Consider evidence-based strategies.
Takeaways:
- Hectic healthcare settings and lack of understanding of colleagues’ roles and skills can contribute to miscommunication between nurses and physicians.
- Several evidence-based strategies—for individuals, departments, and organizations—can promote improved communication.
The art and science of medicine and nursing requires effective communication to establish relationships and ensure a good workplace environment. However, when nurses and physicians face the time pressures of a busy clinical workday, communication frequently becomes scrambled, which can lead to poor outcomes. To ensure communication serves as a catalyst for improving patient care quality and safety, clear and effective strategies require individual and organizational accountability, education, and collaboration.
Understanding causes for communication breakdown
Manojlovich and colleagues and Farhadie and colleagues posit that communication breakdown is a primary driver of care mistakes. Amudha and colleagues note that communication issues can stem from various causes, including personality clashes and hierarchical structures.
Tan and colleagues found that incongruent views between nurses and physicians related to communication may result from different training backgrounds, which may then play a role in the effectiveness of communication interventions and strategies. This lack of co-educational experience leads to a lack of understanding of what each profession brings to the care team and complicates communication.
Manojlovich and colleagues observed and recorded potential causes of communication failure during a small pilot study at the University of Michigan. They noted that nurses didn’t clearly express their needs and that they frequently communicated indirectly, which confused physicians. Rather than asking for clarification, physicians ignored nurses’ requests. The researchers also reported that physician responsiveness to nurse-initiated texts, telephone calls, and face-to-face communication depended on tone of the message itself and other non-message-related determinants such as having a history of conflict with one another, hierarchy, and professional stereotyping
Improving communication
The perception of nurse–physician collaboration plays a key role in exploring potential contributing factors to effective cooperation at both the individual and organizational levels. A study by Bowles and colleagues found a significantly lower perception of interprofessional collaboration scores among nurses compared to residents and attending physicians. The researchers concluded that understanding that nurse–physician collaboration contributes to superior patient and organizational outcomes may aid in predicting effective individual and organizational communication and identifying effective interventions. House and Havens, however, found that nurses and physicians reported different opinions about what constitutes effective collaboration and that more nurses were satisfied with their collaborative interactions.
Individual and department recommendations
Strategies that support individual and department communication improvement include collaborative rounding, inclusivity and teamwork, respect, and mindfulness.
Collaborative bedside rounding. Nurse–physician bedside rounding provides an opportunity to share information collectively with patients and families. It empowers them to play an active role in their care, fosters informed decision-making, and promotes the care team’s trustworthiness.
Inclusivity and teamwork. To promote inclusivity and teamwork, use pronouns such as “our” patient rather than “your” or “my” patient. This simple change promotes teamwork. Also consider pronoun use. Using a person’s personal pronoun shows respect and validation. This small gesture goes a long way to create a safe environment for everyone. Using the wrong pronoun, whether intentional or not, can be interpreted as disrespectful.
Role model respect. Although this may seem basic, know and use care team members’ preferred names. If you’ve forgotten a name or a new care team member has joined the unit, ask. Inquiring shows others that you care enough to learn about them. Avoid negative commentary and never speak poorly of others to coworkers. Any negative comments should be shared as constructive criticism with the person involved, not behind their back.
Practice mindfulness. Ramaci and colleagues found that mindfulness practice (being intentionally aware of what you’re sensing and feeling in the moment without interpretation or judgment) improves listening skills, social–emotional skills, and workplace satisfaction. Practicing mindfulness involves breathing techniques, guided imagery, and other exercises to relax the body and mind and reduce stress. Devoting too much time to daydreaming, planning, problem-solving, or negative thoughts can lead to higher levels of stress, anxiety, and symptoms of depression. Mindfulness can help redirect your focus so you’re more engaged with the world around you.
Organization and system recommendations
Suggestions for improving nurse–physician collaboration at the organization and system level include empathy training, stress management, structured communication tools, technology, team huddles, and communication-focused events.
Empathy training. Empathy allows you to put yourself in another person’s shoes and to approach situations with curiosity, rather than certainty. Having an empathetic mindset deepens your understanding of complex topics and allows you to notice when you’re not being understood by the listener and then react accordingly. Empathy incorporates emotional intelligence (self-awareness, self-regulation, social skills) and small, nonverbal actions that provide comfort and make a connection. For example, making eye contact and speaking calmly show respect and compassion to listeners. Patel and colleagues found that empathy isn’t an inherent trait, but rather a skill that can be developed through training. Empathy training includes activities or simulations that allow participants to experience the perspectives, needs, and problems of others. Content may include decoding facial expressions and other body language, mirroring, and active listening.
Stress management. Organizations can provide employees with stress management training customized to support the needs of their workforce. The training can include everything from deep breathing exercises, yoga, stretching, and mindfulness to smoking cessation, fitness and nutrition education, and financial planning.
Structured communication tools. Using a structured communication tool, such as SBAR (Situation, Background, Assessment, Recommendation), can help remove the guesswork from nurse–physician communication. An established procedure that everyone must respect and follow helps form communication expectations and ensures nurses can quickly and effectively prepare to share vital information with physicians. A structured communication tool also can help overcome some language barriers, particularly when it comes to jargon, and clarify care team roles. For example, the Agency for Healthcare Research and Quality TeamSTEPPS curriculum provides evidence-based teamwork tools.
