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Nurse Relationships
The Doctor-Nurse Drama
Fixing a broken relationship.

Doctors and nurses have been trained to be suspicious of each other.

So writes Suzanne Gordon, author of Nursing Against the Odds (Cornell UP, 2006). And while this has historical roots, it is particularly dysfunctional today. In this RealityRN interview, Gordon describes the complicated relationship between nurses and doctors—and gives practical advice for nurses to help remedy the situation.

RealityRN:  Describe the history of nurse/doctor relationships.

Suzanne Gordon: The perception of nurses has long been influenced by men. According to historical, patriarchal views on society's structure, men were able to define our roles—first as women, then as nurses. Women only received knowledge men thought they should have.

Hospitals became hierarchal systems. Doctors were at the top and nurses followed in descending levels of importance. Hospitals developed into job-specific, gender-specific environments—males were doctors and females were nurses.

How does this affect health care today?

Nurses and doctors have been socialized to believe they are not each other’s healthcare partners. They are taught they belong to opposing teams; they view the other team as somehow messing with their goals, mission, or skills. Doctors sometimes think nurses don’t know anything, and nurses sometimes think doctors know the wrong thing.

Do nurses perpetuate this?

You can’t have a bad relationship without the participation of two or more parties. Whenever there’s a failed nurse/physician relationship, there’s potential for something bad happening to the patient downstream.

I don’t think nurses, any more than doctors, know how to negotiate or resolve conflict. Physicians and nurses are taught dyadic communication. They’re taught to focus on nurse/patient or doctor/patient communication—not nurse/doctor/patient communication or team relationships. There are good, historical reasons for this model, but it’s proven to be quite dysfunctional now; nurses are very critical of it.

So what should they be focusing on?

I think people have to focus on being a team—and recognizing what the concept of “team” actually means. A team is not a bunch of people doing different things in the same room. It’s not a bunch of different people engaged in power-plays around the patient’s bed. Nurses often confuse venting and communicating. Venting isn’t communicating. It’s really important for nurses to learn how to communicate well with physicians and other nurses.

Often, complaints go to the nurse manager and the nurse manager goes to the doctor.

Absolutely. And the nurse manager and the doctor, whom the nurse talks to, often have equally poor skills in negotiation, communication, and conflict resolution.

It seems like a problem of the entire work environment.

Right. It’s a systems problem. Doctors don’t communicate well with each other, so why would we expect them to communicate well with nurses? Nurses don’t communicate well with other nurses, so why would we expect them to communicate well with doctors? Between 75 and 80 percent of medical errors and injuries are caused by human error, often from shortcomings in communication.

This is not just about “being nice to each other.” This is not charm school. Patients are dying—they’re experiencing preventable complications because of errors in communication. It’s a systemic problem and it has to be solved systemically.

How can an individual nurse fix a systems problem?

A friend who’s a PT thinks that, on the first day of nursing school, every nurse is told that she’s the only one who cares about the patients. The PT felt most nurses conveyed this attitude: “I’m the patient advocate. I’m the only one who communicates with that patient. I have to protect the patient from you.”

The nurse thinks she’s working for patient advocacy, but inadvertently she’s suggesting that everyone else is the patient’s enemy.

Nurses have to admit they need help and find ways to learn better communication skills. Systems don’t change because the people who run them suddenly notice they’re flawed. Systems change because human beings in those systems force them to change.

So, really, a new mindset needs to be developed.

Yes.  A team is a group of people who help each other work efficiently and effectively to fulfill a shared mission.

A new nurse, for example, should ask physicians for briefings. If a new nurse sees a doctor in a patient’s room, she shouldn’t wait for the doctor to approach her. She should go up to him/her and ask questions. She should clearly state her concerns, and not hold them in.

What about the fear of being put down by the doctor?

The nurse should always stick to the facts. For example, “I’m concerned about the patient’s blood pressure,” “The patient looks clammy,” or “The patient was acting one way and now he’s acting another.” State the reason you’re concerned and say it over and over again. If the doctor says he or she is really busy and can’t talk, you say, “I’m really concerned about this—I think you need to come now.”

In teamwork training, I teach what we call the “Two Challenge Rule.” You challenge the presenting issue twice, and if it’s serious, you go to someone else and say, “Help.”

