Addressing the Disrespect Disconnect
Joe Cantlupe, for HealthLeaders Media
This article appears in the February 2012 issue of HealthLeaders magazine.
Smooth working relationships among nurses and physicians are seen as vital to increasing value in healthcare delivery, but there is a vast divide in the perception of how doctors treat nurses, the HealthLeaders Media Industry Survey 2012 reveals.
When asked how pervasive physician abuse or disrespect of nurses is, there was a clear disconnect between the two. While 42% of nurse leaders said it was common, only 13% of physician leaders said it was common. Likewise, 58% of nurse leaders said it was uncommon, while 88% of physician leaders said it was uncommon.
Pam Kadlick, RN, BS, MBA, MSN, vice president of patient care and chief nursing officer for 112-staffed-bed Mercy St. Anne Hospital in Toledo, OH, says she is surprised at what she cited as a high level of disrespect reported by the nurse leaders.
The findings illustrate fundamental "ineffective communication or having different expectations" among the two groups, with physicians sometimes having a misperception of nurses’ roles, and nurses in conflict with physicians over the "misunderstanding of what needs to be done at a given time," Kadlick says. She acknowledges that such communication problems could manifest themselves when a physician "cuts off" a nurse’s suggestion or comment.
"I do believe nurses and physicians are on two different pages when it comes to communication," Kadlick adds. "Time is a commodity for physicians today. When they present to do rounds, they want to have pertinent data given to them. Nurses have a tendency to give a very detailed report, more than what a physician may want to hear; hence, the physician may interrupt, seem to be abrupt, even rude at times."
When confronted as being rude or disrespectful, a physician often would be "truly taken aback, as they do not see it this way," Kadlick says. Referring to reports of alleged abuse, Kadlick says she believes that "while there are validated incidents of true disrespect for nurses by physicians, these incidents are minimal."
As health systems improve care coordination and increase the roles of nurse navigators, Kadlick says she expects the communication between nurses and doctors to get better.
"I do see it improving on the acute care level, with care coordinators working with primary care physicians," Kadlick says. "As you add care coordinators and change the delivery models, you will see registered nurses more at the bedside than tied to the computer, and the communication will be getting better. You have more advanced nurse practitioners popping up in the acute care settings. We are getting there, but still moving at a snail’s pace.
"Physicians have acknowledged how important it is to have that mid-level provider to help them with their greatest commodity—time," Kadlick says.
But as health systems work to improve value-based care, nurses see themselves as becoming increasingly important to coordinate care and should have more of a stake in care delivery, the survey of nurse leaders shows. Indeed, nearly one in 10 respondents say he or she believes nurses will help save healthcare, though most (28%) say they see hospitals as the key to righting the healthcare ship, followed by the government (13%).
While most healthcare leaders acknowledge that the industry is in a mess, not one lays the blame on nurses. Of the more than 1,000 survey respondents, most say government is the culprit (40%), followed by health plans (22%), and even 6% cited physicians.
Nurse leaders are in sync with their colleagues in blaming the government for industry woes (37%), followed by health plans (23%), physicians (8%), hospitals (5%), vendors (3%), patients (1%), technology (1%), and nurses (0%).
"I think when they start pointing fingers at who is to blame, why nurses aren’t pointed out is because they aren’t reimbursed by third-party payers," says Kadlick. "They aren’t seen as the ones delaying discharges in acute care settings or ordering unnecessary diagnostic tests in the outpatient facilities."
In an area of disconnect between nurses and doctors, about 77% of nurse leaders said in the survey that the quality of their organization would be positively affected by increasing the scope of care for nurses, while only 10% thought it would worsen. When physician leaders were asked that question, 48% said it would improve, while 26% said it would worsen.
As nurses become more involved in coordinated care and multidisciplinary approaches, Kadlick says the impact of nurses on quality will be more fully appreciated. "The nurses can do more—add value to the interaction with physicians and for patients’ care," Kadlick says.
According to the survey, patient experience and satisfaction is the top priority among nurse leaders; 72% rank it among their top three priorities. Next is clinical quality and safety at 55% and cost reduction and process improvements at 45%.
"I think nurses believe they could have a voice to make things better, although I think it’s misleading to think they can fix it," Kadlick says. "The only true way to do that is to get all the shareholders together to put out a model, and everyone has a voice in planning."
With the advent of healthcare reform, it’s a chance for the industry to recognize the evolving role of nurses, Kadlick says.
"When I see the patients coming into the acute care setting, and the baby boomer nurses starting to retire, new nurses are being recruited," Kadlick says. "It’s time to be more proactive for nurses with patients and providers.
"Nurses as a whole should take responsibility to be more involved in care coordination; it’s that opportunity for us today," Kadlick adds.
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