INTEGRATING EVIDENCE INTO PRACTICE
For registered nurses and physicians to be competent in their line of practice, effective communication skills are required. It is through their ability to communicate effectively and creating a connection with patients and their families that they build strong relationships, avoid mistakes in their practice and promote safety and high level of care to their customers. Communication failures in healthcare have been termed among major problem as they determine the quality of care given to patients. Communication failure cause nearly 66 percent of the medical errors occurring daily in the healthcare sector. Researchers have revealed a strong association between the communication skills of healthcare practitioners and the ability of a patient and families to follow medical recommendations and adopting preventive health behaviors. The tendency of a registered nurse and physician to explain to the patient about their condition, listen and empathize with them determines the outcome of the interaction regarding the safety of care provided.
Barriers of communication exist between registered nurses and physicians which lead to negative treatment outcome when such cases occur. Ineffective communication between the nurse graduates and the physicians affect their collaboration which in turn impact negatively on patient care. Newly graduated registered nurses have a negative attitude towards seeking help from physicians. Communication barriers may exist between nurses and physicians due to negative attitude facing nurses. Lack of exposure to the field or practice extends barriers because new nurses are not used to getting directions, and since they are restricted from some healthcare practices like prescribing, they require directions from physicians in charge. What is more, nurses lack confidence that is required for their interprofessional collaboration more so in areas related to communication? A study by Tang et al.,(2013) revealed that ineffective communication between nurses and physician was the major issue affecting healthcare safety and it occurred as a result of a negative attitude by nurses to seek physician’s help.
Implementation of a communication training program is assumed to bridge the gap between nurses and physicians communication. Barriers between registered nurses and physicians’ communication are mainly due to physicians’ attributes, work environment as well as the readiness of nurses to work. New nurse graduates have been assumed to have reduced confidence in their work and have limited collaborations with physicians at the workplace. According to Ammentorp et al. (2007), improved nursing communication and self-efficacy are improved when nurses engage in communication training program. Such a program improves their confidence at work as well as in relating with other healthcare professionals, physicians included. Communication training program is also assumed to impact positively on the attitude of nurses which will promote their collaboration with physicians.
With effective training, it is expected that the confidence of new registered nurses will have increased confidence which will allow them to communicate effectively with physicians. Education will also change their attitude towards physician by increasing their collaboration with them. A study by Ortiz (2016) proved that confidence for nurses is gained with years which proved that new nurses in practice are expected to experience challenge while relating with other healthcare practitioners. Although confidence in nurses is gained over the years, communication training programs have been identified as a way that can increase nurse confidence since it offers the nurses with techniques that can be applied when seeking clarification and expressing their concerns in the workplace.
Literature Review
Effective communication between healthcare providers determines the quality of care given by the physicians. Decisions made regarding patient care largely depend on the relationship between healthcare providers and in this case, nurses and physicians. Communication and collaboration of nurses and physician form the backbone of healthcare organizations and help to promote patient safety. A study in the year 2013 proved that more than 440,000 people die each year due to preventable medical errors that arise due to poor communications. Medical errors account for a third of all death cases reported in the United States, and among these deaths, 80 percent are due to miscommunication between health professionals and patients (Reed, 2014). The status of health is the major topic of discussion in the United States due to increased demand for quality and safe care. The most critical way to ensure quality and safe care is having effective communication between caregivers. Since nurses and physicians have challenges with communication. Commutation training programs and courses should be made mandatory for all healthcare practitioners which will enhance relationships between new registered nurses and physicians and patients too. Communication has been proved to minimize costly errors, ensure streamlined care without delays as well as demonstrating a united healthcare workforce.
Amudha P et al. (2018) conducted an exploratory study that reiterates the need for effective communication among different healthcare providers as the prerequisite to successful health outcomes. According to the authors’ research findings, all the decisions linked to patient care are dependent on the implementation of an effective communication system that addresses the communication gaps between nurses and doctors. The study that examined the experience of 24 staff nurses selected from six private hospitals was completed using a semi-structured interview that emphasized three broad aspects that could be attributed to the communication gap between nurses and physicians (Amudha P, et al., 2018). The three areas included the work environment, physician attributes, and the nurses’ work readiness (Amudha et al., 2018). Notably, the authors drew the conclusion from the nurses’ sentiments that it was important to maintain healthy nurse-physician communications as the means of reinforcing the quality of care and patient safety. The nurse-physician relationship is complicated because of the influence attached to the power of authority, gender, and social status among other distinguishing factors that limit effective communication (Amudha et al., 2018).
According to Lacoste (2017) communication between nurses and physicians serves as an important component that serves in meeting the objectives of healthcare. The study contends and asserts the consensus between nurses and physicians who identify communication as an important problem that should be resolved and improved as the means of enhancing the outcomes of healthcare. The research uses a sample of 25 nurses and 25 physicians to interrogate the causes and effects of miscommunication alongside the measures that could be implemented to improve nurse-physician communication. The study emphasizes the need for implementing a program that has a communication class for pre-nursing and pre-medical students, inter-professional education, and the improvement of structured communication tools between physicians and nurses (Lacoste, 2017).