Isn’t this good old-fashioned patient advocacy?

Yes. But advocacy is not simply having the best interest of the patient at heart. If the doctor blows you off and you do nothing, you are no longer that patient’s advocate. Advocacy means inquiry and persistent assertion for your patient and your profession. It means speaking clearly.

Suzanne Gordon is an award-winning journalist and author. She’s the author of five books including her newest book on the nursing crisis, Nursing Against the Odds: How Health Care Cost Cutting, Media Stereotypes, and Medical Hubris Undermine Nurses and Patient Care.

Read more Nurse Relationships articles

6 Responses to “The Doctor-Nurse Drama”

  1. Lori Says:

    Wow … really practical advice. I need to remember this next time I want to scream at someone.

  2. Debra Says:

    So true, I also feel that a few of the senior nurses can have the same drama with the new nurses almost like “stay out of my territory”.

  3. Mr Ian Says:

    I find it disquieting to still hear this kind of advice as being so necessary to old and new nurses.

    I would pick up on one aspect of the article:
    “Nurses and doctors have been socialized to believe they are not each other’s healthcare partners. They are taught they belong to opposing teams; they view the other team as somehow messing with their goals, mission, or skills. Doctors sometimes think nurses don’t know anything, and nurses sometimes think doctors know the wrong thing.”

    Tho our aims remain generically the same – to heal – we do come from different bases. Medics treat an illness. This is their role and remit. They are not required to understand the person. This is why nursing developed it’s profession the way it did. Nurses support the treatment of the illness – but also address the issues of ‘the person’.
    My nursing base is different to the medical case for this very reason and, as such, I respect their limited function and role and always try to fit their wants and needs into my nursing duties.
    However, what also perpetuates this ‘doctor-nurse drama’ is for the very same reasons the title doesn’t read nurse-doctor drama – not because we kow tow but because society still regards doctor as knowing best. Even tho the patient will often more likely trust the nurse – they still insist on doctor as being the authority. And in many ways they are. But in equally many ways they are not. However, it is not for us to educate patients on politics of health care as it is simpoly of no value to them. They merely wish to be healed.

    So, meanwhile, back at the bedside…
    If a doctor does not attend a patient as I request – I only ask once and if a refusal ensues, I simply ask how they spell their surname for my entry in the patient’s clinical file.

  4. s.m. ng Says:

    I do agreed with the article. My place was sometime like that, but he nurses not teritorize. The sometime a slow learner. They did not have enough knowledge to assist with the doctor. Do people scold at u if u said something wrong. I often heard that some or 1 particular nurse were good, but not the entire nursing team. Sometime they did not trust the nurse. The Doctor will always asked who’s working tonight. they will calmer if the 1 they trust were around.

  5. b2anawong Says:

    I’m pretty much being an observer of the doctor-nurse drama since i started to work as a nurse. Count me lucky, the unit/department where I worked is really upholding the spirit of team work. The doctors regard us as colleague instead of subordinates. That turn the whole working environment at lot more plesant! When everybody is able to pay repect to each other, we are more open to professional discussion of management. Ears are open to constructive suggestions and comments are taken with serious consideration. It really help doctors or nurses to deliver better care to the patient.

    I would think that such change of attitude really based on the trusting relationship among the two profession. In order to earn/gain that trust (quoting the statement that society still regards dr as the best, and doctors think they really are, in terms of medical training), nurses should be able to demonstrate accountability, sufficint clinical knowledge and skills in reality. It is important to show that nurses are improving and moving at par the medical advances.

    I must agree to Mr Ian that we fit in the limitation of the doctors. Since everybody has their own role to play, why not play it nicely?

  6. Stwart Jenssen Says:

    I just read Donna’s response on the Glamour web site blog and it was well written and very positive about nursing and DNPs. Many of the others who responded to the original post wrote about positive experiences they had with DNPs or NPs. Interesting as I guess it was mainly younger women writing the comments — that it mostly involved ob/gyn settings!

    Thanks to all responsible nurses who make an introduction to a new patient by stating their name and title.

    On another note: I myself worked at one hospital unit with a male nurse preceptor who had lost his ID badge. During orientation, when we went into a room together, the patient assumed he was a doctor and that because I’m a woman, I was the nurse.

    Stwart Jenssen

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