Even though the US is in the middle of a nursing crunch, with an estimate 126,000 unfilled nursing positions, many physicians do not realize that their own bad behavior may be driving some nurses from the field, according to the results of a new survey.

“One of the things we are concerned about is the nursing shortage,” the report’s author, Dr. Alan H. Rosenstein, the medical director of VHA West Coast in Pleasanton, CA, told Reuters Health. As administrators struggle to deal with the ramifications of the nursing shortage, they must focus not only on recruiting new nurses to the field, but also on retaining current nurses, he said in an interview. The relationship that physicians have with nurses can have a “profound” effect on whether nurses choose to stay in the field, he said.

Many doctors seem unaware of that, suggest the results of the survey of 1,200 nurses, physicians, and hospital administrators. Though nearly 93% of all respondents had witnessed disruptive behavior by a physician, doctors were significantly less likely than nurses and executives to believe that such incidents have an important influence on nurses’ morale, according to a report in the June 2002 issue of the American Journal of Nursing. About 31% of all respondents knew of a nurse who had left their hospital as a result of a physician’s disruptive behavior.

Nurses were also more likely than physicians to believe that doctors do not value their input and collaboration as much as they should. And nurses were more likely than doctors and executives to feel that nurses do not have enough administrative support to deal with conflicts with physicians. Nurses reported several barriers to reporting problems with physicians, including intimidation, concerns about retaliation, and a belief that nothing would be done about the complaint, the report indicates.

Solving the problem with require a “multifaceted approach,” according to Rosenstein. Doctors and administrators “must make an effort to cultivate a more supportive environment, one in which nurses and nursing care are valued and respected.” However, other factors that contribute to low morale among nurses, such as cutbacks, scheduling issues, and mandatory overtime, must be dealt with, the California physician added. Educational programs aimed at fostering better relationships between nurses and physicians “can’t be successful if the underlying factors aren’t first addressed,” he concluded.

But Dr. Diana J. Mason, the editor of the Journal, disagrees that trouble in the nurse-physician relationship cannot be worked out until other problems are tackled. There are several steps that can and should be taken right now, she notes in an editorial that accompanies the study. Among other things, Mason suggests that hospitals study the state of nurse-physician relationships on their own wards, and adopt a “zero-tolerance” policy toward all abusive employees. And nurses should be helped to develop the skills needed to communicate effectively with physicians, Mason suggests. In addition, Mason states, “Nurses should stop referring to physicians as ‘Doctor So-and-So’ while physicians address them by first names. Whether we use last or first names, we must stop perpetuating such inequality.”

Nurse-doctor relationships can also affect patient care, Mason told Reuters Health in an interview. “We have research documenting that communication between nurses and physicians strongly shapes patient outcomes.” She cited a 1986 study that found that nurse-physician communication was the leading predictor of patient mortality in intensive care units. “Nurse-physician communication is not just a matter of ‘let’s be polite to each other,’” Mason said. “It’s a matter of true teamwork with mutual respect for each provider’s expertise that he or she brings to a patient’s care.”

In an interview, Rosenstein said that he did not mean that immediate steps should not be taken to improve relations between nurses and doctors. Instead, he said it is important to realize that this issue is just one of several related to nurses’ morale. “This is one piece,” according to Rosenstein. “ Other pieces have to be dealt with” as well, he said.

Reuters Health

as reported in the Charlotte Observer

June 2002