Nurses and doctors partnership.
Instructions: Nurses are generally seen as having much less authority than doctors in the decision-making process related to patient care. Discuss the challenges and provide solutions for nurses to be accepted as equal partners in an inter-professional team.
Challenges Faced in Nurse and Doctor Relationships and Recommendations
There has never been a straightforward relationship between nurses and doctor. Such disparity is mainly catalyzed by the differences of perspective, power, pay, education, class, status, and gender. Nevertheless, many of the conflicts and problems between doctors and nurses within the hospital environment stem from the hospital organizational structure as opposed to the personalities of the involved individuals. Often, nurses assert the latter. For one to understand such conflicts, it is important that they examine them in terms of their context.
There are three major aspects of the structure of the hospital that that could be termed as the major sources of the problems between doctors and nurses. One such important factor is that doctors consider themselves as independent entities as opposed to being full-fledged organizational members, hence they function as free agents. On the other hand, while nurses feel as members of the hospital organization, they feel constrained by the hospital operational rules. Nurses remain limited in terms of their ability to reduce the source of such restrain. Another aspect of organizational structure that has contributed to the inequality between doctors and nurses involves the two lines of authority within the hospital setting, including the medical and administrative authority. This is different from most large scale organizations as they only have one line of authority. Nurses fall within the administrative authority while doctors fall under medical authority. Lastly, another source of conflict is the assumption of responsibility for coordinating patient care by nurses without requisite authority, when functional health teams are absent. This paper is going to review the various challenges that nurses face in the wake of inequality in the healthcare setting, and solutions that could be adopted to facilitate the acceptance of nurses into the inter-professional health care team as partners as opposed to assistants.
The quality of patient care highly depends on the ability of nurses and doctors to collaborate their efforts. The healthcare environment has been established in a way that the functions of the nurse and those of the doctors are intertwined. Both professions greatly need each other in order to effectively progress towards high quality care (Gunnarsdóttir, Clarke, Rafferty, & Nutbeam, 2009). Nevertheless, as much as increased research and advocacy towards promoting increased partnering of the two professions has been observed, they are still curiously apart. Nurses and doctors keep separate records of patient care, train separately, read different journals, are under different hierarchies, and apply different jargon. Such differences are the sources of conflict and problems between the two professions. The patient and both the professions highly benefit from collaboration and close cooperation.
Collaboration is multidimensional such that it may occur in both face-to-face interactions and electronic interactions that may involve media such as e-mail and voice mail (Fewster-Thuente, 2015). Importantly, collaboration involves more of exchanging of ideas and views with proper consideration of each collaborator’s perspective, whether an agreement is reached or not. As such, collaboration does not involve supervision and neither does it involve a mere exchange of information between two entities. For collaboration to be effective among professionals, there must be an aspect of respect, tenacity, and trust. Collaboration has always been a problem in the health care system considering the sophisticated and complex nature of the structure of such organizations, with the doctors considering themselves highly placed as compared to nurses, considering their education and level of autonomy, an aspect that makes it difficult for them to listen to nurses (Karanikola, Albarran, Drigo, Giannakopoulou, & Kalafati, 2014). Instead, they expect to be listened to and for their directions to be followed to the later without being challenged.
With a good relationship between the doctors and the nurses, there is proper communication between the two professionals, an aspect that ensures close management of the patient needs. One of the major causes of medical error is lack of proper communication among the health care providers (Voyer & Reader, 2013). As such, a good relationship between the nurses and the doctors ensures that each of them is efficient at not only carrying out their responsibilities but also complementing the role of the other entity. Despite the various challenges faced by nurses in fighting non-collaborative habits, it is clear that true collaboration is important both for the satisfaction of the patient and the health care providers. Proper cooperation between the nurses and the physicians is highly rewarding as it allows for the sharing of the responsibility for the well-being of the patient. There is strengthening of professionalism the moment all the members of the healthcare delivery team take credit for the achievements of the group. Nevertheless, it has always remained difficult to identify the nurses’ contribution towards the bottom-line. In most cases, physicians are considered as the masterminds behind effective patient care and increased income for the hospital. This is regardless of the fact that nurses spend most of the time with the patients and play a major role in patient care, thus highly contributing towards patient satisfaction (Churchman & Doherty, 2010).
As earlier mentioned, the issue of authority is one of great importance to the conflict between nurses and physicians. The doctor operates under the medical authority, meaning that their authority is based on their professionalism. On the other hand, the nurses operate under the hospitals administrative authority, which means that they must adhere to regulations and rules established by the healthcare organization (Natan, et al., 2015). As such, unlike the nurses, the doctors have increased autonomy, such that they can make their own decisions in patient care without the need to abide by the organization’s rules as much as their decisions are within their scope of practice. This gives the physicians an upper hand over the nurses in the care of the patients as they make the ultimate decisions without the need to consult the nurses and to understand their perspective, given the importance of nursing to the healing process. On the other hand, the nurses are expected to always consult the physicians before making any of the decisions, with their decisions being founded within a predetermined setting, without consideration of any changes that may take place in terms of context (Voyer & Reader, 2013). The nurses’ perspective is thus considered irrelevant with the perspective of the doctors being used to drive the hospital operations and patient care.
