The Importance of Healthy Doctor-Patient Relationships
Both safety and quality of care patients receive depend upon the quality of the The relationship between [doctors and nurses] is a major. A negative or intimidating relationship between a physician and a nurse can create a situation that puts the patient at risk. There are four areas in which. Impact of organizational and individual factors on patient-provider relationships: A national survey of doctors, nurses and patients in China.
Doctors and nurses make up the largest groups of individuals within this environment. It is important that healthcare organizations not only have a method in place to identify intimidating or disrespectful behaviors and a process for disciplinary action for offenders, but also a way to monitor relationships between nurses and physicians over time to determine the impact of any remediation interventions.
No studies were found that looked at the positive aspects of the healthcare practice environment associated with nurse and physician relationships; and no studies assessed the relationships between nurses and physicians in the same healthcare practice environment as perceived by both nurses and physicians at the same time, and using the same instrument. Our research sought to address this gap using a large, two-group-comparative study. The research questions were: Do nurses and physicians differ in their assessment of the quality of the healthcare practice environment where they are employed?
Do nurses and physicians differ in their perceptions of respectful behavior? Do perceptions of nurse and physician relationships affect practice decisions made by nurses? It has been posited that those organizations with a positive professional practice environment, characterized by healthy and respectful nurse-physician relationships, are better able to recruit and retain the best nurses; and that this, coupled with higher levels of communication, respect, and collaboration between nurses and physicians, contribute to a better environment for patients Galletta et al.
Helping to Navigate the Nurse-Patient Relationship | Nursing
Although previous studies have examined the impact of various aspects of the professional practice environment on nurse satisfaction, nurse retention, nurse recruitment, and patient outcomes Nelson, et al. The professional practice environment is affected by the historical development of the nursing and medical professions and societal norms The professional practice environment PPE model Figure proposed by Siedlecki and Hixson was used as the theoretical base for this study.
According to this model, the professional practice environment is the place where nursing and medical care take place, and perceptions of relationships between nurses and physicians is a good indicator of the quality of the practice environment. The professional practice environment is affected by the historical development of the nursing and medical professions and societal norms; thus time and geographical location impact the professional practice environment and the people who practice within it.
The Study In this section, we will present the measures we used to assess perceptions of the quality of the healthcare environment and the steps we took to protect our human subjects.
Helping to Navigate the Nurse-Patient Relationship
We will also describe our research and data analysis procedures, along with assumptions made in this study. It looks at the presence of positive physician and nurse characteristics, organizational characteristics beliefs about the importance of nurse-physician respect, communication, and collaboration on patient outcomesand frequency of joint-patient-care decision making.
The 13 items in the PPEAS are worded so it does not matter if the respondent is a nurse or physician; respondents are asked to rate their agreement with each item using a scale of 1 to Larger numbers indicate a more positive perception of the presence of that element in the environment.
The overall quality of the professional practice environment is assessed by summing the 13 items. Scores can range from 13 towith higher scores indicating a more positive professional practice environment. Scores are standardized 0 to by converting the raw score to a percentage to allow for easier comparisons. This suggests it was a reliable measure in this sample. The PPEAS examines perceptions of evidence of mutual respect experienced in the professional practice environment; however it was unclear if nurses and physicians would differ in their beliefs about what respectful behavior looks like.
Rosenstein et al 29 have conducted an extensive study of adversarial-abusive relationships, measured by numerical count of instances of abusive behavior and numbers of nurses who left employment because of abusive-hostile incidents with physicians. Concern about adversarial relationships gave rise to the formation of the National Joint Practice Commission on collaborative relationships supported by the American Nurses Association and the American Medical Association in And the differences were quite large.
Inwe set out to explore what staff nurses working in magnet hospitals meant by good nurse-physician relationships. We interviewed staff nurses in 14 magnet hospitals 1 and discovered some interesting facts. Throughout the s, good nurse-physician relationships were assessed by having the 2 groups complete the Weiss and Davis collaborative practice scales, 31 which operated on the principle that all nurse-physician relationships on a clinical unit were the same or highly similar.
