Nursing your Relationships–Improving the Way Doctors and Nurses Work Together

“When I first arrived in nursing a long time ago I was told that my job was to get coffee, carry charts, and help the doctors with whatever they needed or ordered in my little rural hospital,” says Pamela Gardner, MSN, RN.

While we know that times and the nursing profession have changed, the doctor/nurse relationship can still be difficult.  TV shows often play on this relationship–nurses either “fear” the doctors or, conversely, show humorous disrespect for doctors.  The truth is somewhere in between, and mutual respect between the professions is a key development for both sides to focus on. Taking on a prevailing misaligned attitude may be daunting for new nurses, but with a little guidance even the greenest RNs can learn to work with “old school” doctors and nurses and improve job quality and patient care.

As educators it’s important to make sure nursing students know what steps they can take to foster successful working relationships with physicians.  Gardner relies on her years of experience and offers these tips:

1. Start early.  Student nurses should interact with physicians from the very beginning.  Ask a question, share an observation, and advocate for the client.  Through thoughtful questions, meaningful actions, and advocacy you will earn respect.  You have to show your worth.  “I once had a physician order me to give a medication I knew was contrary to current practice in newborn care,” remembers Gardner.  “After the baby was stabilized the doctor and I had a ‘meeting,’ and I bet him he was wrong.  Groveling  would be the “prize” for the loser.  We both did our research (which he was surprised I knew how to do!)  We then met to compare our findings.  I won, but I did not require groveling.  What I asked for was to be considered part of the client’s team.  The doctor continued to see how important it was to have a team, and he recognized that I had something important to contribute.”
2. Be prepared when talking with other members of a team.  Nothing drives team members more crazy then getting a call at 3 a.m. about a patient with an elevated BP, but the nurse has not evaluated pain, pulses, lab work or medication.  Nurses need all of this data to make decisions and should be prepared with all the necessary assessment data to help others make appropriate decisions.  “As we show we are thoughtful prepared members of the team, we will gain patient confidence and team confidence,” says Gardner.
3. Nurses MUST understand what their practice is.  It is very difficult to to hold your own with a physician if you are not sure what your role is. Nursing is the holistic care of the client.  Nurses are the advocates and the early warning bells for the client.  Patient care is the reason behind all that we do, and each member of a health facility team has a critical role to play. If members of a team cannot learn how to recognize the essential input of all team members, the care the client receives is fractured and not high quality.  “I learned through trial and error how to establish myself as an integral member of a care team,” Gardner says.  “I’ve worked in health care settings where I helped form multidisciplinary teams for rounds, and sharing charts definitely led to improved patient care.  We can’t ignore reporting protocols that are in place to protect patients, but we can work to improve the interactions. Doctors may find nurses irrelevant at first until we prove we are not; nurses tend to have an inferiority complex that convinces us we cannot hold our own with physicians,” says Gardner.  “Time, experience, and the conviction to put our patients first will help change the way we think about ourselves and how others interact with us,” she confirms.
4. Schools of nursing should partner with schools of medicine (PT, OT, RT, pharmacy)  to help students on all sides learn what nurses are good at and how nurses contribute to the client care.  A school Gardner taught at had a program where PT, nursing, and medical students formed a team and went out into the community to work with senior citizens. Together the students developed a GROUP plan of care which is still being used years later.

Additionally, student nurses need to work on developing great communication skills so they can feel comfortable expressing opinions and suggestions to colleagues.  We know that both effective written and verbal skills are essential, and with changing technologies students may not get the same communication experiences that would have gotten even just a decade ago.  A search of some of our favorite nursing articles on eHow.com revealed the following steps educators can take when helping Facilitate Relationships and when teaching Nursing leadership to student nurses:

1. [Teach student nurses to] establish relationships early on in the workplace. Doctors and nurses should introduce themselves to one another prior to working with patients. Friendly, while professional, interactions should be encouraged in order to facilitate patient care according to this eHow.com article.
2. Brainstorming ideas on what could be done better and what areas could be improved upon. Promote the feeling that the [student} nurses’ ideas are valued. New nurses can often contribute a great deal of insight with their fresh eyes and fresh ideas.
3. Create group projects with nursing students. This helps increase their ability to communicate ideas and thoughts about their patients and medical practices to their colleagues.
4. Encourage feedback from nurses about all aspects of their job. This helps promote open communication, which in turn will enable them to feel comfortable making suggestions and initiating changes.
5. Reinforce the role of the nurse as the ground soldier for the patient and likewise the importance of that role. Nurses often spend more time with patients than doctors do and frequently have to make on-the-spot decisions. While the medical position hierarchy places doctors higher than nurses, nurses should also be comfortable voicing their opinions, even to doctors.
6. [Remind student nurses] that patient care will take precedence over all other concerns. According to an article entitled “Doctors and Nurses: New Game, Same Result” published in the British Medical Journal, the experience of the patient determines the failure or success of the doctor-nurse relationship. Doctors and nurses should put aside differences while in the presence of the patient. The patient deserves the reassurance that both doctor and nurse hold his needs above all else.
7. Assign on-staff nurses to nursing students as mentors. This helps to form a leadership-style relationships.
8. Put liaisons in place to help facilitate doctor and nurse relationships. At times, issues between a physician and nurse will require a third party. Specific staff members with human resources training can act as mediators.

With so much focus on mastering all the facts of nursing, nursing students may not remember that the foundation of the doctor/nurse relationship can, in reality, be the single most important factor in patient care.  By training student nurses from the start, we can give them a most effective tool in patient advocacy!