Nurse–Physician Collaboration in General Internal Medicine: A Synthesis of Survey and Ethnographic Techniques

Abstract

Nurse–Physician Collaboration in General Internal Medicine: A Synthesis of Survey and Ethnographic Techniques Lesley Gotlib Conn PhD Sunnybrook Research Institute, Toronto, Ontario, Canada Chris Kenaszchuk MSc Centre for Addiction and Mental Health, Toronto, Ontario, Canada Katie Dainty PhD Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada Merrick Zwarenstein M.B.B.Ch, MSc, PhD Institute for Clinical Evaluative Sciences and Sunnybrook Research Institute, Toronto, Ontario, Canada. Centre for Studies in Family Medicine, Western University, London, Ontario, Canada Scott Reeves PhD Center for Innovation in Interprofessional Healthcare Education, University of California, San Francisco Abstract BACKGROUND Effective collaboration between hospital nurses and physicians is associated with patient safety, quality of care, and provider satisfaction. Mutual nurse–physician perceptions of one another’s collaboration are typically discrepant. Quantitative and qualitative studies frequently conclude that nurses experience lower satisfaction with nurse–physician collaboration than physicians. Mixed methods studies of nurse–physician collaboration are uncommon; results from one of the two approaches are seldom related to or reported in terms of the others. This paper aims to demonstrate the complementarity of quantitative and qualitative methods for understanding nurse- physician collaboration. METHODS In medicine wards of 5 hospitals, we surveyed nurses and physicians measuring three facets of collab- oration—communication, accommodation, and isolation. In parallel we used shadowing and interviews to explore the quality of nurse–physician collaboration. Data were collected between June 2008 and June 2009. RESULTS The results indicated difference of nurse–physician ratings of one another’s communication was small and not statistically significant; communication timing and skill were reportedly challenging. Nurses perceived physicians as less accommodating than physicians perceived nurses (P