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

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 collaboration— 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\u3c.01) and the effect size was medium. Physicians’ independent schedules were problematic for nurses. Nurses felt more isolated from physicians than physicians from nurses (P\u3c.0001) and the difference was large in standardized units. Hierarchical relationships were related to nurses’ isolation; however this could be moderated by leadership support. CONCLUSION Our mixed-method approach indicates that longstanding maladaptive nurse–physician relationships persist in the inpatient setting, but not uniformly. Communication quality seems mutually acceptable, while accommodation and isolation are more problematic among nurses