|Year : 2018 | Volume
| Issue : 2 | Page : 188-195
Nurse physician work-related relationship as perceived by both of them
Elham Y El-Hanafy
Department of Nursing Administration, Faculty of Nursing, Damanhour University, Damanhour; Department of Medical Surgical Nursing, College of Nursing. Taibah University, Medina, Egypt
|Date of Submission||08-Nov-2017|
|Date of Acceptance||07-May-2018|
|Date of Web Publication||12-Nov-2018|
Elham Y El-Hanafy
Department of nursing Administration, Faculty of Nursing, Damanhour University, Damanhour, 22516
Source of Support: None, Conflict of Interest: None
Background Nursing and Medicine are among the few disciplines that work closely and complement each other. They share a common commitment to patient well-being. However a common type of conflict in health agencies is the physician–nurse conflict that is caused by lack of daily interaction between nurse and physician and lack of understanding of each other’s role. Hence, basic to good relationship between doctors and nurses is the clear understanding of the nurse’s role, which is ambiguous, compared with the physician’s role.
Aim The aim of this study was to explore the nurse–physician relation, as perceived by both of them.
Design A descriptive correlational research design was utilized.
Sample A convenience sample of the study included all nurses and physicians who had a minimum of 1 year of experience.
Setting The study was conducted in Damanhur National Medical Institute.
Tool Data were collected by a questionnaire developed by the researcher on the basis of relevant literature.
Results The main results of the study showed that physicians are more satisfied than nurses with their relationship. The nurse–doctor relationship was characterized by cooperation. However, nurses had a feeling of inequity with physicians, especially in the disciplinary actions.
Recommendation Improve the relationship between doctors and nurses through sharing in journals, seminars, and conferences. It is also recommended that the hospital administrator should empower nurse staff with adequate authority to implement the hospital policies.
Keywords: nurse, nurse’, s role, perception, physician relationship
|How to cite this article:|
El-Hanafy EY. Nurse physician work-related relationship as perceived by both of them. Egypt Nurs J 2018;15:188-95
| Introduction|| |
One of the most important factors distinguishing the leading hospitals is the high quality of nurse–physician interaction and communication in the clinical units (Knaus et al., 2007). The best hospitals showed a consistent and coordinated response to patient needs, and a division of responsibility, however, lies in the different approaches each profession takes toward patients and the ways those physicians and nurses communicate their impressions. Not surprisingly, two different educational systems have created two separate languages, which in turn reflect and reinforce the conflict between nurses and physicians that preclude many problems (Jenny, 2008; Kennedy and Gravin, 2009; Stein et al., 2011).
The disciplines of nursing and medicine are expected to work in unusually close proximity to one another, not just practicing side by side, but interacting with one another to achieve a common goal: the health and well-being of patient care, so that the relationship between nurses and physicians is considered the most important one in the healthcare team (Sweet and Norman, 2009; Tshudin, 2010).
Gianakos (2012) emphasized that increased communication, empathy, cooperation and collaboration between nurses and physicians will improve their ability to achieve patient well-being. Furthermore, Cox (2011) added that collaboration and understanding between nursing staff and physicians improves patient outcome and the job satisfaction of nurses and may be a factor in the retention of nurses.
Trust and integrity playing an important role in effective nurse–physician relationship, valuable information about the patient may not be shared, and orders may be delayed if antagonism, poor communication, and mistrust exist between doctors and nurses (Beauchamp and Childress, 2010; Gianakos, 2012).
The current ambiguity in nurse–physician roles and responsibilities arises from the fact that the role of the nurse has not been clearly defined while the role of the physician is unambiguous (Morse and Piland, 2008).
