Navigating the complications of the nurse-doctor relationship is essential to effectively deliver safe patient care.
In the past 20 years, I have found most doctors will give respect if first, they get respect.
Of course, this philosophy is valid for anyone in any profession, but when it comes to the intricate relationships between nurses and doctors (and other clinicians), the importance of this respect is heightened by the context of caring for a patient. The good news is, in my experience, most doctors are more than receptive to input if presented in a professional and concise manner.
Claudia Schmalenberg, RN, MSN and Marlene Kramer, RN, PhD said it best when writing an article for Critical Care Nurse: “Collaborative nurse-physician relationships…lead to better patient and organizational outcomes such as decreased length of stay and net reduction in treatment costs without reduction in functional levels or decrease in satisfaction among patients.” I couldn’t agree more.
We need each other
Nurses and doctors are opposite in many ways, even represented as such in the media. It can sometimes feel as if we are each from separate worlds. We have different strengths and weaknesses but we need the information and skills the other has to safely get through the shift. Nurses have been at the bedside all day and will usually be the first to notice changes in patient status. We are the eyes, the ears, the intuition, the heart, and the advocate. The doctor usually has to run through their rounds quickly. They don’t have the time nurses do to spend hours observing and caring for a patient, let alone a whole floor of them. Therefore, they rely on the nurses’ expertise to support their clinical decisions. One job is not more important than the other, we have different skills and we need each other. I think the humility of recognizing your own shortcomings and the skills of another naturally lends itself to mutual respect. Yes, we are different and that is good. The yin needs its yang and your patient deserves a team that can safely, and respectfully, communicate.
I worked for 9 years in the MICU with first-year Residents, or as I fondly thought of them “baby doctors.” They were young, nervous, and most of them humble and appreciative of any help. Some nurses treated the Residents with disrespect because they were inexperienced and insecure, a real waste if you ask me. I saw it as an opportunity to communicate to them the role of a nurse; how together we could save lives. I respected their years of hard work and sacrifice in medical school and they respected my years of experience in the ICU. I knew we needed each other, each of us had information and skills the other required to safely get through the day. Over the years, I’ve crossed paths again with those “baby doctors'' but they have advanced to become Fellows and Attendings. They often recount the kindness and respect I showed them in those early years and have later returned kindness and respect twofold.
Even when it’s hard – speak up
Sometimes nurses are overlooked, undervalued, and disrespected. It’s a hard truth but one that is not unique to our profession. I once worked with a doctor who rolled her eyes whenever I asked a question to clarify an order; she would snort and raise one eyebrow in total disgust. She often publicly belittled the nurses on her team. I found it very humbling but decided to not take it personally. I realized she had her own issues and it was not about me. I still asked my questions and spoke up when needed. There were other times when I was overlooked as part of the team and not given a moment to speak on rounds. I would have to interrupt to voice concerns and questions. When ignored, once again I did not take it personally, I just kept speaking up because it was the right thing to do. Nurses must speak up even when we are afraid of being belittled or ignored. It is in these moments of disrespect that you cannot doubt yourself or focus on yourself at all. It is not about you, it is about the patient, and you are their advocate, their voice. The nurse has been at the bedside all day and no one else can contribute what you can, you must address your concerns, speak up and make yourself heard even if you are shaking in your boots. Just because no one asked for your opinion or assessment of the situation does not mean the team does not need your input to make the right decision for the patient. I am grateful that difficult conversations and disrespect are the exceptions and not the rule when putting respect and collaboration into action at work.