that when physicians exhibit disruptive behavior, it fuels the nationwide shortage by adversely affecting on-the-job satisfaction and morale for nurses.
Time for Action
Some steps are being made to increase awareness about the impact of these negative relationships and how they affect patient care. The author wrote, in Communicating for Better Care: Improving nurse-physician communication, suggestions to improve communication and collaboration. Listed suggestions include, work at developing relationships by recognizing nurse and the physician are part of a team, and are equal when it comes to caring for the patient. Defining communication strategies and discussing preferred methods of communication are suggested as a best defense against miscommunication among physicians and nurses. (Burke, Boal, Mitchell, 2004, pp. 40-47)
The authors discussed the collaboration efforts implemented between physicians and nurses of the Colorado Permanente Medical Group (CPMG) in, Physician as Healer, Leader and Partner: Tackling the Nursing Shortage. After the group experienced the debilitating effects of the nursing shortage, and the threat to inner-city hospitals, CPMG took action. A strong clinical partnership between the physicians and nurses of the CPMG is now expected because these physician groups believe that improved nurse-physician communication is not only a remedy for a diminished number of nurses, it’s an elixir for improving care. The group instituted the “Preferred Clinical Partner” (PCP) Program and a Nursing scholarship program, both to participate in solving the nursing shortage. (Cochran, 2004) The authors provide proof that measures are being taken to reduce the number of negative physician-nurse relationships. Hospitals and physicians alike, are not only acknowledging the connection between these negative relationships and the shortage of nurses, but are taking the steps to make a difference.
Nursing Values
There are at least five professional nursing values related to disruptive nurse- physician relationships. Collaborative multidisciplinary practice, as discussed has proven to be essential in providing positive patient outcomes. Continuous improvement of service, relates to learning how to open the lines of communication and to implement learned techniques, resulting in better patient outcomes and enhanced service. Corporative work relationships are a value that promotes positive nurse-physician relationships, strengthening the medical team. Sharing decision making, develops work relationships by nurses and physicians recognizing they are on the same team, thus promoting positive nurse physician relationships. Teamwork is essential in increasing morale, decreasing stress, and in the end ultimately the patients prevail. (Chitty, 2005)
Relevance to Nursing
Disruptive nurse-physician relationships are relevant to nursing because it is an issue that nurses cope with on a regular basis. There is much discussion among nurses about how downright intolerable some physicians can be. There is little discussion among physicians, nurses, and administrators collectively, on how these disruptive behaviors negatively affects the overall morale of nurses, job satisfaction, number of nurses, and ultimately the patients’ care. If nurses discuss their concerns about these issues with not only one another but with physicians and administrators, through awareness positive change will come.
Nurses can implement this information into their practice by actively opening the lines of communication with their administrators and physicians. Together they can discuss ways to aid in retaining or regaining optimal professional functioning, consistent with the protection of patients. Nurses can advocate for the hospitals to develop clear-cut, effective policies concerning disruptive behavior. Routines that reinforce nurse-physician communication should remain a focus. (Lindeke, 2005)
‘Professional Nurse’
A professional nurse will benefit from learning about improving nurse-physician relationships because collaboration and open discussion will reduce workplace tension and increase morale. Strengthening knowledge and skills is an important foundational step. The definition of a professional includes a highly specialized professional education; nurses who are in pursuit of or who have advanced degrees, who demonstrate their unique contribution to care, are positioned as intellectual peers. This professional equality promotes needed alliance and communication with physicians. The professional nurse can also initiate more research on how physician-nurse relationships have resulted in negative patient outcomes. Professional nurses can also participate in research geared toward the positive impacts of hospitals, like CPMG, has had on nurse staffing, and reported patient care. (Chitty, 2005)
A professional nurse leader/manager can use the information to promote effective collaboration by bringing both nurses and physicians together, sharing concerns by both sides, and by sending clear messages about nurses and physicians being a team, who’s ultimately responsible for the patient. (Smith, 2004)
Negative nurse-physician relationships have proven to strain the role of the nurse, resulting in job dissatisfaction, and more nurses leaving the profession. Negative patient outcomes, related to the decrease in nursing staff and/or lack of collaboration between nurses and physicians, ultimately result. Personal conduct, whether verbal or physical, that affects or that potentially affects patient care should be addressed. Each medical staff should develop policies for intervening in such unsettling situations.
Ignoring disruptive physician-nurse behavior is no longer an option in today’s changing health care environment. Competition and managed care have caused more organizations to deal with disruptive nurse-physician relationships, rather than upholding the traditional ways of the past by looking the other way. Some physicians are making a difference in the shortage by supporting nurses, investing in a collaborative relationship, and acknowledging and respecting their nurse colleagues.
As professionals we need to practice shared communication and respect, symbiosis of all healthcare providers is critical. Periodically expanding our perspectives of each other can increase mutual tolerance and empathy, even during times of conflict. Education of staff on proper communication techniques, with an emphasis on common courtesy and responsible professional decorum, will improve morale, positively impact the nursing shortage, and will significantly lead to positive patient outcomes.

Burke, M., & MSN, RN. (2004). Communicating for Better Care: Improving nurse-physician communication. American Journal of Nursing, 104 (12), 40-47.
Chitty, K. K. R. (2005). Professional Nursing: Concepts and Challenges (4th ed.). St. Louis, Missouri: Elsevier Inc.
Cochran, J. H., Jr. (Winter 2004). Physicians as Healer, Leader and Partner: Tackeling the Nursing Shortage. Retrieved March 20, 2006, from
Lindeke, L. L., Ph, D, & RN, CNP. (2005). Nurse-Physician Workplace Collaboration. Retrieved from Medscape Web site:
Rosenstein, A. H., MD, & MBA. (2002, June). Original Research: Nurse- Physician Relationships: Impact on Nurse Satisfaction and Retention. Retrieved February 27, 2006, from Nursing Center Web site:
Rosenstein, A. H., MD, & MBA. (2005). Disruptive Behavior & Clinical Outcomes: Perceptions of Nurses and Physicians. American Journal of Nursing, 105 (1), 54-63.
Smith, A. P. (2004). Partners at the Bedside: The Importance of Nurse-Physican Relationships. Retrieved 3/20/2006, 4/10/2006, from Medscape Web site: (Chitty, 2005)