Significance of the study
The interprofessional relationship between nurses and physicians is considered as decisive and has been highlighted in different contexts (Ward et al., 2007; Sollami et al., 2015). Through clinical observation in the nursing field, the investigator noted that the nurse has not been viewed as the main partner in patient care but as the physician’s subservient, which affected negatively their relationship with physicians. Moreover, there are unnecessary conflicts that arise between nurses and physicians sometimes, which could be aggravated to role ambiguity and role overlapping, unstructured policies and rules. Hence, identifying the nature of the nurse–physician relationship from their point of view is very important. If it is positive it will be reinforced, if it is negative, the findings will indicate the reasons, and recommend the appropriate approaches to improve the relationship.
| Aim|| |
The aim of the study was to explore the nurse–physician relation, as perceived by both of them.
Do nurses and physicians have mutual satisfaction with their work-related relationship?
| Patients and methods|| |
Descriptive correlation research design was used in the study.
A convenience sample of the study included all nurses and physicians who are working in Damanhur National Medical Institute. The study sample consisted of 250 nurses and 100 physicians from Damanhur National Medical Institute. The criteria for selecting both physicians and nurses for the study was that everyone should have a minimum of 1 year of experience.
The study was conducted at Damanhur National Medical Institute. This institute is the largest governmental medical institute that provides healthcare services for the population of El Beheira Governorate (n=564 beds).
Data were collected through a questionnaire developed by the researcher, guided by the relevant literature (Christman, 2007; Mariano, 2007; Nielsen, 2008; Sweet and Norman, 2009; Gianakos, 2012). The instrument consisted of two parts.
- The first part was related to the demographic data about the respondents, which included name of hospital, age, sex, and previous experiences in a hospital and job title.
- The second part included statements about the nature of nurse–physician relationship and the participants’ perception of the nurse’s role.
The questionnaire items were grouped into five dimensions as follows:
- Interpersonal relationship (22 items).
- Work stress (five items).
- Job performance (seven items).
- Administrative policies and norms (14 items).
- Perception of nurse’s role (19 items).
The scoring system was as follows: five-point Likert scale degree for each item and guided by McLeod (2008) Likert 5=mostly agree, 4=agree, 2=neutral, 3=disagree and 1=mostly disagree.
A pilot study was conducted aiming at evaluating the study tools’ clarity and relevance to the study objectives. It was carried out on 10% of the total sample (nurses and physicians). These were not included in the main study sample.
Administrative and ethical considerations
An official letter was issued from Faculty of Nursing, Damanhur University, to obtain permission from the administrators of the previously mentioned setting, for gathering the research’s data. Oral consent was obtained from each study participant, after explaining the study, its purpose, confidentiality of information, anonymity and some instructions.
Data were collected, after a meeting with the participants, by the investigator on individual basis, to inform them about the aim of the study, and to gain their cooperation. After the explanation of the study’s purpose by the investigator, the questionnaire was handed over individually by the investigator to each physician and nurse. Data were collected in the period from May 2017 to July 2017.
Upon completion of data collection, each sheet was manually scored; after that the collected data were organized, categorized, tabulated and analyzed using an electronic computer. Data were presented in tables by using percentage, mean, t-test, and Pearson’s correlation coefficient.
| Results|| |
[Table 1] shows that the physicians’ mean age was 35.46, higher than the nurses’ mean age (29.6), and the physicians’ mean years of experience (11) was higher than that of the nurses’ (8.58), and almost half of the sample of physicians (51%) had a bachelor’s degree, and the least percentage (15%) had a doctorate degree. In contrast, the majority (79.2%) of nurses had a diploma, and 16.4% had a bachelor’s degree, and the least percentage of nurses (2%) had a master’s degree.
