Doctors: How to improve your workplace relationship with nurses

Doctors: How to improve your workplace relationship with nurses

Accepting a promotion in the workplace is never easy task.  One must take on a higher level of responsibility, carry out new job objectives, and must quickly form new working relationships with colleagues at the office.

Taking on the role as a newly-branded doctor after years of being a medical student is no different in this aspect from becoming a junior partner in a firm.  And as I quickly discovered, forming strong working relationships with the nurses that are involved in my patients’ care has become one of the most important objectives since becoming a physician.

Many studies and literature reviews have touched upon the dynamics of the doctor-nurse relationship in a hospital setting.  Even so, I found that by simply asking my nurse friends straightforward questions about what irks nurses the most about their workplace relationship with doctors, I got most of the answers I needed to start self-improving on this vital component of patient care.

Below are two most common issues that have come up during such conversations that only break the surface of what we as physicians can work on when it comes to enhancing the relationship between nurses and doctors.

Communication

This is an obvious and continuing issue that nurses have with doctors.  So much so that I imagine a few jaded reader comments are already in progress describing in detail how I’m wasting their treasured coffee break.  However seamlessly evident this may be, the fact that subpar communication still remains a matter of concern to many nurses implies that we as physicians have room to improve.

Here are some simple steps that I’ve picked up in the hospital that have proved priceless in advancing communication between myself and the nurses that care for my panel of patients:

Step 1: Involve nurses in bedside rounds if they are available to do so.  Period.  If the nurses are busy at this time, a 2-minute phone call to the nurse after seeing the patient will make the patient’s plan for the day run that much smoother.

Step 2: Always inform nurses as soon as possible if any of these patient objectives are modified or reversed.  This includes any new imaging, labwork and any other new insights to the patient’s goals of care.  FYI: Signing an order is not sufficient communication; call the nurse or swing by the nurse’s station on your way to the patient bedside to relay this information.

Step 3: The greatest challenge and the ultimate goal is to create a friendly and personal environment where nurses and doctors are able to question each other’s decision-making without fearing an angry or defensive response.  Even the greatest nurses and best-trained physicians make mistakes. In order to mitigate these potential medical errors, nurses and doctors must obtain a level of communication where it is okay to question a medical decision or provide productive feedback on any aspect of patient care.

To do this, doctors must take time to do the obvious: know the name of nurse you are working with, take time to meet him or her face to face, and realize that patient care comes before personal pride when receiving productive feedback.

Understanding

It is common for physicians to go through medical training not understanding one iota of what it might be like to be a nurse working on the same patient team.  Having this lack of knowledge is not only inefficient when it comes to carrying out effective patient care (ie ordering scattered labs throughout the day instead of in sets), but it also creates a series of unreasonable expectations (ie having a nurse come to unkink an IV that you can do on your own).

Basic understanding of what nurses are meant to do on the job can jumpstart an effective relationship with the care team that you work with.  For instance, a lot of physicians forget that, like doctors, nurses care for multiple patients at a time.  Thus, do not expect specific patient care tasks to get done the minute something is ordered on the computer or paper chart.  (Remember, if a plan needs to be carried out “stat,” a simple phone call to the nurse relaying this information can get things moving that much faster)

I have also found that doctors tend to underestimate the clinical training that many nurses carry via years on the job and/or through advanced education.  Engaging them on their thoughts of the patient case as well as getting their angle on how the patient is reacting to your choice of medical interventions will most certainly improve patient care.  This certainly rings true for brand new deer-in-the-headlight physicians like myself.

Work in progress

Although I am at the bottom of the physician totem pole, I am hopeful that my career will continue to have promotions within the field of medicine that bring on new challenges and responsibilities.  And as long as these milestones involve bedside care, it will always be a goal of mine to go beyond having a functional working relationship with the nurses I work with.

With a few simple considerations to keep in mind we doctors can foster better rapport with the nurses caring for our patients.  And what comes with this stronger bond likely involves improved patient care and satisfaction.

Next up – what nurses can do to improve this working relationship?  I’ll leave that for another writer.

Special thanks to my good friend and colleague Le T. for dishing out many of these tips.

Brian J. Secemsky is an internal medicine resident who blogs at The Huffington Post.  He can be reached on Twitter @BrianSecemskyMD.