Staff nurses quickly informed us that such is not the case. Multiple relationships coexist on a clinical unit. Moreover, relationships are dynamic. They change over time. From the examples of nurse-physician interactions described by the interviewees, we constructed the nurse-physician relationship subscale of the Essentials of Magnetism.
Collegial relationships, characterized by equal trust, power, and respect are illustrated by the following excerpt. Nurses and physicians frequently used the words peers or equals in describing these relationships. They value our opinion and ask for input. The doctor asked me whether or not this patient was ready to go home, and I said.
It happens on a daily basis that the physicians seek us out because they know that we know. Collaborative relationships, marked by mutual trust, power, respect, and cooperation are based on mutuality rather than equality. The physician comes in, checks the patient, writes orders, and leaves. Heads roll around here if the docs complain about anything. I watch myself very carefully. The nurse-physician relationship unit climate is a composite of the interactions and relationships of nurses and all physicians who visit or care for patients on the unit—physicians who admit and care for many patients as well as physicians who admit and visit only periodically.
All 5 relationships can and do exist on a clinical unit at the same time. The friendly stranger relationship is a neutral one that can go either way.
Relationships Between Nurses and Physicians Matter
If left alone, it often deteriorates. The unit climate is composed of some combination of the 5 relationships explained in the previous paragraphs. What does the nurse-physician unit climate look like in excellent hospitals? Does the nurse-physician climate in magnet hospitals differ from that in comparison hospitals?
What changes do staff nurses report over time? In a new window Table 2 Percentage of staff nurses responding affirmatively to nurse-physician relationship types by magnet and comparison hospitals and by period Findings Percentage of Each Type of Relationship.
Student-teacher relationships were slightly higher in than inand a shift toward physicians, rather than nurses, as teacher was apparent.
The total, weighted score for the 5 types of relationships on the nurse-physician subscale of the Essentials of Medicine provides a nurse-physician relationship unit climate score that permits statistical comparison of magnet and comparison hospitals for both and Instaff nurses in magnet hospitals reported significantly higher unit climate scores than did their counterparts in comparison hospitals. The F ratio was However the F ratio had decreased to Specifically, nurses in the 16 magnet and 10 comparison hospitals in were compared with 10 nurses in 18 magnet and 16 comparison hospitals in Inthe comparison hospitals were from a convenience sample of hospitals invited to participate on the basis of regional representation.
Inthe 16 comparison hospitals were all hospitals that had requested Essentials of Magnetism testing because they were preparing or considered themselves ready to apply for some mark of excellence—Magnet, Baldrige, or Employer of Choice.
Within the group of 16 comparison hospitals, the proportion of academic medical centers was higher than in the hospital sample in The impact of the larger percentage of critical care nurses in the comparison hospital sample and its positive effect on unit nurse-physician relationship scores cannot be directly assessed because we did not obtain the same sort of information from the sample.
However, we do have some comparative information. In both the and the samples, specialized units, particularly ICUs, in both magnet and comparison hospitals scored higher in nurse-physician relationships than did less specialized units.
Byregularly scheduled interdisciplinary rounds, particularly on medical ICUs and trauma, rehabilitation, and stroke units that included the active participation of all disciplines including staff nurses, were much more common. In addition, when physicians, administrators, and representatives from other professional departments were interviewed, they were asked to rate the quality of interdisciplinary interactions on a scale of 1 to 10 with the following benchmarks provided: Ratings ranged from 4 to 10, with a mean of 8.
No significant rating differences were found between physicians mean, 8. In situations in which therapists had a continuous and regular presence eg, on orthopedic, rehabilitation, or critical care unitsinterdisciplinary interactions were reported to be particularly collaborative, almost collegial.
When therapists provided care on a large number of units, the ratings of quality of interdisciplinary interactions were lower.
A medical director demonstrates this feature in his orientation session with residents: Nurses are our colleagues.