[Table 2] illustrates that the medical staff considered (3.44±1.27) the nurse–doctor relationship as superior to the subordinate. Both agreed that the rank of medical staff does not have influence on the nurse–physician relationship, nurse’s respect to medical staff not reaching to the extent of fear; however, the mean score of doctors (2.89±1.15) is higher than that of the nurses’ (1.97±1.02).
|Table 2 Medical and nursing staff respondents’ perception of the nurse–physician relationship|
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Data showed that physicians do not insult nurses at any time and place with no limit, as reflected in the physicians’ mean score (1.88±1.02) and nurses’ mean score (1.76±1.13). Both respondents disagreed that physicians ignore valuable suggestions offered by nurses, as reflected on the physicians’ mean score (2.35±0.73) and nurses’ mean score (2.87±1.17). Physicians (3.82±1.11) and nurses (3.66±1.01) approved that doctors are keen to read nurses’ notes, because negligence of these notes could lead to many mistakes, as indicated by medical staff (4.32±0.89) and nursing staff (4.29±0.7). Although physicians disagreed (2.37±1.14) that their behavior with nurses negatively influence respect to nurses, the nurses perceived the opposite (4.15±0.83).
Data indicated that nurses and physicians deal with each other formally; this reflected on the physicians’ mean score (4.26±0.81) and that of the nurses’ (3.70±1.37), and this confirmed by their agreement that nurses are not responsible for meeting the physicians’ personal needs Physicians’ mean score was 2.12±1.21 and nurses’ 3.33±1.27. The relationship between nurses and physicians affects their job satisfaction, the physicians’ mean score being 3.25±1.0 and the nurses’ being 3.40±1.21. Physicians perceived that there was good human relationship (3.98±0.96) with nurses and nurses confirmed this perception 3.33±1.27. Both respondents characterized their relationship by cooperation, physicians mean score being 3.90±1.28 and nurses’ 4.29±0.7. Also, they characterized their relationship by excellence but by low mean physicians (3.28±0.83) and nurses (3.60±1.09).
[Table 3] illustrates that the physicians and nurses agreed that patient care was a shared responsibility between nurses and physicians, which was reflected on physicians’ and Nurses’ mean scores, 4.37±0.61 and 4.56±0.7, respectively. Physicians agreed (3.85±0.9) that nurses should tolerate physicians during work overload and nurses supported this (3.36±1.3). Although doctors (2.76±1.33) do not tolerate poor nurses’ performance during high workload, nurses perceive the opposite (3.09±1.23).
|Table 3 Physicians’ and nurses’ perception of work stress effect their relationship|
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[Table 4] shows that both medical and nursing staff agree that nurses’ performance level affects their relationship, as reflected by their mean scores, 3.6±1.08 and 3.89±1.05, respectively. Similarly, physicians agreed (3.03±1.34) that their level of performance influences their relationship with nurses, nurses supporting this (3.53±1.0). Nurses disagreed (2.06±1.13) that they are always not performing well, and physicians confirmed this (2.9±0.97). Physicians and nurses highly perceived that the physician’s trust in the quality of the nurse’s performance reflected on their mean scores, 3.25±0.97 and 3.94±0.75, respectively.
|Table 4 Physicians’ and nurses’ perception of the effect of job performance on their relationship|
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[Table 5] shows that nurses highly perceived (3.58±1.24) their role as vague; physicians also perceived this but in low degree (2.98±1.3). However, physicians and nurses agreed that their roles were overlapping, physicians’ mean score 3.0±1.3 and 3.78±1.06 for nurses. Physicians disagreed (2.8±1.2) on the inequity of accountability between nurses and physicians, contrary to nurses (4.32±1.07). While physicians disagreed (2.5±0.1) that the nurses’ complaints against physicians is ignored by administration, nurses perceived the opposite (3.44±1.5). Physicians agreed that they are blamed privately when they commit mistakes (3.1±1.1) and nurses supported this (3.89±1.25). Physicians disagreed (2.3±0.9) that nurses are insulted strongly and publicly; nurses agreed on this to some extent (2.98±1.61). Physicians disagreed (2.6±1.1) that their authority over nurses creates problems, whereas nurses see the opposite (3.37±1.17). Physicians (2.8±1.0) did not perceive that the administration believes they are always right, whereas nurses strongly perceived it (3.45±1.39). While nurses perceived that they were victims of physicians’ mistakes (3.91±1.09), physicians denied this (1.8±0.8).