Flicek (2012) highlights the need for considering the impact of communication in the delivery of quality and safe healthcare. Communication is outlined as one of the components that eliminate costly errors and serves to streamline patient care as the means of preventing delays. The research offers statistical evidence from The Joint Commission that links about 60% of the medical errors to communication breakdown in the healthcare setting (Flicek, 2012). The author offers evidence-based practice solutions targeted at addressing the breakdown in nurse-physician communication. Among the proposed solution is the implementation of unit-based care teams that serve to place nurses and physicians close to each other while mandatory bedside rounds further promote communication (Flicek, 2012).
Pfaff et al. (2014) conducted a study that explored the confidence of new graduate nurses in interprofessional collaboration. The assessment of 514 nurses, using a cross-sectional descriptive survey, revealed the need for interventions that could provide the needed support for interprofessional collaboration at various levels in the hospital setting (Pfaff et al., 2014). Notably, the new graduate nurses indicated better communication skills in situations where the managers and educators were available and accessible and the team environment in the hospital setting. The development of programs that encourage collaboration between new graduate nurses and physicians working in teams is encouraged while such collaborative practices are lauded for enhancing the confidence of the nurses in maintain interprofessional communication.
Tang et al. (2013) reviewed the relevant literature that highlights the significance of dealing with ineffective physician-nurse collaboration. Ineffective communication between physicians and nurses is identified as an element that leads to work dissatisfaction and consequently affects the quality of patient care. The review considers three important areas of collaboration between nurses and physicians, including the strategies to improve collaboration, attitudes of physician and nurses regarding collaboration, and factors that affect nurse-physician collaboration (Tang et al., 2013). Unequal power, task prioritizing, understanding professional roles, and communication serve as some of the barriers that were identified as affecting the nature of collaboration between nurses and physicians (Tang et al., 2013). The areas of improvement include the use of interdisciplinary ward rounds and the involvement of interprofessional education.
To increase the confidence of new registered nurses, it is important that they all enroll in communication training programs. Education from such programs will offer them strategies and tactics that can be employed when communicating with medical doctors. Also, the implementation of unit-based care teams that serve to place nurses and physicians close to each other promote unity, thus enhanced communication. Another way to increase their confidence is by enforcing mandatory bedside rounds which further promote communication between all healthcare practitioners. This also promotes collaboration where nurses and physicians by giving them roles meant for experienced nurses in practice. New registered nurses confirmed to have increased rate of satisfaction when they attain better communication skills. Thus, they should attend a communication training program to improve satisfaction and have a good relationship with physicians.
Argument
Effective communication is vital in nursing care although nurses lack the skills to communicate with physicians, patients, and other carers. Communication training programs should be implemented so that they can offer nurses with relevant skills to employ in their practice. It has been argued that communication training programs are important for both nurse students and nurse in the practice so that they can gain the relevant skills required for their line of profession. However, most nurses believe in self-rated ability where they find themselves competent when communicating with other care providers. Research by Mullan & Kothe, (2010) confirmed that although nurses believe in themselves, they understand the significance of the communication program on their career. There is increased satisfaction and confidence gained by nurses after pursuing a communication course. Through the training, nurses had a perceived belief of having the ability to communicate effectively with not only the patients but other care providers. With the skills, both registered nurses and the nursing students can ensure the safety of patients care. Thus, a changed attitude is experienced where nurses interact with physicians freely without fear due to a reduced barrier of communication.
Communication barrier between newly registered nurses and physicians are not only affected by the perception of each other, but other factors also create a barrier between the communications. The current healthcare system is increasingly adopting the use of technology to increase efficiency in the treatment of patients. For technology to promote quality care, it has to offer a continuous communication channel between physicians and nurses. Technological failures can also affect communication between the nurses and the physicians because each of them is in a different department and largely rely on the computers and other electronic devices for communication. Flicek (2012) affirmed the advanced use of technology could result in communication breakdown due to communication modalities employed in healthcare. Such modalities including electronic ordering system, patient inbox messaging and text pagers can result in increased medical errors. When the modalities are not used effectively, the errors that arise reduce the safety of care and can lead to adverse effects to the patient in case of a wrong medication. Although many researchers support that communication training program will reduce communicating barriers between nurses and physicians, the training cannot address technological barriers identified.
Although many healthcare organizations understand the value of nursing communication in their practice, they have no control of the quality and extent of training offered to the new registered nurses during their training. Due to this, implementation of unit-based care teams that serve to place nurses and physicians close to each other have been opted by various healthcare organizations while mandatory bedside rounds further promote communication. Besides, it is important that all those responsible for training nurses to consider the quality of education offered and the extent so that it can cover the most crucial areas required in their practice. It is evident that communication barrier between nurses and physicians as well as patients cause a larger part of medical errors and unnecessary costs in healthcare. Besides communication, technological breakdowns and other problems lead to medical errors in healthcare. Sometimes it is assumed that doctors have relevant communication skills compared to nurses. The truth is 71% of medical malpractices and errors occur due to a lack of effective communication between nurses and patients as well as physicians (Smith & Pressman, 2010). Thus, it is important to include physicians in the training programs and encourage them to form unit-base care teams so that they can gain the skills for their practice as well as skills to be used when relating with patients and nurses. Such skills can impact positively on their confidence while administering care. Consequently, improved safety of care will be assured as patients will have a good relationship with the nurses and physicians.
