PLN 7: Physician- Nurse Conflict

Relations between physicians and nurses are sometimes strained. Physician-nurse conflict, tension, and stress have been thought to be contributing factors in job dissatisfaction and burnout for nurses.
Controversy arises about the reasons for physician-nurse conflict, possible solutions to this problem, and the proper relationship between physicians and nurses.

Conflict and tension do not characterize all physician-nurse relations.  In many healthcare contexts physicians and nurses communicate and work together to serve their patients. Conflict can occur between workers in business and professional contexts outside of healthcare, of course.  Workers may not get along because of personality differences of various sorts.  Workers may perceive they are being treated unfairly relative to coworkers.  The organization may create a situation of competition among workers.  Sexual harassment can occur.  Situations such as these may conflict and tension between coworkers or between supervisor and coworker.I believe that in this instance,management should be made aware of such problems and take steps to address and resolve them.

Some other physician- nurse relationships are causesd by interpersonal conflict. This  occurs in many areas of business and personal relationships and sometimes it is due to the particular personalities of the parties involved. Some people are simply less friendly, more impatient, have greater expectations, etc. than others. This can occur in relations among physicians, among nurses, and between physicians and nurses.

 Another issue is the power imbalance between physicians and nurses in modern healthcare in the United States is well known.  This power imbalance occurs both outside and inside healthcare.

As an adminstrator,vone common recommendation is to improve communication between physicians and nurses.  Poor communication can result in unmet expectations and resulting frustration and poor working relationships.

Another suggestion is that there be available an optimal method of conflict resolution.  Nurses sometimes avoid conflict or are resigned to it, whereas some form of conflict resolution fostering collaboration and cooperation might help alleviate physician-nurse tensions and achieve better overall outcomes.

An important point to note is that conflict between physicians and nurses is likely to hurt the optimal functioning of the team and result in poorer patient care and lower quality healthcare, so as the administrator  i would take whatever steps are necessary to ensure the organizational culture and management support create an environment in which such destructive conflict is minimized and nurses feel more empowered.

As the administrator, I believe in a hospital setting, the head physician executive (such as the medical director) and head nursing executive (such as the director of nursing) should build a relationship of collaboration and mutual respect that can act as a model for others.  They should learn each other’s disciplines and contributions.  They should also develop an organizational vision of how physicians and nurses should interact.  This vision should include expectations of their own and other’s behavior – physicians stating their expectations for nurses and nurses stating their expectations for physicians.  The vision and expectations should then be translated into standards of behavior and concrete policies to correct misbehavior (violations of the standards).  Inappropriate behavior will not change unless it results in consequences for the perpetrator.

Furthermore, they should examine hospital systems and policies to ensure they are not interfering with the development of better relations; for example, if nurses have to police the physicians’ compliance with medical record policies, collaboration will be difficult.  Also, opportunities for collaboration should be pursued – physicians providing continuing education to nurses, nurse serving on credentialing committees, etc. -- where they can develop respect and good working relations.

In conclusion, the problem of physician-nurse conflict needs to be addressed not just by individual clinicians but by a healthcare organization’s executive leaders.  Hospital administrators and managers may prefer to avoid dealing with the problem.  Rather than trying to sweep the problem under the rug, senior management should work to develop an organizational culture in which inappropriate attitudes and behavior of physicians toward nurses and vice versa are not tolerated.