Improving communication between nurses and physicians

According to The Joint Commission (TJC), nearly 60% of medical errors are the direct result of communication breakdown.  But, sometimes communication barriers between different entities can be a challenge, especially when it comes to doctors and nurses.

A look back

Communication between nurses and physicians has a reputation for being strained. Over the years, much has been written in an attempt to demystify the “doctor/nurse relationship.” Literature has contained descriptions of verbal abuse of nurses by physicians, disruptive physician behavior, and advice on how nurses can better converse with physicians. One thing, in particular that both nurses and physicians strive to avoid is open disagreement in front of patients.

One of the recurring themes in the literature is the difference in perceptions between nurse and physician. Nurses are typically less satisfied than physicians with the communication or interaction patterns and express the need for their opinions to be heard by physicians. Areas of particular difference involve those of ethical decision-making and the moral dilemmas confronted by nurses related to these decisions.

Many theorists have evoked the issue of gender as it relates to the work of nurses and the relationship between nurses and doctors. Others see it as hierarchical. Thankfully, we’ve been moving away from the notion that nurses are completely subordinate to doctors, merely workers who follow orders. Instead, nurses are now seen as knowledge sources, and there is a new emphasis on interdisciplinary collaboration.

Some nurses have argued that much has changed—and improved—in the relationships between nurses and physicians. Despite much wishful thinking, communication between doctors and nurses often still remains contentious.

Overcoming obstacles

Why is it important to improve communication between nurses and physicians? Some research has shown that the lack of interpersonal skills between doctors and nurses is associated with frustration, errors, and inefficiencies in the delivery of care. There is evidence that links better collaboration with better patient outcomes, such as reduced medication errors, reduced risk of inpatient mortality, improved patient satisfaction, and shorter length of hospital stay.

Hospitals use many communication tools from written and verbal orders, reports, rounds, and team meetings to new technologies like mobile communication systems, electronic medical records, computerized physician order entry, and bar-coding for medication administration.

The following organizational suggestions are meant to improve inter-professional communication:

• Carefully evaluate various strategies for doctor-nurse communication using measurable outcomes that are important to your organization. Plan to use a strategy that meets the needs and culture of your organization.

• Select a strategy, focus training, and provide organizational support and sufficient resources toward improving doctor-nurse communication.

• Slowly implement the change using sufficient resources and sufficient time.

• Do not implement multiple changes simultaneously.

• Persist in that strategy for an extended period of time (years, not weeks or months).

• Critically evaluate the strategy using patient outcomes and worker satisfaction.

• After allowing sufficient thought and time for implementation and evaluation, be willing to publicly eliminate the strategy if it does not improve the outcomes.

Personal strategies for improving communication include having nurses participate in rounds, equalizing the name game by addressing doctors by first name, and encouraging nurses to speak up when they see something amiss.