Technology. Secure communication technology (email, text messaging, electronic health records [EHRs]) facilitates efficient communication. Written nurse–physician communication can help alleviate linguistic or accent-based barriers and ease time-sensitive information by making communication synchronous. EHRs ensure that all parties have access to the same, up-to-date information about patients, which creates a shared foundation of knowledge that facilitates efficient communication.
Team huddles. Team huddles provide an opportunity for immediate clarification of issues and roles. Every team member knows a fixed time has been set at which they’ll have the team’s attention. Daily briefings (similar to huddles) can help a team quickly assess clinical workload changes, identify relevant issues of the day, and aid prioritization. In a very short time, team members can be on the same page for the day to ensure relevant issues are addressed.
Communication-focused events. Nurse–physician communication summits or forums can promote communication. Before the event, administer a survey asking physicians and nurses to name the top five communication elements they’d like to change to ensure optimal care. At the summit, share the survey results and ask break-out groups to work on proposed recommendations. These types of events can help fill the gap in how nurses and physicians understand each other’s roles and identify specific feedback about what’s working well and what needs improvement.
Make a difference
Communication among nurses and physicians plays a vital role in the patient and family experience. Ineffectiveness and inefficiency can result from individual personality clashes, lack of knowledge about communication issues, and healthcare organization hierarchical structures. Leaders must create an open communication environment by modeling appropriate behavior, setting expectations, and investing in organizational support systems. Implementing just one individual recommendation can make a difference in your personal and professional journey and improve organizational outcomes.
Anthony J. Wehbe is CEO and physician founder of Sena Health in Philadelphia, Pennsylvania. Cheri Clancy is founder of Cheri Clancy & Associates, LLC in Sicklerville, New Jersey.
References:
Amudha P, Hamidah H, Annamma K, Ananth N. Effective communication between nurses and doctors: Barriers as perceived by nurses. J Nurs Care. 2018;7(3):1-6. doi:10.4172/2167-1168.1000455
Bowles D, McIntosh G, Hemrajani R, et al. Nurse–physician collaboration in an academic medical centre: The influence of organisational and individual factors. J Interprof Care. 2016;30(5):655-60. doi:10.1080/13561820.2016.1201464
Burgener AM. Enhancing communication to improve patient safety and to increase patient satisfaction. Health Care Manag. 2020;39(3):128-32 doi:10.1097/HCM.0000000000000298
Crowe S, Ewart L, Derman S. The impact of simulation based education on nursing confidence, knowledge and patient outcomes on general medicine units. Nurse Educ Pract. 2018;29:70-5. doi:10.1016/j.nepr.2017.11.017
Farhadie A, Elahi N, Jalali R. Nurses’ and physicians’ experiences of the pattern of their professional relationship with each other: A phenomenological study. J Qual Res Health Sci. 2017;6(2):201-13.
House S, Havens D. Nurses’ and physicians’ perceptions of nurse–physician collaboration: A systematic review. J Nurs Adm. 2017;47(3):165-71. doi:10.1097/NNA.0000000000000460
Jha D, Frye AK, Schlimgen J. Evaluating variables of patient experience and the correlation with design. Patient Exp J. 2017;4(1):33-45. doi:10.35680/2372-0247.1176
Jiménez P, Winkler B, Dunkl A. Creating a healthy working environment with leadership: The concept of health-promoting leadership. Int J Hum Resour Manag. 2017;28(17):2430-48. doi:10.1080/09585192.2015.1137609
Kohn LT, Corrigan JM, Donaldson MS, eds. To Err Is Human: Building a Safer Health System Washington, DC: National Academies Press; 2020.
Liaw SY, Ooi SW, Rusli KDB, Lau TC, San Tam WW, Chua WL. Nurse-physician communication team training in virtual reality versus live simulations: Randomized controlled trial on team communication and teamwork attitudes. J Med Internet Res. 2020;22(4):e17279. doi:10.2196/17279
Manojlovich M, Frankel RM, Harrod M, et al. Formative evaluation of the video reflexive ethnography method, as applied to the physician–nurse dyad. BMJ Qual Safety. 2019;28:160-6.
Manojlovich M, Harrod M, Hofer T, Lafferty M, McBratnie M, Krein SL. Factors influencing physician responsiveness to nurse-initiated communication: A qualitative study. BMJ Qual Safety. 2020;30(9):747-54. doi:10.1136/bmjqs-2020-011441
Patel S, Pelletier-Bui A, Smith S, et al. Curricula for empathy and compassion training in medical education: A systematic review. PLoS One. 2019;14(8):e0221412. doi:10.1371/journal.pone.0221412
Ramaci T, Rapisarda V, Bellini D, Mucci N, De Giorgio A, Barattucci M. Mindfulness as a protective factor for dissatisfaction in HCWs: The moderating role of mindful attention between climate stress and job satisfaction. Int J Environ Res Public Health. 2020;17(11):3818. doi:10.3390/ijerph17113818
Tan T‐C, Zhou H, Kelly M. Nurse–physician communication—An integrated review. J Clin Nurs. 2017;26(23-24):3974-89. doi:10.1111/jocn.13832
von Knorring M, Griffiths P, Ball J, Runesdotter S, Lindqvist R. Patient experience of communication consistency amongst staff is related to nurse–physician teamwork in hospitals. Nurs Open 2020;7(2):613-7. doi:10.1002/nop2.431
Yusuf FR, Kumar A, Goodson-Celerin W, et al. Impact of coaching on the nurse–physician dynamic. AACN Adv Crit Care. 2018;29(3):259-67. doi:10.4037/aacnacc2018624
