As a nurse practitioner who started my career as a bedside nurse, I’ve witnessed firsthand the importance of communication in my field. Nurse/patient communication gets a fair amount of attention, but doctor/nurse communication is equally critical for patient outcomes.
I’m not the only one who thinks so – and I’m also not the only one who thinks there’s room for improvement in this area. I’m part of a nursing group on a social media site. A recent post asked for tips on improving healthcare communication. Responses flooded in, and a striking majority of them referenced frustration and difficulty when it came to effective communication between nurses and doctors.
It made me stop and think about my own experience with doctors; as a nurse and then a nurse practitioner. How did I learn to “talk to doctors”? I turned to the collective experience of nursing history to further investigate.
Florence Nightingale and beyond
When Florence Nightingale first organized nursing, she persuaded army physicians that nurses could help them in their workplaces. She realized a nurse’s success depended largely on the physicians’ approval, which set up a power dynamic from the very beginning that was rife with communication barriers.
In the 1920s and 30s, doctors were responsible for the education of nurses (primarily hospital-based programs) and they served on nurses’ registration boards. For many nurses back then, it was who you knew rather than what you knew. Doctors would “cherry-pick” their specific nurses to work for them. The role of the nurse in early days was not defined in terms of patient care but in terms of proficiency with which she carried out the doctor’s orders.
In the 1960s, Leonard I. Stein, M.D., coined the phrase “doctor-nurse game’ in his work on professional relationships. The game’s objective was for the nurse to be “bold, have initiative, and be responsible for making significant recommendations while appearing passive.”
That’s quite a paradox.
The unofficial rules of this “game” stipulated that nurses:
- Must show doctors respect
- Cannot openly diagnose and make recommendations to doctors
- Are not allowed to openly disagree with or confront doctors
Inevitably, Stein’s approach promoted wildly ineffective communication, which ultimately affected patient care.
Today, with the continuous expansion of the nurse role, along with university education, and changes in professional norms, nurses are a critical part of the patient care team. And yet, communication gaps persist.
Contemporary implications for communication gaps
Communication is a two-way street – and there are varying degrees of proficiency within both the doctor and nurse roles. Communication in contemporary healthcare is now also affected not just by the interpersonal, but by the different and varied communications platforms available to both roles (and others).
When I started my career, communication within the medical industry was almost exclusively face-to-face or through sticky-notes attached to the patient’s charts. Advancements in digital communication have made a lot of things easier, but they’ve also underscored the need for precision and consolidation to ensure proper information without cognitive overload.
If nurses and doctors need to work with multiple communication platforms it increases the risk that we could lose critical meaning. Add in solutions that are not always intuitive and you have a never-ending onslaught of information, causing many people to struggle with knowledge burnout. And worst of all, this information may have life and death consequences. “Poor communication and communication overload have a direct correlation with patient outcomes, adverse events, patient delays, and increased length of stay.” (Curtis et. al.)
4 steps to improve clinical communication
All hope is not lost. Research demonstrates three steps we can all take to improve clinician communication across the board.
- Support interpersonal communication and interprofessional training (doctors and nurses in class together) as part of clinical education.
- Provide a clear policy for both written and verbal communication among medical staff. Include in this a definitive policy for digital communication.
- Deploy techniques such as the SBAR (Situation Background Assessment Recommendation) communication tool, plus graded assertiveness to help shape the communication between the doctor, the nurse, and the whole care team in general.
I would add to this list:
- Have a unified communication plan and solutions that BOTH doctors and nurses (and even other roles in the clinical care team such as lab, nutritionists, transport, etc.) can leverage.
The role of technology in effective communication
We’ve come a long way since Florence Nightingale and Dr. Stein. Today, hospitals and health systems have access to digital communication systems to support effective, efficient communication and help make the doctor-nurse communication “game” truly a thing of the past.
A unified communication strategy can go a long way toward improving exchanges among clinicians. By leveraging technology and implementing frameworks that work within the SBAR structured communication, you can keep the conversations on point and help ensure mutual understanding.
Part of that strategy is also looking for an enterprise level solution that isn’t just for nurses, or just for physicians, but extends beyond that to other healthcare workers. In fact, having separate communication systems only supports the old notions of communication and will be less effective with every new system introduced or person who participates in communication about a patient.
Whether it’s a secure message from a doctor to his resource nurse, alerts and notifications to assigned nurses, or a critical mass page going out to hundreds of people at once, clarity is paramount. Technology that delivers information quickly and allows for immediate acknowledgment and response, can reduce errors and improve outcomes.
And that, of course, is everyone’s goal.