Understanding the relationship culture between physicians and nurses and their effects on perceived clinical outcomes and nursing outcomes

Abstract

The US healthcare industry faces a variety of complex challenges. Simultaneously, pressures continue to mount with regard to the expectation for lower costs with improved quality of care. These problems have drawn the attention of many researchers seeking ways to improve healthcare delivery. These efforts regularly identify two key issues requiring solutions: 1) Improving clinical outcomes by reducing adverse patient conditions due to medical errors, and 2) Improving care delivery by reducing staffing shortages and turnover within the nursing profession. Several studies have shown that workplace culture and incivility can be a material contributor to both of these issues. While many researchers have investigated the nature of nurse-physician interaction, and their effects on clinical and nursing outcomes, they mostly focus on the 'perception' of nurses and not physicians. Perhaps more importantly, these studies generally did not distinguish between descriptive and injunctive norms suggested by Social Norms Theory (SNT). This study seeks to close both of these gaps. This study developed a new survey instrument to measure these norms and performed a sample survey of the physicians and nurses of Montana and Denver area. This study used SNT to identify any gaps between descriptive and injunctive norms of RNs and MDs regarding their relationship culture and their effects behaviors on perceived nursing outcomes (e.g. job satisfaction, retention, etc.) and perceived clinical outcomes (e.g. medical errors, quality of care). The study sought to investigate these gaps because SNT suggests that people tend to behave in the way they believe is most typical of and accepted by their peers (perceived norms). Unfortunately, perceptions of others' behaviors are quite frequently inaccurate, with views of problematic behaviors tending to be overestimated and healthy behaviors tending to be underestimated. SNT offers an innovative approach for addressing such situations by changing perceptions. The findings of the study suggest significant differences between the perceived norms of physicians and nurses when compared to their actual norms. The findings are expected to be helpful for developing an intervention program to improve the relationship culture between physicians and nurses which can contribute to improve quality of patient care and nursing retention.