Nurse-Physician Collaboration: A Cornerstone of Quality

Flu season hit hard here in California, targeting a younger population this year. Emergency departments are scrambling to cope with surges in patient volume. So it was no surprise when I arrived at a recent facility visit to find the ED running at full capacity. Every bed was occupied, three ambulances were waiting outside to offload, and 70 patients were crowded into the lobby.

What was heartening was watching the ED medical director and nursing director team up to deal with the surge. Both were checking in at each bedside around the unit, working seamlessly to support both nurses and physicians, troubleshoot issues and even render patient care. Despite the challenging circumstances, morale on the unit was high and it was clear that the patients were getting quality care.

How did this department rise so admirably to the challenge? I believe a key factor is the culture of collaboration that exists here between the medical and nursing teams.

The ED medical director of this particular hospital is a champion of not only his own team but also of the nursing staff. He and the nursing director meet regularly to set joint goals, evaluate progress and share input from their respective teams. Both are very visible on the unit, where they demonstrate mutual respect for one another.

Their teams follow their example. Physicians and nurses participate in joint decision-making and communicate freely at the bedside regarding patient care. Conversations are collaborative and focused on the patients' needs. The provider-nurse relationship here is very much one of equals, where each profession is valued for the skill set it brings.

As a former acute care nurse and director of nursing with 30 years experience, I know firsthand the importance — and indeed the power — of strong nurse-physician collaboration. The joining of hands between nurses and providers makes it easier to accomplish almost any goal, from improving patient safety to opening a new service line. And as a practice management consultant for Vituity, I've seen how alignment of the nursing and provider teams can lower turnaround times, improve staff retention and boost patient satisfaction — all for the benefit of our patients and hospital clients.

These observations are supported by research suggesting that effective nurse-physician collaboration results in:

Strengthening nurse-physician collaboration is especially vital given the pressures of healthcare reform. In an era of diminishing reimbursements, hospitals simply can't afford to deliver substandard care. And in an organizational culture that allows physicians and nurses to remain "friendly strangers" or even adversaries, patient care tends to suffer.

I can often gauge the culture of a unit by looking at the faces of the patients and their families. When they're surrounded by tension, low morale, negativity and sarcasm, it shows in their demeanor. It's hard to feel valued when the doctors and nurses caring for you clearly resent being at work. And it's hard to trust your care team when you sense distrust among the members. Core measures and patient satisfaction scores tend to suffer in these environments.

Building a culture of collaboration between nurses and physicians takes time and sustained effort, but the energy we put in to improvement pays large dividends. Some practical suggestions teams can take to get moving in the right direction:

1. Acknowledge the need for improvement. The first step is frequent, open communication about the issues, which can be painful to both sides. Hearing the reality is never easy but is necessary to accelerate positive cultural change. Once this honest, respectful communication has been established and the roadblocks of mistrust are removed, the newly established joint leadership team can begin to move forward to achieve the common goal of truly patient-centered care.

2. Make time to meet. Communication between physician champions and nursing leadership must be tireless. Frequent, regularly scheduled provider/nursing interfacing is necessary to keep collaboration moving forward.

3. Seek input from the front lines. The joint leadership team next needs to seek out the perspectives of those who work with and next to the patient and other staff members. This will help leaders of both disciplines understand the realities and needs of the current work environment.

4. Join hands in small tests of change to enhance the patient experience. This will align the whole team with the desired outcomes. This is an opportunity to learn from successes and failures and act on feedback from staff that will pull everyone along toward the common goal. Engaging staff in joint goals also helps create a motivating and exciting work environment.

5. Loop in key people. Since patient-centered care encompasses many different cross-functioning boundaries, including ancillary and support services, a persistent effort must be made to overcome and creatively deal with obstacles. Multidisciplinary teams should be formed that include key leaders and knowledgeable staff who can aid decision-making and lead other staff members in owning the desired outcome. This positive approach empowers the team to begin to be the start of the solution.

6. Sustain the effort. Keep it simple, listen carefully to all feedback from the front-line staff and consistently act on feedback that is received. Make the interface with staff a dialogue rather than a one-way conversation. Follow through consistently and explain and clarify the "why." If a test of change doesn't achieve the anticipated result, go back and try it again.

In summary, keep the team moving in the right direction of enhancing the patient experience.