Journal of Nursing

Physician And Nurse Engagement: From Concept To Collaboration


By Alan H. Rosenstein, MD, MBA & Kathleen Bartholomew, RN, MN

Task Overload

For nurses, the standard for delivering basic quality care has changed dramatically over the last decade as well. Although length of stay has decreased, associated comorbidities and the complexity of care have increased. As Ebrite and colleagues have noted, nurses care for more patients who are severely ill and require a more compressed and intensive workload, which requires new roles and responsibilities characterized by multiple goals, unpredictability, and constant change.

This situation explains why the chief complaint of physicians is that they cannot find the nurse, and why the chief complaint of nurses is that they can't find the physician. These are both valid points, as nurses perform more than 160 tasks in an 8-hour shift, with each specific task taking just under 3 minutes to complete. As Krichbaum and colleagues documented, nurses report being in a constant state of task overload, with seven to eight stacking items on their "to do" list at any given time. In order to accomplish the variety of tasks assigned, nurses must focus intently; unfortunately, this myopia decreases peripheral vision and unconsciously shifts the focus from the relationship with the patient or physician to the tasks at hand.

With computerized charting, staffing requirements, 12-hour shifts, and staying up-to-date on the latest pharmaceuticals, products, technologies, and best practices added to this workload, it is easy to understand why up to 40% of a nurse's work is not related directly to patient care. No wonder patients complain of not seeing their nurses. Task overload can lead to a growing amount of moral distress and compassion fatigue, as demonstrated in a 2014 study by Mason and co-workers

Patient Safety

Developing collegial working relationships with physician partners may appear optional in a world where each day nurses are asked to do more with less. There is a well-documented direct relationship between the supportive and collaborative relationships nurses have with physicians and the ultimate safety of their patients that has been known for decades, discussed in the 2008 study by Rosenstein and O'Daniel in the Joint Commission Journal on Quality and Patient Safety. Yet not all relationships feel equal and collegial despite the attention paid over the last decade to the damage caused by disruptive physician-nurse interactions. Research published by Lyndon and colleagues found that a clinician's perception of risk is an important predictor of speaking up about safety concerns. If nurses do not feel at ease approaching a physician with a question or concern, the patient can suffer. Ineffective communication and silence undermine quality and safety. Positive, collegial physician-nurse partnerships increase morale and job satisfaction for both groups and improve patient safety.

Common Goals

As long as we remain siloed within our own perceptions and realities, nothing changes. To be truly successful, organizations need to do a better job of engaging their staff. Leadership must acknowledge and articulate that the individual pressures and incentives faced by both physicians and nurses impede true multidisciplinary teamwork. Leaders must create the structure for physicians and nurses to discuss, evaluate, and share both challenges and success stories. Within the changing landscape of health care, with both physicians and nurses facing high levels of pressure, there is an unprecedented opportunity to create seamless physician-nurse partnerships in a patient-centric culture, with the goal of delivering the best health care that medical science can provide.

As a final step in the engagement process, always take the time to say thank you. Showing respect and appreciation will go a long way toward improving satisfaction and motivation.


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