|Table 5 Physicians’ and nurses’ perception of the influence of administrative policies and norms on their relationship|
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Data in [Table 6] show that both physicians (3.82±1.08) and nurses (3.79±1.01) agreed that the physician respects and understands the nurse’s role. However, they were indifferent about the fact that the nurse is keen in protecting patient’s rights more than any other person, physicians’ mean score being 2.35±0.93 while the nurses’ mean score being 3.97±0.92. Physicians agreed (3.97±0.95) that the nurse’s role is not less important than his role, and nurses also agreed (4.24±1.05). Physicians disagreed (2.9±1.07) that the nurse’s role includes evaluation for patient health status, whereas nurses agreed (3.59±1.12). Both doctors and nurses disagreed that the nurse’s role was doing paper work and accompanying the patient outward; their mean scores were 2.03±0.73 and 2.0±1.16, respectively.
|Table 6 Physicians’ and nurses’ perception about the nurse’s role and its effect on their relationship|
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[Table 7] shows that there was a statistical difference in dimensions, job performance (t=5.7, P<0.05), administrative policies (t=5.9, P<0.05) and perception of nurse’s role (P=3.9, P<0.05), whereas there was no statistical difference in the dimensions of interpersonal relationship (t=0.7, P<0.05) and work stress (0.5, P<0.05).
|Table 7 Difference between physicians’ and nurses’ perceptions of all dimensions|
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[Table 8] shows that there was a statistically significant relation between physicians’ perception of the nurse’s role and their respecting and understanding of the nurse’s role (r=0.63, P<0.05), whereas there was no statistically significant relation between physicians’ perception of the nurse’s role and the presence of human relationship with nurses (r=0.14, P<0.05), their acceptance of superior–subordinate relationship with nurses (r=0.09, P<0.05), cooperation with nurses (r=0.05, P<0.05), their approach with nurses influencing the relationship between the nurse and physician (r=0.2, P<0.05), and presence of an excellent relationship with nurses (r=0.3, P<0.05).
|Table 8 Relationship between doctors’ perception of nurse–physician relationship and some selected items|
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| Discussion|| |
In the present study, the nurse–physician relationship was assessed, because excellent working relationships between nurses and physicians are important in creating safe and satisfying practice environment to furnish quality of nursing care.
The findings of the study indicated that physicians were more satisfied than nurses with their relationship, whereas Amsalur et al. (2014) show that neither nurses nor physicians are satisfied with their relationship. As compared with nurses, physicians were more satisfied with their relationship with nurses. The same trend was observed by a study conducted in Hawassa Teaching Referral Hospital, Ethiopia (Yatasa and Cherie, 2011). In contrast, Getachew et al. (2014) found that nurses’ were satisfied with their good working relationship with physicians in their hospitals. This was also supported by the finding of an in-depth interview‘ … the nurse–physician relationship is not bad in our institution … ’ but is important for the quality of service delivered by our institution and for the two professionals’ job satisfaction.’
The medical staff respondents considered the nurse–physician relationship as superior–subordinate while nurses denied it. Aymen et al. (2017) pointed out that, traditionally, physicians view nurses as subordinate, in which they receive orders for implementation. This tradition views that the physician-nurse relationship can affect health workers’ attitudes toward collaboration. In addition, the nurses are considered as a subordinate of physicians and have collegial relationships with physicians (Getachew et al., 2014). Likewise, the qualitative study ‘… if I accept the reality that I am employed here to save lives … ’ with the auxiliary health personnel. Auxiliary health personnel are assistants to the physicians. Their task is to assist physicians and work in accordance with this division of labor ‘… nurses do not want to accept that they are subordinates of physicians.’ This finding is lower than the findings in the USA in 2008; 46% of the respondents said nurses are subordinates of physicians, and 38% nurses have a collegial relationship with physicians (Kramer and Schmalenberg, 2008). This difference might have resulted from the difference in understanding of their roles in the clinical settings and cultural difference and individual characteristics.
