This is part three of a four-part series on conflict in the workplace. Part one dealt with bullying and part two covered intergenerational conflicts among nurses.
For the last 40 years, we’ve slowly been moving away from the traditional healthcare hierarchy, in which nurses were completely subordinate to doctors. Instead, nurses are now seen as knowledge workers in their own right. There is a new emphasis on interdisciplinary collaboration, which theoretically brings doctors and nurses closer together in the hospital hierarchy. Yet a 2013 survey found that only three percent of survey respondents rated the nurse-physician relationship as “strong,” characterized by a climate of mutual respect.
Conflict can arise from fundamental disparities in knowledge and power. Despite efforts to make medicine less paternalistic, there is still a general perception that doctors are in charge, giving orders that both nurses and patients must follow. These rigid hierarchies can endanger patients, by making it harder for nurses, who are usually lower in the hierarchy, to speak freely when they see a potential error or otherwise need to question authority—instead, there is often the expectation that nurses will defer to physicians. There is also an essential difference in perspective between nurses and doctors. Nurses are trained to view the patient holistically, while physicians have been taught to focus on “the case” and strategize treatments and cures, without necessarily considering the emotional, social, or cultural factors that affect the patient.
It’s clear that hostile or adversarial roles between providers can threaten patient safety and lead to nurse burnout that translates into high staff turnover. So what can we do, to improve the nurse-physician relationship?
There are both interpersonal strategies and organizational strategies for minimizing interdisciplinary conflict. Interpersonal strategies often focus on making nurses feel more empowered, by teaching ways to levelize the playing field between disciplines. Organizational culture is also an important determining factor in nurse-physician relationships. Hospitals should consider a shared governance model that gives nurses a voice, and should have policies in place that make it clear the organization will not tolerate verbal abuse or disruptive behavior from physicians.
But the most promising approach, by far, to reducing interdisciplinary conflict is for doctors and nurses to actually train together. New models of team-based care are taking collaboration to a much higher level than we’ve typically seen in the past, and it makes sense that this collaboration should start while doctors and nurses are still in training. This helps both sides to move away from an adversarial mindset and toward understanding each other’s roles better—which in turn promises to improve patient care and enhance job satisfaction for both nurses and doctors.
An American Journal of Nursing article (June 2009) titled “Conflict in the Workplace” states that:
…experts agree that unresolved workplace conflict contributes to occupational stress, poor morale, job dissatisfaction, and turnover. This is especially so when conflict is managed by confrontation, avoidance, or withdrawal. Burnout is reduced when workers are able to resolve conflicts through collaboration.
Collaboration is generally regarded as the best way to resolve conflict because it reduces competition and avoidance without excessive accommodation or collaboration. However, studies have shown that nurses most often use withdrawal.
To participate fully in interdisciplinary teams, nurses will need to demonstrate greater leadership abilities. And one way to do this is to acquire greater educational parity with other providers, who typically have graduate-level education. When you advance your education through a BSN or MSN program, you are more likely to stand out as a respected member of a multi-disciplinary team and as a capable leader.