9 Ways Physicians Can Effectively Collaborate with Nurses
Much has changed during the last 40 years, including an understanding of the importance of doctors and nurses working together, using a team-based approach to improve patient care.
“The relationship between nurses and physicians is vital to the well-being and outcomes for patients and their families,” said Linda Cassidy, MSN, EdM, RN, CCNS, CCRN-K, strategic advocacy manager at the American Association of Critical-Care Nurses (AACN). “Additionally, there is ample evidence spanning decades that supports the importance of nurse–physician collaboration and patient outcomes.”
A study published in Critical Care Nurse in 2015 found collaborative relationships between physicians and nurses decreased rates of healthcare-associated infections in critical care, she explained.
Cassidy noted that team-based care and physician and nurse partnerships are part of a healthy work environment, which can influence patient outcomes and the quality of care delivered across the care continuum.
To that end, here are some tips and reminders for physicians to work effectively with nurses and build strong patient care teams.
Nine Ways Doctors Can Improve Collaboration with Nurses
1. Build Trust and Partnership
“Building trust and partnership between clinicians, whether physicians and nurses or allied health professionals, is really important today,” said Tracy Duberman, PhD, MPH, FACFE, founder, president and CEO of The Leadership Development Group in New York.
Duberman described a “trust cycle.” First, everyone must put the patient in the center and remember the goal, then work on finding common ground, having conversations, sharing collective wisdom, and building trust.
“If we start from understanding each other and what value each of you brings to the reason we are here, hence the patient in the middle, it can help to have an open dialogue,” Duberman said.
2. Keep Communication Open
“Collaboration requires an equal, nonhierarchical partnership between the nurse and physician grounded in open communication, trust and mutual respect,” Cassidy said. “Both nurses’ and physicians’ unique contributions to patient care must be valued and solicited.”
3. Round Together
Rounding together helps in providing team-based care and patient perceptions of cooperation. It leads to better handoffs and increased patient satisfaction, Duberman said. Rounds can be time-intensive, she added. A quick scripted review about the patient’s status helps make the rounds go more quickly.
Researchers at Penn State College of Medicine in Hershey, Pennsylvania, studied interprofessional rounding and found the use of scripts and staff support was associated with more team-based rounding.
4. Involve Mid-Level Providers
Improving collaboration among physicians, nurses and other medical providers is “an excellent opportunity for mid-level providers to get involved in a process, so that physicians can focus more on clinical decision making and allow some of the legwork to be done by their mid-level providers,” said Alejandro Badia, MD, a board-certified hand and upper extremity orthopedic surgeon with Badia Hand to Shoulder Center in Doral, Florida. “This can be the group that perhaps most interacts with nurses who are the first line of actual patient care.”
5. Build a Collaborative Culture
Collaboration begins at the top of an organization and should be carried through and modeled by everyone.
“Achieving effective nurse–physician collaboration requires a focused effort that is supported throughout the healthcare organization,” Cassidy said. “A culture of collaboration must be the expectation and role modeled by leaders. All must be held accountable for assuring that true collaboration is the norm.”
Duberman described an effective coaching model to help foster physician and nurse partnerships. It requires active listening, asking questions about the topic, challenging assumptions and giving feedback. Ask to help you understand, without being judgmental.
6. Participate in Team Training
All members of the health care team training together, perhaps in a simulation lab, can help ensure better teamwork when a crisis situation develops. A 2011 Mayo Clinic study found enhanced patient-care decision making and greater physician–nurse collaboration when the professionals participated in high-fidelity simulation training.
7. Use Mobile Communication
Badia noted that there is “an absolute need to increase the use of mobile communication between physicians and nurses, which is done in many sectors outside of health care, but we need to catch up in this area. Physicians are now communicating through their smart phones to a great extent, but I believe more of this needs to be done with nursing colleagues.”
8. Contain the Urge to Yell
Yelling at a nurse, because the nurse disturbed your dinner or sleep with a report of a change in a patient’s condition, is a good way to shut down collaboration. The next time a patient has a change in status, that nurse may hold off calling, which could harm the patient.
Nurses should effectively communicate the situation, using standard tools and be prepared to answer questions by having all of the facts at hand.
Controlling your speech volume and tone is important in other situations, as well. Both sides need to learn “to effectively resolve conflicts that naturally occur in complex environments such as healthcare,” Cassidy advised.
9. Recognize Diversity as Good
A difference of opinions is helpful when doctors and nurses work together.
“You usually come up with better solutions when you ask lots of people for input,” Duberman said.
“Remember the mission, vision and values,” Duberman advised. “If you go back to that, it creates a better environment to work in.”
