Are you on BOARD for COMMUNICATION? Ideas to improve physician-nurse relations By Krista Hollowell

"Know this, my beloved brothers: let every person be quick to hear, slow to speak, slow to anger" (James 1:19, ESV)

Situation....

  • Decrease in quality of care given to the patients
  • "We are second-class citizens within the department"
  • 25 % increase in the number of last-minute call-ins
  • Shouting of nurse and surgical resident

Background...

Within the past six months the nurse manager has noticed increased problems with poor communication between nurses and physicians. This has led to nurses feeling as if they are not appreciated, making them feel as if they are not valuable to the department resulting in a decrease in the quality of care being performed to the patients. In addition, there has been an increase in the number of last minute call-ins as a result of the issues. Today, one of the nurses and a surgical resident began shouting within the hallway resulting in the nurse walking away crying and the surgical resident refusing to work with this nurse again. Following the confrontation, and upset about the recent changes within the department, the nurse manager states to the OR Medical Director "We have a problem"! "How did I now recognize this"? "What do we do"?

"I will not work with her anymore"! "I cannot do this anymore"!
"How did I not see this"? We have to improve or the safety of our patients and staff will be at risk.
We need to fix this problem NOW! A meeting of the minds MUST take place or the safety of both our patients and nurses are at risk!

First, a departmental meeting with both the nurses and physicians was held. Prior to the start of the meeting, rules were established. The rules included not blaming anyone, yelling at anyone, nor any negative body language (Patterson, Grenny, McMillan, & Switzler, 2012). It was time for crucial conversations to be held, talking from the heart. Collaboration must be used in order to effectively resolve conflict (Finkelman, 2016). Every person that is part of the healthcare team is important, and has a distinct role. We are all needed. It was important to stress this to the department. The group was instructed to really express their feelings and why they thought it is not working anymore. What has changed? How does it make each of us feel? Active listening was encouraged in order to really learn from the issues at hand. Great ideas for improvement were shared from the group and new processes are being reviewed. One idea is the implementation of daily departmental safety huddles. Within these huddles, a forum will be established for a few minutes each morning in which good catches will be shared, any potential safety issues or just generalized issues that each discipline would like to address that day to stop conflict before it arises. Both groups decided to get on board with communication because if not, not only are patients at risk so are they!

Daily Departmental Safety Huddle
The aim is to ELIMINATE rude and disrespectful behavior. Education to both nursing and physician staff was completed. There will be a ZERO tolerance for this behavior and consequences will follow. We have to stop conflict in its tracks....

As a NURSE Leader and Physician Leader....

We will be an advocate and act as a liaison for our nurses and physicians. We will meet with our staff on a monthly basis and follow-up with each other on any issues that needs to be addressed. Next, we will round with each other and role model appropriate behaviors and explain the importance of doing so. We also have to praise our staff and sponsor joint events to celebrate success.

As a Nurse I can...

  • Adopt good, standard communication
  • Be prepared
  • Take the time to thank those physicians that are doing an outstanding job and approach those in private to talk about an issue- explain the behavior and the effect it has- if the conversation is not productive, always include your nurse manager
  • ALWAYS report disruptive behavior of not only physicians but of other nurses as well
  • Round with physicians and always ask questions

As a Physician I can...

  • Always address nurses by name- if unsure ask!
  • Be a leader, not a commander- recognize your role and create an atmosphere where nurses feel comfortable with sharing information
  • If you have a problem, speak to the nurse in private and share your concerns- Always involve the nurse manager if you continue to have concerns
  • Recognize staff that are a high performer
  • Invite nurses to round or even shadow you for the day
  • Provide education!
"We will work together.... we are a TEAM"
"Two are better than one, because they have a good reward for their toil. For if they fall, one will lift up his fellow. But woe to him who is alone when he falls and has not another to lift him up! Again, if two lie together, they keep warm, but how can one keep warm alone? And though a man might prevail against one who is alone, two will withstand him—a threefold cord is not quickly broken" (Ecclesiastes 4:9-12, ESV).
It will take time and much effort, but the puzzle will be put back together. How? Success is possible with a TEAM

References

Finkelman, A. W. (2016). Leadership and management for nurses: Core competencies for quality care (3rd ed.). Boston, MA: Pearson

Patterson, K., Grenny, J., McMillan, R., & Switzler, A. (2012). Crucial Conversations: Tools for talking when stakes are high (2nd ed.). New York, NY: McGraw-Hill

Created By
Krista Hollowell
Appreciate

Credits:

Created with images by sasint - "progress clinic medical" • Walt Stoneburner - "Nurse from overhead" • maxlkt - "hand united hands united" • PublicDomainPictures - "connect connection cooperation" • ccPixs.com - "3D Team Success"

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