Nurse-physician collaboration: a comparison of the attitudes of nurses and physicians in the medical-surgical patient care setting

MedSurg Nursing, April, 2007 by Stacy Thomson

Throughout the last decade, various factors have changed the complexion of the nursing work environment. Managed care with shorter lengths of stay has led to increased patient acuity levels and nurse work loads by increasing discharges and consolidating the amount of nursing care expected in a much shorter, more intense time frame. Every part of the patient care continuum now is expedited with discharge being planned on admission. The emphasis on cost containment creates a mandate to shorten the length of stay and the nursing care process (Budge, Carryer, & Wood, 2003). Both nurses and physicians are challenged to do more with less, and to do it more quickly and efficiently while improving the quality and cost of outcomes. The impact for nursing is documented as nurses have less time to create the therapeutic care environment which is related directly to nursing job satisfaction and burnout (Aiken, Sloane, & Sochalski, 1998). Studies support professional fulfillment as having greater impact than salaries on nurse retention (Fischman, 2002; Rosenstein, 2002; Spence Laschinger, Shamian, & Thomson, 2001).

Professional fulfillment, autonomy, control over practice, and quality relations with physicians are core characteristics of practice environments that attract and retain nurses (Aiken et al., 1998). Many hospitals which demonstrate these characteristics have been identified by the American Nurses Credentialing Center (ANCC) as Magnet[R] hospitals; their high nurse job satisfaction and retention are linked significantly to improved patient outcomes (Aiken et al., 1998; Spence Laschinger et al., 2001).

Wake Forest University Baptist Medical Center has been designated a Magnet hospital by the ANCC. With nurse-physician relations identified as an important variable of nurse retention, a measure of nurse-physician collaboration at this hospital was considered. A study was conducted to answer the following question: Are there differences in the attitudes of physicians and nurses toward nurse-physician collaboration in the medical-surgical patient care setting?

Background

Studies with other countries. Numerous research studies reveal the multifaceted dimensions of nurse-physician relationships and collaboration in the practice environment. Hojat and colleagues (2001) conducted a cross-cultural study of male and female nurses and physicians and their attitudes toward nurse-physician collaboration. Study participants consisted of 118 physicians and 84 nurses from the United States, and 149 physicians and 288 nurses from Mexico. Specific clinical specialties were not identified. The findings revealed that U.S. physicians and nurses expressed more positive attitudes about nurse-physician collaboration than their Mexican counterparts (p<0.01). Nurses in both the United States and Mexico expressed more positive attitudes about nurse-physician collaboration than physicians overall (p<0.01). No significant difference in attitude related to gender existed in either group. Investigators concluded that gender was not as strong an influence as social learning and culture in influencing prescribed roles in society. As a possible solution, authors recommended inter-professional education to improve nurse-physician collaboration (Hojat et al., 2001).

In another study, Hojat and associates (2003) conducted a cross-cultural investigation comparing U.S., Israeli, Italian, and Mexican nurse and physician responses related to questions regarding attitudes of nurse-physician collaboration. See Table 1 for sample survey questions. Findings revealed that overall, nurses desired collaborative nurse-physician relationships more than physicians, regardless of cultural background and independent of gender and age. This was demonstrated by nurses' total mean scores (m=51.5), which were significantly (p<0.01) higher than physicians' scores (m=46.3). These researchers also found that in Mexico and Italy, where more prescribed professional roles are maintained (for example, nurses are subordinate to physicians), there was less conflict of attitudes than in the United States and Israel, where professional roles appeared more complementary (for example, greater shared autonomy and mutual authority). Authors concluded that this anecdotal finding may be attributed to greater role ambiguity between nurses and physicians in complementary practice environments.

Weinstein and Antonova (2003) discussed the impact of an innovative medical education model developed in Russia on nurse-physician collaboration. After completing the 3rd year of medical school, medical students were encouraged and paid to work as nurses prior to continuing their medical education. This program was designed originally to relieve a nursing shortage but created a new generation of physicians who are more knowledgeable of and empathic to the role of the acute care nurse. The nursing shortages were decreased through this program by providing better nurse-patient ratios, with at least 10% of the vacancies being filled by the medical students. The traditional nurse-physician communication gap also improved. Nurses specifically reported that physicians more readily recognized the important role nurses play in positive patient outcomes.