Nursing

Tips for improving nurse-physician communication

Nurse Leader Weekly, May 13, 2005

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Editor's note: This article is adapted from Speak Your Truth: Proven Strategies for Effective Nurse-Physician Communication, by Kathleen Bartholomew, RN, BS. Call 800/650-6787 to find out more.

"Bad scenes" are caused by poor communication between nurses and physicians. They may include verbal abuse, intimidation, or any behavior that demeans or belittles the nurse or physician involved in the conflict. Bad scenes leave doctors and nurses at odds, which, inevitably, puts their patients at risk. Therefore, it is important to understand why bad scenes occur and how to handle them.

According to Kathleen Bartholomew, RN, BS, nurse manager at Swedish Medical Center in Seattle, bad scenes always have one thing in common: a tremendous amount of emotional charge, which she explains in her new book, Speak Your Truth: Proven Strategies for Effective Nurse-Physician Communication.

What to do? Disengage-physically remove yourself and others from the verbal abuse-and then return to the issue at a later date.

Faye's story
Faye tried to hold on to the squirming baby. The physician's first two attempts at a lumbar puncture had already failed. And then he missed for a third time.

Faye put the baby back in its crib and took off her gloves. "What do you think you're doing?" yelled the doctor. "Get back here!"

"No," she replied. "That's enough."

"I will have you fired," he said, shaking his finger wildly. "I will report you to the chief executive officer and you will have to answer to him."

"Fine," said Faye as she left the room.

Two days later, Faye and the doctor were sitting in front of the CEO. The doctor ranted loudly, stating his case for several minutes.

Then it was Faye's turn. She said only one sentence: "If that was your son, would you have wanted the nurse to hold him for yet a fourth try at a lumbar puncture?"

The doctor was caught off-guard. "No," he said hesitantly. "If that were my son, I would have wanted you to do exactly what you did."

Like Faye, refuse to allow yourself to be affected by the abuse. Instead, try any of the following:

  • Page the manager or medical director
  • Call your hospital's code for disruptive behavior
  • Take the conversation off the floor
  • Refuse to participate if the physician yells
  • Tell the physician you will make an appointment with him and his superior so you can all discuss the issue later

Telephone trouble
Physicians often act as though a nurse's phone call is a huge interruption, without considering that the call interrupts the nurse's day as well. Try these tips:

  • Don't begin with an apology. Begin by identifying yourself and the patient.
  • Always have the chart, labs, and latest vital signs in hand.
  • Put yourself in the physician's shoes; use critical thinking skills and have an idea of what you think is needed before you call.
  • Don't beat around the bush; say what you need.
  • Anticipate after-hours needs as much as possible.
  • Repeat back to the physician a summary of the order or the conversation.
  • Use the speaker phone for rude physicians and let them know you are doing so.
  • If a physician is verbally abusive, say, "I am hanging up now. Please call back when you are calmer." Then hang up.


Source: Adapted from Competency Management Advisor (March 2005), published by HCPro, Inc.



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