In Sickness and In HealthPhysician-Nurse Collaboration

Karen E. Johnson, MDAssociate Professor of PediatricsBaylor College of Medicine

Physician-Nurse Collaboration

Objectives:1) Recall factors that predict retention of RNs2) Understand how physician-nurse

relationships affect this3) Describe ways/efforts to improve this

professional relationship

Physician-Nurse Collaboration

• “burnout”• “engagement”

• “job satisfaction”• “retention”

Physician-Nurse Collaboration

Conceptual Framework for Predicting Nurse Retention

Sawatzky JA, Enns CL. Exploring the key predictors of retention in emergency nurses. J Nurs Manag. 2012 Jul;20(5):696-707.

Van Bogaert et al. 2009, Wieck et al. 2010, Cowan et al. 2008, Rafferty et al. 2001

Physician-Nurse Collaboration

Impacts many issues: including-• Job satisfaction/intention to leave• Patient outcomes, including LOS• Nursing engagement

Autonomy plays a central role in this collaboration!!!!!!!

Coombs & Ersser 2004

Physician-Nurse Collaboration

“Power and authority have traditionally been used to preserve the dominance or hegemony of the medical profession in health care decision-making over other team members”

Clough J, Forum, May 2008 Vol 26 Number 2 p1-2

Physician-Nurse Collaboration

Fundamental to:1) improved outcomes2) error and risk reduction3) optimum care/patient satisfaction

Physician-Nurse Collaboration

Current “pressures” for MD/RN:1) financial concerns2) technology(i.e. EMR)3) “pipeline” shortages of both

Pauly B, Varcoe C, Storch J, Newton L. Registered nurses' perceptions of moral distress and ethical climate. Nurs Ethics. 2009 Sep;16(5):561-73.

Physician-Nurse Collaboration

Puntillo KA, McAdam JL. Communication between physicians and nurses as a target for improving end-of-life care in the intensive care unit: challenges and opportunities for moving forward. Crit Care Med. 2006 Nov;34(11 Suppl):S337.

Physician-Nurse Collaboration

Physician-Nurse Collaboration

• COMMUNICATION!!!!!!

• COMMUNICATION!!!!!!

• COMMUNICATION!!!!!!

Physician-Nurse Collaboration

Puntillo KA, McAdam JL. Communication between physicians and nurses as a target for improving end-of-life care in the intensive care unit: challenges and opportunities for moving forward. Crit Care Med. 2006 Nov;34(11 Suppl):S333.

Physician-Nurse Collaboration

??What can be done about this??

Competent performance and self confidence are the keys to clinical autonomy/collaborative working relations!!

Sawatzky JA, Enns CL. Exploring the key predictors of retention in emergency nurses. J Nurs Manag. 2012 Jul;20(5):696-707.

Physician-Nurse Collaboration

• Expertise

• Autonomy

• Responsibility

• Interdependence

• Deliberation

• Dialogue

Physician-Nurse Collaboration

Successful collaboration =• Cooperation +• Shared responsibility +• Jointly formulate/carry out patient care

plans +• Open communication +• Mutual respect