Nurse-Physician Work Relations and Role Expectations

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Physicians and nurses have a unique opportunity to provide quality patient care in a collaborative manner. Congruence of role expectation is key to the success of this team. Many hospitals today aspire to achieve Magnet status. An important aspect of a Magnet hospital is good working relationships between nurses and physicians. In 3 different surveys of nurses, Laschinger et al1 found that job satisfaction and workplace empowerment were positively related to collaboration with physicians and perceptions of autonomy and control.Although nurses and physicians work together to treat patients, their professional cultures tend to be quite different. In addition to an imbalance in authority, nurses sometimes focus more on the individual patient, whereas physicians focus more on the science of medicine.2 Although there are important benefits from collaboration, this emphasis is often not sufficiently stressed in medical education. Successful collaboration is dependent on the mindset of the practitioners. Physicians often have expectations suggesting that nurses are an extension of them, whereas nurses want to apply their knowledge directly to patient care. In the mind of physicians, collaboration is sometimes seen as undermining their authoritarian role. Baggs3 argued that collaboration between physicians and nurses was not yet a reality, emphasizing the divergent points of view inherent in these professions. Obstacles to good working relationships often emerge from incongruent role expectations.Significance of the ProblemLittle empirical research has attempted to explore the perceived role between nurses and physicians or to investigate its impact on working relationships. Blue and Fitzgerald4 identified only 9 such investigations from 1966 to 1999, typically using interviews or questionnaires.5 Aspects of nurse-physician collaboration have been more seriously explored, and Dougherty and Larson6 reviewed 5 published scales that have focused on collaboration. Probably, the most systematic exploration involved the development of the Jefferson Survey of Attitudes Toward Physician-Nurse Collaboration, administered to a large sample of first year medical and nursing students.4 A factor analysis revealed 4 factors and a number of significant differences between medical and nursing students.An improved understanding of role expectations for nurses and physicians can serve as a first step to recognize differences and enhance partnerships. Existing questionnaires covered a limited range of role-related attitudes and were often tailored to either nurses or physicians.A revised survey was distributed to the registered nurse staff and physicians associated with a 321-bed, nonprofit, multispecialty community hospital. The instrument expanded on the Jefferson Survey of Attitudes Toward Physician-Nurse Collaboration.4 The survey explored 5 categories that assessed attitudes in regard to the respective roles of nurses and physicians. Topics of interest included shared duties between the nurse physician team, nurses' competence and training, work environment activities and priorities, nurse-physician communication, and the impact of the Joint Commission on Accreditation of Healthcare Organizations on the professions.Role ExpectationsHistorically, physicians have frequently assumed a paternal and directive role, with nurses assuming a more subservient role emphasizing patient care. Conflicts sometimes arise between physicians and nurses partly because of a contrasting focus. Nurses focus on individual patients and teamwork compared with physicians, who view patient care from an individual provider standpoint. Together, these healthcare professionals have a responsibility for patient outcomes, and their partnership is key.TeamworkOn the surface, a healthy perspective of teamwork is important for both nurses and physicians. There are important benefits from collaboration, and yet this collaborative emphasis is not sufficiently stressed in medical education nor seen in actual practice. In the mind of physicians, collaboration is sometimes seen as undermining their authoritarian role.

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