Improving Communication Between Nurses and Physicians

Collaboration and communication between healthcare workers are important in helping provide safe care to patients. Despite the best efforts nurses (RNs) make to ensure effective communication, communication breakdown between RNs and physicians (MDs) sometimes occur. Ineffective RN to MD communication has been a problem in the medical field for a long time. As Tan, Zhao, and Kelly (2017) explain, the term ‘doctor-nurse game’ was coined back in 1967 to describe the problem that persists to this day (p. 3975). Research shows that there are several adverse events linked to the communication barriers between RNs and MDs. Manojlovich (2010) states that patient safety, preventable errors, length of hospital stay, and hospital readmissions can be adversely affected by communication barriers between RNs and MDs (p. 941).

Research shows that the “doctor-nurse” game does not affect specialty, but can be seen throughout the different units within the hospital. Several studies have been done on this topic in areas such as the Intensive Care Unit, Operating Room, Labor and Delivery, General Surgery, and Neurosurgical units. The problem does not affect MDs and RNs who work within hospital settings only, but is also common among those working in home settings. While most of the studies included in this paper target those working in the hospital setting, evidence indicates that RNs who work in home healthcare experience this problem as well. As Brown et al., (2010) note, ”Failed communication between home healthcare personnel and the patient’s physician has been identified as a barrier for depression care” (p. 483). Research shows that the problem of RN-MD communication can be found within multiple different settings of healthcare.

Interventions have been studied in an effort to solve the problem of ineffective communication between RNs and MDs. In one study by McCaffery et al. (2010), nurses attended a two-hour class where they learned how to work with communities, communication techniques, and how to collaborate with other health care team members (p. 175). In another study conducted by Yusuf et al. (2018), a Neurosurgical unit utilized a coach that implemented ”initiatives” that focused on strengthening skills like teamwork, communication, and respect between RNs and MDs (p. 261). The interventions recommended in these studies produced multiple positive outcomes. Results showed improved communication and collaboration between RNs and MDs, patient satisfaction scores (McCaffrey et al. 2010, p.176), nurse job satisfaction, and patient safety and outcomes (Tan et al. 2017, p. 3987). From these studies, therefore, it can be concluded that implementing communication training programs in facilities (including coaching programs and in class communication training techniques) improves nurse satisfaction when communicating with physicians.

Review of Literature

The review of literature shows positive correlation between implementing a communication training program and increased communication between RN’s and MD’s. The training utilized differed from one study to another; Brown et al. (2010) and McCaffery et al. (2010) used in-class training while Yusuf et al. (2018) implemented a coach. Regardless the type of training used, all studies showed positive impact in the ”doctor-nurse” game.

McCaffery et al. (2010) used a qualitative study design to help and increase communication and collaboration between nurses and medical residents. In their study, McCaffery et al. had 65 nurses on one unit participate in a two-hour class that focused on communication skills, including listening, expressing clear messages, assertive versus aggressive communication styles and culture and gender issues, prior to a new group of medical residents coming onto the floor (p.175). Group meetings were then implemented where nurses and residents could discuss their communication styles and give feedback. The unit saw an improvement in communication and collaboration, where participants in the class could name an instance where they utilized their training, as well as an increase in patient satisfaction scores (p.176). However, while the study did yield positive results it was broad and limited to only one unit on a hospital.

Argument

            Ineffective communication between health care professionals can result in adverse patient outcomes. Research has shown that ineffective communication has been linked to prolonged patient stay, delay of treatment, and errors. Communication breakdown between RNs and MDs can obstruct the timely relaying of pertinent information from RNs to MDs thus causing delays of treatment for patients which can adversely affect them. As Tan, Zhao, and Kelly (2017) rightly observes, ”errors arising from miscommunication among health-care professionals have been identified as the second highest contributor to sentinel events in the United States, causing an estimated 210,000-440,000 patient deaths in 2013” (p. 3975). The Joint Commission also found 30% of malpractice claims (which had a total cost of $1.7 billion dollars) were a result of communication failures in hospitals and medical practices (2017). When miscommunication happens between health care providers the potential for harm is increased, whether the miscommunication stems from misunderstanding, incomplete or incorrect information, the outcome can be severe.

            On the opposite side of the spectrum, effective communication between RNs and MDs results in increased patient satisfaction. Effective communication between RNs and MDs leads to timely identification of patients’ needs and timely treatment. A study conducted by McCaffery et al. (2010) showed that after successful implementation of communication training through an educational program within a unit, the facility registered the highest patient satisfaction scores for six months. Increased patient satisfaction stems from knowing that they are important and that their nurses and doctors are working to take care of them to the best of their abilities. This happens when their needs are identified and met quickly because nurses and doctors are collaborating and communicating successfully and efficiently. If nurses do not feel like they have an important voice, or do not know how to properly use their voice, they might not be able to discuss as quickly what they need, and what their patients need.

            Enhancing communication and collaboration between nurses and doctors has many beneficial outcomes. Increased communication between RNs and MDs results in improvement of service delivery and impacts the patient outcomes by facilitating timely responses to the needs of the patients. The only real problems and objections some might have towards these studies and their implications would be with the studies themselves. Such limitations were pointed out by Tan et al., (2017) who state that, ”Current interventions only address information needs of nurses and physicians in limited situations and specific settings but cannot adequately address the inter-professional communication skills that are licking in practice” (p. 3974). Some of the studies found do not have large study groups, and some were not done within multiple hospitals or units in hospitals. However, irrespective of the small study samples and other inadequacies cited, all the studies produced positive results that supported the arguments brought up in this paper. The paper argues that ineffective communication between healthcare professionals can lead to adverse patient outcomes, while effective communication not only leads to better patient care but also increases patient satisfaction.

Discussion

The paper has shown that ineffective RN to MD communication can result in adverse effects, and that working on the problem will result in positive outcomes for patients and health care providers alike. The studies utilized in this paper show the positive outcomes that result from implementing a communication training program within different facilities. But what do we do with this information? It would be beneficial for more studies to be done that include larger sample sizes across multiple hospitals. Additionally, more studies should be done to see if more consistent training can be implemented instead of multiple different modes (such as coaching and in class training) of communication training. Once this information is gathered from more studies, implementation of communication training throughout multiple facilities will be effective as well as consistent.

Tan et al. (2010) recommends the need for implementing these practices into undergraduate and university programs, as well as within educational programs and in the workplace (p. 3987). Providence Medical Center – Everett (PMCE) has a Nurse Residency program that takes new graduate RNs, and new to acute care RNs, and gives them training that they need to transition to actual practice. Implementing a communication training program in the Nurse Residency would promote effective communication between new RNs and MDs.

References

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