Strategies for collaborative nurse-physician relationships

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The following excerpt is adapted from the book, Speak Your Truth: Proven Strategies for Effective Nurse-Physician Communication, HCPro, Inc. 2004:

 When I have a good working relationship with a physician, I feel comfortable approaching him or her, asking questions, and more respected for my own expertise. And the patient also benefits because they receive the best care.

-Lynsi Slind, University of Washington MSN student

Opportunities for improving communication between physicians and nurses pop up every day. You find them in the irate doctor who belittles a nurse right in front of her patient, or in the physician who refuses to call nurses by name. It is during these unfortunate events that the nurse can learn to curb this behavior.

Addressing the conflict and uniting under a zero-tolerance policy for disruptive behavior and verbal abuse is paramount. Yet there are many other strategies that a staff nurse can adopt, as well to foster better communication and collaboration between nurses and physicians. Have your nurses begin by utilizing the following tips:

  1. Understand that the difference in your roles may cause confusion. Reinforce your role in patient care. Use the progress notes to identify concisely the problems you addressed on your shift, the progress made, and the plan of care. 
  2. Education is key to gaining knowledge and respect. Further your education in any way possible-from pursuing a bachelor's degree to pursuing a master's degree. Take advantage of certification courses in your specialty. Request assertiveness training workshops at your institution. Sponsor a conference by nurses and physicians. Turn physician complaints about nursing knowledge deficits into inservices. Use the vast knowledge of the experienced professionals around you to raise your level of knowledge. 
  3. Perform a root-cause analysis whenever there is an unplanned outcome, and include both physicians and nurses on the team (Knox and Simpson 2004; LeTourneau 2004). 
  4. Ask for what you want. If you feel strongly that the physician needs to see a patient, say so. You don't have to have a diagnosis because you are not the doctor. 
  5. Insist physicians call you by name. 
  6. Be prepared for telephone calls by having the chart, labs, and recent vital signs in your hand if there is a change in patient status. 
  7. Round with a physician whenever possible. If staffing is tight on the unit, take turns. There is no better way to learn what a physician is looking for, to clarify nursing's role, and to offer input. 
  8. Remind coworkers and physicians that you are all on the same team. 
  9. Advocate for the patient. Keep the patient as the main focus of conversation. Advocate for a formalized collaborative practice model. 
  10. Take personal responsibility for working out any negative relationships that you may have with a physician. Always these conversations off the floor. Remember, "If you see it, you own it." Ask for manager support, if needed. Nurses report that they are often surprised that simply stating how a behavior makes them feel to a physician will heal the situation. Raising awareness of the problem and maintaining boundaries in this way is critical. 
  11. Connect with coworkers first. Promote a sense of belonging by forming a community of people who genuinely care about each other. Realize that nurses must have solidarity in order to raise their self-esteem. Then connect on a human level with the physicians. The work environment is a product of your relationships. 
  12. Acknowledge positive behavior and relationships. If there are physicians with whom you enjoy working, send thank you notes and list specific reasons why you enjoy working with them. Send copies of the notes to the medical staffing office.

Editor's note: This excerpt was adapted from the book, Speak Your Truth: Proven Strategies for Effective Communication. To find out more about the book and to order a copy click here.