The study result pointed out that doctors and nurses agreed about the physician respecting and understanding the nurse’s role. While they perceive that the physician’s role is the most important one in the health team. This reflects physician respect to nurse’s role due carrying out his orders without arguments and interfering from her which showed the physician’s superiority over nurses. However, around 31% of participant perceive a gap in physicians’ understanding of nurses’ roles and responsibilities as a nurse and cite ongoing problems with communication and collaboration (Getachew et al., 2014). It is also supported by the qualitative study ‘…I feel that some physicians do not always recognize the knowledge, and experience base that nurses have and often overlook it as a resource.’ This value was lower than a similar study conducted in the USA in 2008, in which 70% said that physicians do not understand their roles and responsibilities as a nurse (Fatma, 2008). This could be caused by the difference in competency and culture of the study participants.
The findings of the study reflected the nurses’ feeling of inequity with physicians, especially in the disciplinary actions; this showed in the following facts. Nurses’ complaints against doctors are ignored by the administration; the physician is blamed privately when make any mistakes are made and the opposite is true with the nurse. Moreover, the nurse cannot express his/her objection for physicians’ violation of policies and regulations, and the nurse is a victim of physicians’ mistakes or negligence. All of these facts reflect the physician’s authority to control the nurse and maintain their superiority. Fatma (2008) supported the fact mentioned above that, the majority of nurses, 127 (52.5%), were dissatisfied with administrative support in nurse–physician relationships.
The findings of the study indicated that the nurse and doctor relationship was characterized by cooperation, and it was related to their perception of the nature of their relationship correlating with their perception of the cooperative relationship. O Daniel and Rosenstein (2008) support the fact that the cooperation between physicians, nurses, and other healthcare professionals increases team members, and other type of knowledge and skills, leading to continued improvement in decision-making (O Daniel and Rosenstein, 2008). In contrast, Aymen et al. (2017) found that the attitude toward collaboration between physicians and nurses is significantly different, and nurses showed more favorable attitudes than physicians. Other studies showed different results, in which physicians in ICU had more positive attitudes toward collaboration than nurses (Hamric and Blackhall, 2007).
The study indicated that the nurse and doctor relationship was characterized by cooperation, and it was related to their perception of the nature of their relationship correlating with their perception of the cooperative relationship. Masson (2007) supported that cooperation and collaboration between doctors and nurses is vital to patient care. The physician and nurse working together with a clear sense of their individual and professional strengths and limitations has potential for healing the whole person, unequaled by either healer alone. Mackay (2010) added that having a good relation, doctors and nurses learn from each other, and share valuable information, which promotes good patient care and maintains a productive work environment. In addition, collaboration is the most preferred strategy of the conflict resolution styles; it requires both cooperation and assertiveness, and involves fully recognizing others’ concerns while not sacrificing or suppressing one’s own (Carolyn, 2011).
| Conclusion|| |
The main result of the study showed that physicians are more satisfied than nurses with their relationship. While the most of physicians understand and appreciate the nurse’s role. Moreover physicians perceived that they are important one in the health team. The investigator correlate between some selected items and respondents’ perception of the nurse’s role. It showed there was statistical relation between nurses’ perception of nurse’s role and their understanding and respecting of nurse’s role. It showed there was statistical relation between both nurses and physicians’ perception of nurse’s role and their understanding and respecting of nurse’s role. There was statistical relation between nurses’ perception of nurse–physician relationship and their acceptance of superior–subordinate relationship with physician.
- Hospital administration should empower nursing staff with adequate authority to implement the hospital policies.
- There should be well-planned orientation program for physicians and nurses, which cover the roles of the health team members, policies and procedure.
- Improve the relationship, collaboration and communication between physicians and nurses through sharing in conferences, seminars, workshop, journals, and so on.
- Administrators have to be fair and apply disciplinary action equally to nurses and physicians.
Financial support and sponsorship
Conflicts of interest
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8]