Doc-nurse relationships: A sore subject in sore need of a solution

Alicia Caramenico

Alicia Caramenico

In a recent Hospital Impact blog post, Jonathan H. Burroughs recalled an instance early in his medical career when he disrespected an inexperienced nurse and drove her to tears.

"In my most caustic and superior tone I told her so that everyone could hear, 'If you don't know what epinephrine and atropine are, you should not be here; please send me a nurse who knows what [he or she] is doing'," wrote Burroughs, a certified physician executive and American College of Physician Executives fellow.

With a daughter entering the healthcare field, Burroughs wondered whether physician-nurse relationships have since improved.

His disrespect--and subsequent apology--struck a chord with readers and spurred a lot of interesting feedback. And according to most of the readers, the industry still has room for improvement.

"I do think that nurse-physician relationships have improved," one reader wrote. "However, there is still a very long way to go to having truly collaborative relationships. The residents I see daily have so much more respect towards the nursing staff and the amazing knowledge and skill we have. I think a lot of this has to do with the fact that nursing is seen much more as a profession than it had in years past. The culture of healthcare is changing."

Wrote another: "I think this type of situation is far from over, but just like most fields the medical field is slowly leveling the notion of equality between providers and staff."

One reader shared a similar experience to the one Burroughs described--and her story illustrates that physician-nurse relations are still a sore subject:

"I am sorry to say it is not better. Just last week I informed an M.D. on the unit of a critical lab. I was laughed at by him and his colleague. Mind you I am a seasoned 20 year veteran.  I had to interrupt their comments to tell them it is my responsibility to inform them within 30 minutes or less of critical values and to document that transaction. [I] really don't think they got it. [I'm] feeling angry and hope to avoid any future interaction with them."

But what struck me in the reader feedback were the calls for education and training. Those readers appear to be onto something, as recent research found that hospital training programs aimed at increasing physician-nurse communication and teamwork helped reduce surgery-related complications, including blood clots and infections. Moreover, hospitals that used teamwork training saw a 15 percent decrease in patient deaths, compared to a 10 percent drop at hospitals that didn't use the program, according to a December 2011 study in the Archives of Surgery.

That approach was echoed in a study published in February in Nursing Management, which advised that education and training play a key role in conflict management so that nurses learn how to effectively mediate disputes themselves. It recommended using case scenarios and role-playing to teach skills to handle conflicts. Hospital leaders should consider offering such lessons to their physicians, technicians and other hospital staff.

With professional conflict linked to medical errors and poor outcomes, what else can hospital leaders do to keep the peace between physicians and nurses and ensure high-quality care? According to Gus Geraci, vice president of physician leadership in quality and value at the Pennsylvania Medical Society, it's more about the willingness and cooperation of both parties involved than executive intervention.

"When execs come to both groups and ask them to work together to improve, it works if both sides understand each other's roles and are both flexible," Geraci told FierceHealthcare. "Working harder is not the solution. Working together and including others is what works." - Alicia (@FierceHealth)