In Sickness and In Health Physician-Nurse Collaboration Karen E. Johnson, MD Associate Professor of Pediatrics Baylor College of Medicine.

In Sickness and In HealthPhysician-Nurse Collaboration

Karen E. Johnson, MD

Associate Professor of Pediatrics

Baylor College of Medicine

Physician-Nurse Collaboration

Objectives:

1) Recall factors that predict retention of RNs

2) Understand how physician-nurse relationships affect this

3) Describe ways/efforts to improve this professional relationship

Physician-Nurse Collaboration

• “burnout”• “engagement”

• “job satisfaction”• “retention”

Physician-Nurse Collaboration

Conceptual Framework for Predicting Nurse Retention

Sawatzky JA, Enns CL. Exploring the key predictors of retention in emergency nurses. J Nurs Manag. 2012 Jul;20(5):696-707.

Van Bogaert et al. 2009, Wieck et al. 2010, Cowan et al. 2008, Rafferty et al. 2001

Physician-Nurse Collaboration

Impacts many issues:

including-• Job satisfaction/intention to leave• Patient outcomes, including LOS• Nursing engagement

Autonomy plays a central role in this collaboration!!!!!!!

Coombs & Ersser 2004

Physician-Nurse Collaboration

“Power and authority have traditionally been used to preserve the dominance or hegemony of the medical profession in health care decision-making over other team members”

Clough J, Forum, May 2008 Vol 26 Number 2 p1-2

Physician-Nurse Collaboration

Fundamental to:

1) improved outcomes

2) error and risk reduction

3) optimum care/patient satisfaction

Physician-Nurse Collaboration

Current “pressures” for MD/RN:

1) financial concerns

2) technology(i.e. EMR)

3) “pipeline” shortages of both

Pauly B, Varcoe C, Storch J, Newton L. Registered nurses' perceptions of moral distress and ethical climate. Nurs Ethics. 2009 Sep;16(5):561-73.

Physician-Nurse Collaboration

Puntillo KA, McAdam JL. Communication between physicians and nurses as a target for improving end-of-life care in the intensive care unit: challenges and opportunities for moving forward. Crit Care Med. 2006 Nov;34(11 Suppl):S337.

Physician-Nurse Collaboration

Physician-Nurse Collaboration

• COMMUNICATION!!!!!!

• COMMUNICATION!!!!!!

• COMMUNICATION!!!!!!

Physician-Nurse Collaboration

Puntillo KA, McAdam JL. Communication between physicians and nurses as a target for improving end-of-life care in the intensive care unit: challenges and opportunities for moving forward. Crit Care Med. 2006 Nov;34(11 Suppl):S333.

Physician-Nurse Collaboration

??What can be done about this??

Competent performance and self confidence are the keys to clinical autonomy/collaborative working relations!!

Sawatzky JA, Enns CL. Exploring the key predictors of retention in emergency nurses. J Nurs Manag. 2012 Jul;20(5):696-707.

Physician-Nurse Collaboration

• Expertise

• Autonomy

• Responsibility

• Interdependence

• Deliberation

• Dialogue

Physician-Nurse Collaboration

Successful collaboration =• Cooperation +• Shared responsibility +• Jointly formulate/carry out patient care

plans +• Open communication +• Mutual respect