I can vividly recall how stressful it was as a nursing student and new nurse graduate to communicate with physicians. I was already intimidated by doctors and it seemed my mind drew a predictable blank when I had to interact with them. As a novice, I had to learn how to organize my thoughts and provide the appropriate information to communicate the patient issue clearly. This is a learning process most students and new nurses will experience and build confidence. There are tips for communicating with doctors and an interdisciplinary team that may make this process a little easier.
A study published in the Journal of Patient Safety, by Tija et al, found several factors that can affect nurse-physician communication. These included:
Lack of openness and collaboration- nurse feeling hurried by the physician or feeling the physician was not interested in the information the nurse was sharing.
Frustration with the lack of professional respect- 16% reported being interrupted by the physician before they were finished communicating important information.
Logistical challenges- difficulty finding a quiet place to communicate, finding time to communicate with the physician and not being able to get in contact with a physician when needed.
Language barriers- difficulty understanding physicians due to language, accent or use of medical jargon.
Nurse preparedness- nurse not being prepared with assessment data or information the physician will need to make decisions and/or changes to patients care.
Being aware of nurse-physician communication barriers is the first step in students and new nurses building skill and confidence in communicating with the interdisciplinary team.
Jane is a nursing student at clinical and is reviewing a patient’s record at the nursing desk. Jane is approached by a doctor asking for information on a patient and her instructor or another nurse are not at the desk. Jane explains to the physician she is a student at clinical and the physician, frustrated, states “can you not find someone who can tell me something about my patient?”.
Matt is a new graduate and just completed orientation for his first nursing position. Matt is approached by a cardiologist asking why patient X was ordered a cardiology consult. Matt provides background information and the physician states, “What do they think I can do for them? This is a waste of my time!”.
What do you do when you find yourself in a situation similar to the above scenarios? Your first reaction may be to go blank or become defensive. Here are some tips to help when you find yourself communicating with a difficult physician.
Stick with the facts and leave emotion and opinion out of the conversation. It may be as simple as, “I don’t know the answer to your question but let me find someone who can help you”.
Be aware of your body language and stand straight to convey a look of self-confidence.
Take a step back to avoid a defensive or aggressive response. Respond in a respectful manner and expect respect will be returned.
Apologize when appropriate.
Report the interaction with your clinical instructor, preceptor or charge nurse to ensure acknowledgment of the behavior. The physician’s behavior may be a pattern and documentation may be needed to address. Do not accept inappropriate or abusive behavior- walk away, stand silently or ask to be spoken to respectfully.
Practice communicating with physicians on a regular basis. The best time to practice is when you are with your instructor or preceptor. Take notes on how your preceptor approaches, answers questions and communicates with physicians.
Be prepared before calling or talking to a physician about a patient. Write down pertinent information to clearly communicate the patient situation. Having information available and organize may help minimize problems. For example
Patient’s name and room number
Reason for call
Lab values that relate to your reason for calling
Recent vital signs
Medications related to your reason for calling
Effective nurse-physician communication is key to providing safe care for positive patient outcomes. Fortunately, there are steps nursing students and new nurses can take to improve their communication with physicians. With practice and experience, the novice nurse will become confident, even when dealing with difficult physicians.
What tips would you like to share to support students and new nurses?
Institute for Healthcare Improvement: The SBAR Tool for Communication
Tija, J., Mazor, K., Field T., Meterko, V., Spenard, A. & Gurwitz, J. (2009). Nurse-physician communication in the long-term care setting: perceived barriers and impact on patient safety, Journal of Patient Safety, 5(3):145-52.
Patient Safety and Quality Healthcare (2012). Nurse to physician communication: Connecting for safety.