Image credit: Shutterstock.com

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  • http://www.facebook.com/linda.montagno Linda Montagno

    I agree with most of the information here. I do believe that doctors need to respect nurses. Doctors need to understand that nurses work shifts that are time managed by the schedules of labs, pharmacy, radiology and procedures, also families and the few doctors that seem to need their “hand held” . Everything that nurses have to get done in their shifts must work around these times. so when you have a doctor that comes to the floor at shift change and starts wanted things done “right away” ( and they don’t need to be done asap). you lose the respect of those nurses. Because they need to give the on-coming nurse the best report they can, so YOUR patient gets the best care. They cannot work over their scheduled hours or they can get in trouble with their manager – it doesn’t matter that they were “talking with the doctor” overtime is overtime. These type of doctors that treat nurses like their “slaves” do not have the respect of any nurse. Nurses are your eyes, ears, and hands. We handle the families, the small problems and most anything we can without “bothering” you. We chart this infomation ( that most chose not to read) so remember when we, the nurses, call you for something, especially off-hours ( nurses work 24/7) we do it because it needs to be done and not because we want to “bother” you about your patient. Maybe some of these calls could be avoided if the doctor stopped and asked the nurse )or the patient) if there is anything they think they may need ordered while they are there seeing the patient. That would also make it easiler for the nurse to have that tylenol, mylanta, pain medication, etc already ordered. Do the doctors realize that it can take, what it feels like forever to a patient, for the — call to office ( sometimes takes for than 1 call), call back from physician, order to be written, pharmacy to process the order, then for the nurse to actually see the item availiable in her computer.Doctors and nurses along with the other hospital departments need to communicate, we are all in it for the benefit of the patient.. We need to respect each other, for without each other we could not do our jobs.

  • http://www.thehappymd.com/ Dike Drummond MD

    Doctors graduate from residency to assume a natural role at the head of the patient care team … with no training in leadership or communication. We are simply plopped on top of the care team and have to figure out how this whole leadership thingy works on our own. This gap in our medical education is a major source of stress to the doctors and nurses and other staff on the team.

    The single most important thing you can do to bridge this gap is a BID team huddle. Here is full training on how to do that well.

    http://www.thehappymd.com/physician-leadership-patient-flow-and-team-huddle-power-training/

    Dike

    Dike Drummond MD
    http://www.thehappymd.com

  • http://www.facebook.com/cynthia.flick.3 Cynthia Flick

    Nice to hear a physician addressing this issue.

  • RK

    Thank you for this article. I started my nursing practice in a critical care environment where the doctors respected and depended upon nursing autonomy and judgment. The physician-owner made this part of the company culture. I am now in a different setting. I think the biggest challenge is helping physicians and administration to appreciate that nursing and medicine are each distinct but complimentary sciences. Nurses are independently licensed and independently accountable for the consequences of their actions (or inactions). Doctors can no more replace nurses than nurses can replace doctors.

  • Kitt Wolfenden

    FYI, the links (“here, here and here” did not appear properly – there is nothing to click.

    • http://www.kevinmd.com kevinmd

      My broken link checker must have removed them. I revised the text.

      Thanks for the heads up.

      Kevin

  • Megan Parker

    It can be a shock to enter the bizarre caste system that exists in a large teaching hospital. I was puzzled at how so many otherwise normal people could all exhibit such socially inappropriate behavior–none of the common courtesies one finds in other areas of our culture or other workplaces. Nurses and physicians learn to inhabit parallel universes in the same physical space—often never even addressing one another. There is work to be done on both sides! A LOT of diagnostic information is lost when doctors and nurses have poor communication. To their credit, it is easy to identify physicians–they are well “marked”—with a lab coat. But it is often impossible to FIND “the nurse” much less talk to him/her. There are processes and interventions that can improve physician-nurse communication at those big teaching hospitals, but someone in hospital administration would have to make it a priority…..good luck with that.

  • http://www.facebook.com/diran.ajayi.3 Diran Ajayi

    Quite instructive. Will forward this piece to my team of Doctors right away.

  • http://www.facebook.com/profile.php?id=100000031912898 Len Singer

    Think of how much more effective your blog would have been if it had been co-authored by a nurse and addressed the two viewpoints in one article.

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