Three Steps to Improve Physician-Nurse Relationships

HealthLeaders Media Staff, December 8, 2009

Working with nurses over the years, I've heard many stories about disruptive physician behavior and its effect on nurses and patient care. Here's one I heard just last week: A neurosurgeon walks on to the floor and starts screaming at a nurse because of something the surgeon didn't like about a patient's chart. After the surgeon leaves, the nurse looks at the other physician in the room and says, "I can't even breathe when he's in the room. Let alone talk to him."

The story was related as an example of the challenge hospitals face with improving patient safety. After receiving a public berating like that, how likely is the nurse to question the surgeon when he gives an order that might not be clear or that is not understood?

There's been a lot of discussion about the importance of interdisciplinary collaboration in recent years and a lot of work done to improve it, but a new survey conducted by the American College of Physician Executives demonstrates that disruptive physician behavior—and disruptive nurse behavior—is still alive and well.

More than 2,100 physician and nurse executives took part in the survey. Nearly 98% reported witnessing behavioral problems between nurses and physicians within the last year. Apparently, the behavior is not infrequent. Thirty percent reported witnessing bad behavior between physicians and nurses weekly, 25% said it happened several times a month, 30% said only a few times a year, and a shocking 10% said they witnessed it every day.

Sixty-seven percent of respondents were nurses and 33% physicians. Interestingly, while there were complaints about nurse behavior, both physicians and nurses reported that physicians were a large cause of disruptive behavior.

The most common complaint was about degrading comments or insults—reported by 85% of respondents—while 73% cited yelling. Other problems included cursing, inappropriate joking, and refusal to work with each other. Complaints about nurses covered issues such as backbiting, gossiping, or attempting to blackball physicians.

None of these stories are new to Kathleen Bartholomew, who has been speaking about improving relationships in healthcare since 2005 and published a book on the topic, Speak Your Truth: Proven Strategies for Effective Nurse-Physician Communication.

Bartholomew explains that problems persist because of the deeply-engrained healthcare culture. "Culture is so powerful that it even trumps best practice and education."

And she says that leadership has to take the lead in changing culture at organizations so that disruptive behavior is eliminated and relationships can improve.

There are three things organizations can do to reduce the effect of disruptive relationships, according to Bartholomew:

  1. 1. Survey your staff: Leaders need to have an understanding of the extent of disruptive behavior and how that behavior affects the institution, and the only way to do that is to ask.
  2. 2. Educate: The organization's zero tolerance policy has to cover everyone—without exception. The policy must be clear and direct: Describe what behavior is acceptable and desirable and which types of behavior will not be tolerated. Then, educate everyone about the zero tolerance expectations and continue with frequent reminders.
  3. 3. Follow up: There's no point having a policy if transgressions are ignored or swept under the carpet. For example, at one hospital, when a nurse makes a complaint about a physician, the situation is handled, and then someone comes back to the nurse and tells him or her, in confidence, what is being done about it.

At many organizations, complaints against physicians by nurses are dealt with by a committee staffed by physicians, which Bartholomew says can be a problem.

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