When Doctors and Nurses Work Together

By Barbara Ficarra, RN, BSN, MPA

From KevinMD’s medical blog, in a recent post, Kevin Pho, MD answers the question, “Is the doctor-patient relationship really more sacrosanct than the nurse-patient relationship?” posed by Theresa Brown from the Well Blog, The New York Times Health Blog.

The answer is “clearly no” writes Pho.

Physicians have the ultimate responsibility for treatment decisions, but because nurses spend so much more time with hospital patients than doctors do, we have a unique view of how the patient is really doing…

We are shifting away from a paternalistic model of care, and more towards a team-based approach. This is especially true in the hospital, where not only a doctor takes care of a patient, but also nurses, social workers, physical therapists, dietitians and discharge planners, to name a few.

He is exactly right.  The doctor-patient relationship does not take priority over the relationship between a patient and a nurse.

Patient care is the responsibility of nurses, doctors and other members of the health care team.

Good nurses and doctors work together and they know how to effectively communicate with each other and other members of the health team.

It takes a team for quality patient care.

Patient care is a multidisciplinary, team-based approach, comprised of a diverse group of specialized professionals.  Patient care has become very complex due to comorbidity that exits with many patients today.

With these multifaceted patients it takes a team of medical professionals to provide the absolute best quality care.  The patient is the most important part of the team, and through a collaborative team based approach, patients can receive the highest quality of care.

And like any team, the medical team needs to work together respectfully and thoughtfully.  The medical team needs to listen attentively to each other and communicate and problem solve together.  Each member of the team supports and respects one another.  The synergy of collaboration will greatly benefit the patient.

A good team will foster a positive working environment.

Without communication and collaboration we risk sustaining a fractured team.

The medical team of doctors, nurses and other medical professionals that engage and respect each other will create a positive working environment and perform at an elevated level which can produce quality patient care with exceptional patient outcomes.

When nurses and doctors disagree

Nurses and doctors may not always agree, and when disagreements occur we need to address them in a professional manner.

I understand how busy and chaotic a hospital can be and tension can mount because of the pressures, but despite that, it is the responsibility of nurses and doctors (and other members of the team) to effectively communicate.  If there are issues with patients, they need to be addressed professionally and thoroughly.  Conversations between nurses and doctors need to be continuous and we need to understand, appreciate and value each other’s role.

It is important to note that the doctor-nurse relationship is sacrosanct and building a professional relationship is essential.  Patient care should not be a tug-of-war between nurses and doctors, but instead it should be about professionals working together for the good of the patients.

Your turn

We would love to hear from you.  Please share your insightful thoughts with us.

[Image:  istockphoto]

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    I work in a very busy ED that is only 18 ER rooms and some fast track rooms.  We have 2 docs and sometimes 1 midlevel most of the time.  We (nurses and providers)communicate very well with each other in order to give great patient care.  Most of us have been there long enough that we know the providers well enough to know what they are thinking and we are comfortable enough to just ask or give our opinion.  We also describe what we see alone with patients which is usually different then when the providers assesses them (for some reason!?).  A really good reason would be that nurses spend at least 4 to 5 times longer with patient than the providers does and we can truly get a better picture of the real issues of the patient.  We (nurses) are in there when the family is in there and we can here the conversations with visitors and the phone calls… not that we are listening in or anything!  But it is our job to be detectives and try to find out what is going on.  We can share our thoughts and findings with the providers as long as they are objective findings, not opinions.  Our providers will even ask us what we think or have noted.  It comes from working together for a good amount of time and gaining trust.  Some providers I trust more than others and I’m sure some providers trust some nurses more than others.  Gain trust from communication and responsibility and you can work better as a team.

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