This month AJN has published a qualititative study called ‘It Depends’: Medical Residents’ Perspectives on Working with Nurses. Why ask the doctors, not the nurses? That’s a good question, but put it in brackets for now. The study authors focused their questions on two aspects of coordination that theorists consider to be especially important in high-pressure work settings: “frequent, high-quality communication” and “high-quality relationships.” Here are some quotes from the study:
“I tell them tests that I need, but I don’t give them much information. They’re not making decisions about treatment or anything.”
“The day-shift nurses, some of them have a lot of experience and have actually been working for 20 years and, you know,
[have] been educating themselves the whole time and getting better and learning from their experience, and then others have been doing the same things incorrectly for 20 years.”“Some might tell you way too much, and it’s like there is no processing of it first . . . and others know exactly what to say and only call you when they really need you.”
The authors’ conclusions may anger some nurses, but they pose a challenge as well:
Although residents’ concerns about nurses’ cooperativeness and competence might be seen as professional posturing, still they represent an enduring critique of the nursing profession, particularly as it relates to professionalism and standardized education. Whereas some physicians grudgingly collaborate with nurses, surely some nurses—though eager for collaboration—actively withhold the communication and cooperation it requires. To the extent that nurses play a role in perpetuating undesirable nurse–physician interactions, perhaps the nursing profession has the power to change the rules of the nurse–physician game.
What do you think?
Jacob Molyneux, senior editor
I also think that education levels play a role. I did my capstone paper (I’m a BSN) on Nurse/physcian communication and Nurses and Doctors are taught different ways to communicate. Doctors want a succint report, nurses tend to include too much info. I’ve noticed through a couple of jobs now both in acute care and long-term care that nurses who went to shorter programs (diploma, associates) seem to have more issues communicating with MD’s, I’m not saying their not good nurses, the majority are excellent nurses but being in a program where you are there for 4 years gives that program a bit more time to teach you how to communicate effectively. Every nursing program should have a course specifically on communication.
I did a bit of research on this and SBAR is really the most effective way to put doctors and nurses on the same page. The majority of errors in healthcare are the result of poor communication. Some of us, are really intimidated when we have to speak to a doctor (I know I was) and tend to ramble a bit so as nurses we need to learn to organize our thoughts before calling (I usually will actually write out using the SBAR formula) what I am going to say before I call. On the other hand doctors need to trust our judgement a bit more. We are all their for a common goal-the welfare of the patient.
I believe that part of the issue is the fundamental concepts of the physician approach of curing by doing “to” a patient and a nursing approach of healing by being “with” a patient therapeutically.
Janice, thank you. Great observations. Your conclusion seems particularly worth emphasizing: “Whether we are at fault for communication issues, or the MD at hand is at fault, it is always the patient who suffers.” -Jacob
Seems true enough. I have been an RN for 29 years in various roles. Now, as a hospice nurse, I find the MDs all are more willing to listen as they are not good with end of life issues.
The MD’s most frequently rude to nurses? Surgeons. And guess what? Nurses do not perform surgery. Makes sense to me that the more hands off we are in a given specialty, the less collaboration there seems to be.
I have the most difficulty with MD’s who are on call for other MDs. They do not want to do anything that interferes with the primary MD’s patient, even if it is a life and death issue. hard to believe, but still true. It is not so much about RN and MD relationships as much as it is about stepping on the toes of another MD. They have an odd brotherhood at times.
What we, RN’s, have to deal with, that MD’s do not realize, is the aftermath of the MD’s decisions for the next 8-12 hours of our shift. If they have ignored our pleas to increase pain medication or to order a test, we have to watch the patient suffer, answer to the family, and we feel very helpless. This adds to our burnout issues, for sure. This sometimes occurs because MD’s are young and inexperienced, or it is because the MD, who is very experienced, will not do what the RN suggests. He is arrogant and misguided. It is more about his ego than regard for the patient. Notice I say “he” frequently. I do this becasue, in my experience, male MD’s are worse than female MD’s in this regard. Females seem more nurturing; males more ego driven.
There is an old saying, “Whether the knife falls on the melon, or the melon falls on the knife, it is still the melon that suffers.” Whether we are at fault for communication issues, or the MD at hand is at fault, it is always the patient who suffers. Patients should be our primary focus. We should all be working toward the same goal; that is, the patient’s well-being.
Does not always happen, I am sad to report.