Recently on my unit, I have noticed a strain between nurse-physician relationships. Are there any ways I can strengthen the relationships and help improve the quality of care patients receive?

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As with all nursing processes, we must begin by assessing the situation. You have to narrow the focus from a collective to an individual standpoint—after all, poor nurse-physician relationships can only improve when you take ownership of and personal responsibility for your role in the problem.

The first step is to assess the quality of your work relationships. The second step is to assess barriers and individual responses to conflict. By taking the emotional pulse of the relationships on your unit, you will begin to understand why we respond the way we do to negative behavior. With this insight, you will learn to respond differently and to change the existing culture.

Addressing conflict and uniting under a zero-tolerance policy for disruptive behavior and verbal abuse is paramount. And there are many other strategies to share with staff nurses to help them foster better communication and collaboration between nurses and physicians:

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.

Education is key to gaining knowledge and respect. Further your education in any way possible. Take advantage of certification courses in your specialty. Use the vast knowledge of the experienced professionals around you to raise your level of knowledge.

Ask for what you want. If you feel strongly that the physician needs to see a patient, say so.

Take personal responsibility for working out any negative relationships that you may have with a physician. Always take these conversations off the floor. Raising awareness of the problem and maintaining boundaries in this way is critical.

Relationships are complex and dynamic. Take a minute to think about the physicians with whom you work, or the physicians with whom you wish you had a better relationship. Remember that the best way to improve nurse-physician relationships is one relationship at a time.


-- Kathleen Bartholomew, RN, MN

(November 2009)