Educational differences between the physicians and the nurses are also another major of source of conflict between the nurses and the physicians in the healthcare setting. Both the prerequisites for joining the courses and the number of years that students spend in an institute of higher education differ between the professions (Shen, Chiu, Lee, Hu, & Chang, 2011). Depending on the country, the number of years taken studying medicine and surgery is higher as compared to that of years spend studying nursing. In as much as the curriculum used to educate nurses covers a wide range of topics, it fails to adequately prepare the nurses for nursing in the real world, which may include promoting their familiarity with the hospital systems, the sloppy clinical nursing learning curve, and proper communication with doctors (Shen, Chiu, Lee, Hu, & Chang, 2011). As much as it is laudable to expect registered nurses to rise to the capacity of diagnosing patients, such a position cannot be achieved without the nurses attaining the same level of training and education as doctors. According to reality, for nurses to become diagnosticians, they have to produce assessments that are clinically based and not those that are solely based on task-oriented approach that is currently used.
Regardless of the professional ad social view that doctors are placing nurses as second to them, the two professions have an array of differences. The essence of each of the professions are different, while they are expected to achieve the same goal. In simple terms, doctors have a role to cure while nurses have a role to care (Galletta, Portoghese, Battistelli, & Leiter, 2013). Interestingly, none of the two is mutually exclusive, such that, they cannot function without each other. In this case, professional responsibility between the two professions differs. However, there exists discordance between the nurses and doctors in view of their responsibilities and roles. The conflicting and confused role perspectives are a major cause of the disparities that exist between the nurses and the doctors. Most the of the doctors believe that nurses are yearning for authority in areas that they are not trained in. with poor preparation for the profession right from the educational level, the nurses lack knowledge in the basic issues that affect the patients and keep on looking up to the physicians to come and respond to such issues in the hospital setting, an aspect that transfers the authority back to physician and widens the inequality gap (Natan, et al., 2015). The need for the nurses to practice within a particular legal, ethical, and evidence-based framework has limited their ability to explore further possibilities that would allow them to develop better skills such as decision-making skills, that would enable them to match the competence of doctors. The defined role of the doctor, which involves creating a good relationship with the patient and making complex decisions that would facilitate healing, as opposed to that of the nurse that is confined within a certain framework, grants the doctors authority, which impedes any efforts to establish cohesion and collaboration between the two profession (Fewster-Thuente, 2015).
Given the need for nurses and doctors to collaborate in the health care setting, it is important for such a cohesion to be established at an earlier stage of their education and training. As such, introduction of inter-professional education programs at the university level would be important in ensuring that proper inter-professional relationships are established at such an earlier stage (Voyer, 2014). Such programs could promote mutual intergroup differentiation through encouraging positive changes in terms of attitudes and acknowledgement of the valued identity of each of the groups on specific dimensions. Such would be highly effective in reducing negative stereotype and promoting synergy towards patient care. In addition, the nursing curriculum may be improved through combined education, an aspect that may allow the nurses to apply more clinical thinking in their assessment of patients (Voyer, 2014).
Another way through which collaboration can be promoted between doctors and physicians is through team building. Collaboration is the process that requires side-by-side efforts among the doctors and nurses, and any other professionals within the healthcare team. As such, it is important to establish a team setting that allows for the development of shared meanings and trust, all of which require patience and time (Manojlovich, 2010). As such, proper effort should be directed towards promoting the development of valuable partnerships and commitment among the healthcare providers. Establishment of a shared team language is important in ensuring that allows for proper communication of the diversified healthcare team in terms of professions, is one of the approaches of team building. As such, team building would allow the nurses to be viewed as equal contributors to the patient care process as the doctors.
In conclusion, it is clear that the history of nursing has
seen significant changes, ranging from the introduction of the schools of nursing,
apprenticeship training at the hospital, university education, to the
establishment of nursing unions. Advancement in nursing science has been
accompanied with an increase in the responsibility of nurses not only to learn
more but also to be more active in the clinical care of the patient. As much as
much efforts have been directed towards professionalization of nursing, it is still
professionally and socially seen as an inferior profession in some cultures. In
terms of education, the prerequisites for studying nursing are seen as lesser
as compared to those for studying medicine. Nevertheless, the doctors’ and
nurses’ roles are inherently different, meaning that there should not be
dissimilarities in terms of the educational prerequisites. Despite the
differences that exist between the doctors and nurses, the professionals remain
highly inter-dependent when it comes to providing patients with optimal care.
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