RunningHead:COMMUNICATIONBETWEENDOCTORSANDNURSES

CommunicationBetweenDoctorsandNurses

BrendaF.Porchay

UniversityofArkansasatLittleRock

COMMUNICATIONBETWEENDOCTORSANDNURSES

Introduction

InmyexperienceasanursingassistantattheVAHospitalinthe1980s,therewasconsistent
communicationconflictwithinthemedicalprofession.Doctorstendedtohaveanairof
superiorityoverthenursingstaffduetosocialclass,education,andgender.Duringmyyearsat
theVAhospital,anysuggestionsorinputorquestionsImadeweredisregarded.ItwasifIwas
invisibleordidnthaveaclueaboutwhatIwastryingtocommunicate.Thiswasdiscouraging,
especiallysinceIwastheonewhoprovidedthepatientcareandspentmuchtimewiththe
patient.Itwasnevermyintentiontousurptheauthorityofthephysician,buttoinformhimof
somevalidconcerns.Nowinspiteoftheincreaseinnursingeducation,thenursingstaffisstill
subjectedtobeingdiscountedasunimportantwhenitcomestoinputonpatientcare.However
whenitcomestopatientcare,bothprofessionsareneededtogivethepatientthebestpossible
care.Thedoctor/nursegamestillexistsasnotedinarticle
BridgingtheGapBetweenDoctors
andNurses
(2012,p.52).

COMMUNICATIONBETWEENDOCTORSANDNURSES

ProblemStatement

Inmosthospitalsettings,nursesareexperiencingmajorissueswithtryingtoexpressvalid
concernsabouttheirpatients.Mostdoctorseitherrefusetolistenorrefusetoacknowledgethe
validityoftheirconcerns.Nursesspendtwicetheamountoftimewiththepatientsin
comparisontothedoctorswhospendapproximately15to20minuteswitheachpatient.
Consequently,thepatientsuffers.McKayandNarashimhanstates:Theroleofnursing,simply
put,istocareandthatofadoctoristocure(p.53).

Purpose

Thepurposeofthisreportistoidentify,addressthecausesofthiscommunicationgapwithall
medicalpersonnel,andtoremedythisdilemma.Consequently,withbothpartiesworkinghand
inhand,respectingeachothersinput,thepatientwillbenefitfromtheirexpertise.

COMMUNICATIONBETWEENDOCTORSANDNURSES

Scope

Thisreportwilldealwithdifferentscenariosinthemedicalfieldinwhichcommunication
betweenmedicalpersonneliskeytopatientsrecovery.

Discussion

Gender/Education.
AccordingtoLockhartWoodsarticle,genderandeducationplayeda
majorroleinthebreakdownincommunicationbetweenphysiciansandnurses.Doctorsmainly
camefromhighersocialclasses,weremaleandwereeducatedinacademicinstitutions,whereas
nurseswerepredominantlyfemale,ofalowersocialclassandweretrainedinschoolsofnursing
attachedtohospitals(Mackay,1993).Sadly,evenmalenurseswerecollaboratedwithversus
highlyeducatedfemalenurses.Whileontheeducationside,theaveragedoctormustobtaina4
yeardegree,thenattendmedicalschoolfor4years,andcompleteapproximately7to8yearsof
residencytrainingtoobtainhislicense.Whereasanassociatedegreeinnursingcanbeobtained
in2yearsandabachelorsdegreecanbeobtainedin4yearsandanursepractitionercantakeup
tonineyearstoobtainadoctorate.Whilephysiciansweretraditionallytaughttodevelop
technicalskillsandfocusonfindingcurefordiseases,nursesweretrainedindeveloping

COMMUNICATIONBETWEENDOCTORSANDNURSES

interpersonalskills.Nursesprovideholisticcareforpatientsandmakedecisions
interdependentlywithphysicians(Hughes&Fitzpatrick2010Sirota2007).Thisdiscrepancyin
trainingadverselycontributetothecommunicationbarrierandconsequentlycausesdoctorsto
perceivenursesinasubservientrole.

