Nurse-Physician Communication: An Organizational Accountability

[NRSKarenRN, BSN, RN]

found at medscape.com- nursing economics article.

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nurse-physician communication: an organizational accountability

patricia h. arford

introduction

collaborative nurse-physician communication is one of the attributes of magnet-status hospitals (american nurses credentialing center, 2003). knaus, draper, wagner, and zimmerman (1986) and baggs et al. (1999) have demonstrated that frequent, effective nurse-physician communication is linked to patient survival in intensive care units. dysfunctional nurse-physician communication is linked to medication errors (kohn, corrigan, & donaldson, 2000; leape, 1994), patient injuries (page, 2004), and patient deaths (tammelleo, 2001; 2002). the code of ethics for nurses (american nurses association, 2001) and state nursing practice acts mandate individual nurse accountability for patient advocacy to ensure no harm. however, the recent institute of medicine studies, to err is human: building a safer health system (kohn et al., 2000), crossing the quality chasm: a new health system for the 21st century (committee on the quality of health care in american, 2001), and keeping patients safe: transforming the work environment of nurses (page, 2004) hold the organization in which these professionals practice accountable for adverse patient events resulting from ineffective nurse-physician communication.

the organization provides the context in which nurse-physician communication occurs. the organization determines the structure in which these professionals interact, the professional development opportunities of the employed nurses, the group and individual power dynamics, and the cultural norms of behavior. the organization decides the number and required qualifications of direct care staff, the availability of role modeling to refine communication skills, the authority of the nurse when involved in a conflictive interaction with a physician, and the valuing of nurses' independent practice. organizational theory is useful in guiding an analysis of the relationship between nurse-physician communication and the organizational context using the structural, human resource, political, and cultural perspectives of organizational behavior (bolman & deal, 1997). this discussion will allow identification of management interventions to create an organizational context supportive of collaborative nurse-physician communication.