Abstract. Background: As it is evident in literature review, the working relationship between nurses and doctors was dominant- subservient relationship in the. The doctor–nurse relationship - Volume 10 Issue 4 - Leonard Fagin, relationship in psychiatry has evolved and discuss its current status in. SIXTEEN YEARS AGO, Nursing91 led off a major survey report on nurse/ physician relationships with this quote. Of over 1, nurses responding to the survey.
Results Nurse-doctor working relationships were statistically significantly affected by poor after-work social interaction, staff shortages, activist unionism, disregard for one's profession, and hospital management and government policies. In general, nurses had better opinion of doctors' work than doctors had about nurses' work.
Conclusion Working relationships between doctors and nurses need to be improved through improved training and better working conditions, creation of better working environment, use of alternative methods of conflict resolution and balanced hospital management and government policies.
This will improve the retention of staff, job satisfaction and efficiency of health care delivery in Nigeria. Background Smooth working relationships between doctors and nurses are prerequisite for efficient delivery of health care.
This has often been overlooked to the detriment of patients' care and increased cost to the health care system, particularly in developing countries. In many countries, doctors determine the scope of nursing practice and education, and can directly define the limits of nursing knowledge[ 12 ]. In Nigeria, doctors also head public health care institutions which gives them additional opportunities to influence the training of nurses [ 3 ].
Nevertheless, several authors have argued that these working relationships are changing and should be examined against prevailing developments in the professions, society and workplace [ 4 - 6 ].
Gjerberg and Kjolsrod[ 7 ] opined that increasing male entry into nursing and female entry into medicine may change the perception of the role of gender in doctors-nurses working relationships. In many countries, including Nigeria, nursing is moving away from the traditional practice-based training towards dynamic university based education.
Furthermore, nursing education is increasingly socialized and this may ensure that nurses play a more independent professional role[ 8 ]. Older nurses may also expect traditional cultural respect due to an older person from often relatively younger doctors[ 79 ]. With these developments, nurses and other professionals in the health care industry are challenging the subordination of their occupational status to that of physicians[ 10 ]; nevertheless some authors have warned that higher status workers could just as likely be victimized as those in lower status[ 11 ].
In Nigeria, the working relationships between doctors and nurses have also been affected by episodes of withdrawal of services by both doctors and nurses in recent times.
This has occurred within the context of changing political and social environment, crippling economic difficulties associated with agitations by labor unions and civil society. These factors also affected the health care industry and relationships between various categories of health workers. Nursing and medicine are inseparably intertwined in hospital care. Good hospital care depends on a system that secures continuity of information and inter-professional collaboration [ 3 — 5 ].
Patient outcome has been shown to depend on inter-professional collaboration in intensive care units [ 6 ]. However, the relationship between doctors and nurses in hospitals has never been a symmetrical one. The two professions look at co-operation from different perspectives of patient care, different levels in the status hierarchy, and different sides of the gender gap.
The field of doctor—nurse collaboration has been sociologically attractive as it condenses the classical discourse of profession, power, and gender.
How Can We Improve the Doctor-Nurse Relationship?
Since the origin of the study of professions [ 9 ], the interface between health professions, and particularly that between doctors and nurses, has been extensively analysed by sociologists [ 10 — 15 ].
Emancipating nursing implicitly changed the nursing perspectives [ 18 ] making them more independent of the medical profession. One consequence is an increasing gap between the professions in the daily clinical work. Sociologists have provided major contributions to the understanding of the dynamics of hospital professions, yet this knowledge has remained theoretical and academic.
During the last decade, however, a more practical perspective of collaboration in hospital has been applied. These studies focus on inter-professional co-operation as a condition for effective health care, they are related to patient outcomes, and most importantly, they are published in journals read by health care professionals.
One example is the British Medical Journal, which addressed doctor—nurse co-operation in a special joint issue with the Nursing Times in April The main message was the need to start from scratch.
If so, the very concept of co-operation may conceal divergent meanings. One study of two Dutch hospitals reported discrepancies between role concepts and expectations of nurses and doctors [ 21 ]. Nurses were more critical towards doctors than vice versa, but neither party lived up to the expectations of the other party. Another study, of four hospitals in the UK and two in Australia [ 22 ], concluded that doctors and nurses have somewhat different conceptions of hospital work.
Doctors viewed clinical work more as an individualistic venture than did nurses, who considered clinical work more as a collective undertaking.
In Norway, three empirical studies have touched upon the issue. Their main message is that inter-professional co-operation is not experienced as a big problem in Norwegian hospitals—at least not by male doctors.
The Internet is full of op-ed style articles with suggestions for relationship improvement strategies, many of them written by doctors or nurses. The suggestions seem to fall into two distinct categories: Personal strategies, like those outlined in this blog postoften focus on making nurses feel more empowered.
These include the suggestion that nurses stop apologizing for interrupting a doctor, participate in rounds, equalize the name game by addressing doctors by first name, and learn to speak up when they see something amiss, like a physician who routinely does not wash hands before touching a patient. But organizational culture is also an important determining factor in nurse-physician relationships.
Nursing Research and Practice
Hospitals should have policies in place that make it clear the organization will not tolerate disruptive behavior from physicians. Such behaviors include reluctance or refusal to answer questions, return phone calls or pages; condescending language or voice intonation; and impatience with questions.
Overt and passive behaviors undermine team effectiveness and can compromise the safety of patients.