Communication.
Doctorsandnursesaretrainedtocommunicatedifferently.Doctorsgive
preciseinformationwhereasnursesgivenarratives.Theterminologyusedbybothpersonnel
tendstocreateproblemsaswell.Inthearticle,
NursetoPhysicianCommunications:
ConnectingforSafety
(2012),SBAR(Situation,Background,Assessment,and
Recommendation)wassuggestedasatooltostandardizecommunicationbetweenhealth
professionals(p.24).Thisstructuredcommunicationtoolassistednurseswithcommunicating
hisorherconcernsandrecommendationstothephysicianmoreclearly.Italsostatedthat
technology,suchasemails,textmessages,andelectronicrecordswereinstrumentalinreducing
medicalerrorscausedbyinterruptions.Inspiteofthesedifferences,thesetwoprofessionsare
interdependentuponeachothertoprovidethebestpatientcarepossible.Forexampleinthe
article,
IncreasedCommunicationBetweenNursesandDoctorsonanAcuteMedicalUnit
,
mandatorybedsideroundshavebeenshowntopromoteeffectivecommunication,creating
greatersatisfactionforthepatientandhealthcareteammembers(p.7).Theprojectwas

implementedtoproveordisprovethetheorythatnursephysicianroundingwouldpositively
improve

COMMUNICATIONBETWEENDOCTORSANDNURSES

communicationbetweenthemedicalstaffandincreasepatientsatisfaction.Afterutilizingthis
methodofroundingindifferentareasofthehospital,itwasfoundthattherewasanincreasein
communicationandanincreaseinnurseparticipation(p.16,figure4).

DifferencesinRoles/Power.
Ofcoursethereistheissueofpowerimbalance.Doctors
automaticallyfeelsuperiorbasedupontheireducationandtheirexpertiseindecisionmaking.
However,nursesfeelsomewhatsuperiorbasedupontheirexperiencesinpatientcare.This
powerstrugglecreatesfrictionbetweenthetwowhenapatientisbeingevaluated.Accordingto
thearticle
CollaborationBetweenDoctorsandNurses,
powerimbalanceisacommontheme
thathasbeenidentifiedashavinganegativeeffectonthewillingnessandconfidenceofnursesto
collaboratewithmedicalstaff(ErlenandFrost,1991Mackay,(1993,p278).Toprovide
qualitypatientcare,thesetwoprofessionsneedtovalueeachotherscontributionandstriveto
eliminatethebarriersthatinterferewithcommunicationbetweenthem.

Interview.
IwasprivilegedtointerviewSharralDonahue,anLPNatth
e
VAHospital,who
hasworkedinthemedicalfieldsincethe1970s.Myobjectivewastoverifyiftherehadbeen
changesincommunicationinthemedicalfield.Donahueworksinaclinicanddoesnothaveas
muchinteractionwithdoctorsasthenursingpersonnelhasonthepatientfloors.However,she

statedthatthedoctorsintheclinicsarereceptivetothenursesandtheirinput.Theonlyincident
shehadwaswithanewdoctorwhoworkedinaprivatepracticeandwasnotaccustomedtothe

COMMUNICATIONBETWEENDOCTORSANDNURSES

VAHospitalsetting.Consequently,Donahuewasabletoexplainthemodeofoperationstothe
doctor.Whenaskedaboutgender,shehasnotexperiencedthisissuewithanydoctorshehas
workedwith.Intheclinic,sheisnotexposedtothepowerstrugglethatsomenursesmayhave
experienced.Donahuestatedthatthecondescendingattitudeofdoctorsisreallyindividualand
maystemfromtheirlackofconfidenceintheirownskills.Thereareacoupleofdoctorswho
havethatsuperiorattitude,butthemajorityofdoctorsareprimarilyhumbleandreceptive.

Conclusion

Commonlanguageandtrainingisbeneficialinbridgingthegapincommunicationthusleading
tomoreefficientpatientcare.Nursephysicianrounding,technology,theSBARtool,and
mutualrespectarejustsomeofthesolutionsthatwould,also,bebeneficialtoimproving
communicationamongthemedicalstaff.SeeAppendixAfor
TenStepsforImproving
Physician/NurseRelationships
.