Nurses and physicians have a tremendous amount of clinical and medical expertise though they experience challenges in communication. It is known that nurses and physicians have had a complicated relationship since long ago. Their relationship is affected by power of authority where physicians prove themselves to be senior to nurses more so new registered nurses. The social status of each might affect their relationship which ultimately has a negative impact on healthcare (Amudha et al., 2018). The power of authority affects new registered nurses in their practice as the lack of confidence to relate well with the physicians. Communication between them is important as it is involved in all steps from patient intake to patient discharge. Thus, any miscommunication can lead to reduced quality of care. To increase patient safety, addressing the hierarchical problems can be the solution which will ensure nurses and physicians collaborate during patient care. Since not all people were born to be natural communicators, nurses and other healthcare providers need communication training so that they can possess the relevant skills required for their interaction.
Communication skills training not only improved healthcare professional relationship and communication but had a positive impact on the quality of life for the patients and increased satisfaction for the registered nurses. New Registered nurses gain confidence in their relationship with healthcare professionals which increase their satisfaction while working in the organization. Increased satisfaction in nursing practice translates to improved quality of life for patients as well as promoting safety. A study by Fukui et al., (2011) found that communication skills training for nurses improve their relationship with other care providers and lead to enhanced quality of life for patients. It added that increased satisfaction is experienced when nurses are trained in communication skills. Although communication training programs for physicians are not devised, they should also be included in the nursing communication training programs so that they can acquire the relevant communication skills. The skills will help in determining their relationship with nurses so that they can promote the safety of patient care.
Discussion
Most hospitals have not implemented nurse-physician communication programs, and that has led to increased medical errors and the extra cost of care. Health system reforms have increased their focus on improved care coordination which calls for effective communication among care providers. Unfortunately, this has not been achieved by most hospitals where ineffective communication is experienced. A research by Shannon & Myers (2012) revealed that among all the procedures conducted in a healthcare setting, 30 percent of all of them were involved in communication failure between care providers. Thus, implementation of unit-based care teams that serve to place nurses and physicians close to each other plus mandatory bedside rounds can be used to promote nurse-physician interaction besides training. People think that communication between healthcare providers is a none-issue while most healthcare organization pays attention to the relationship of care providers and nurses. But from the researches compared in this paper, it is clear that communication between healthcare providers determine the safety of care provided because both the physician and the nurse are involved in the care since patient inception to when the patient is discharged (Shannon & Myers, 2012). One of my partners felt that only nurses require training for improved communication skills and that physicians as the most authorized personnel in healthcare, have the skills required in their practice. The truth is that even though physicians have required competency in line with their profession, they also lack communication skills more so when relating with new registered nurses due to the feeling of superiority.
For a hospital to implement a clinical practice, various stakeholders are involved. In the implementation of communication training program, the hospital administrator is the most likely person to decide on the implementation. The administrator and human resource manager are the head of the hospital where they decide which programs are most important for improved quality of care. In the implementation of a communication training program, all medical practitioners including new and registered nurses should be involved. Their participation is vital as it determines the acceptability of the program in the facility and how ready they are to utilize it. Previous researches have demonstrated how nurses are ready to support communication training program as it boosts their confidence and increases satisfaction when in their new workplaces (Fukui et al., 2011). The stakeholders who seem to oppose the change are physicians as they believe they possess necessary communication skills.
During change implementation in healthcare, some steps are followed to ensure the success of the change. Knaus (2009) has proposed several steps that can be used when implementing change in healthcare. The same steps are the ones that would be used in this hospital, and they include inviting suggestions from all hospital stakeholders, holding meetings formal and informal and involving teams in the planning and implementation of the change. When all teams are ready for the implementation, individual expectations are managed, and implementation of change occurs. During the implementation, communication should be efficient for effective change. The involved stakeholders in the implementation of change include healthcare leaders, employees and other hospital stakeholders (Knaus, 2009). This is because the change affects all individuals in healthcare, directly or indirectly.
To evaluate the change to determine if it was successful, I would confirm if there is increased collaboration between new register nurses and other medical providers. I would measure nurses’ satisfaction, attitude and their relationship with patients. Also, medical errors are expected to reduce and improved quality of life for patients. To measure nurse satisfaction, qualitative study can be conducted where the nurses will give their perceptions towards the changing environment. Medical errors can be measured by the number of deaths due to misdiagnosis and extended a length of stay due to wrong medication (Knaus, 2009). Collection of data can be done using questionnaires, interviews, and observation. Nurses with increased satisfaction easily collaborate with other medical professional to ensure positive patient outcomes.
Conclusion
New registered nurses have been reported to have reduced confidence in relating to physicians and healthcare providers. Although confidence is believed to be gained in years, communication training programs have proved to be efficient in boosting nurse confidence within a short period. Nurses who have been trained support that the training increases their satisfaction, thus makes them free to seek clarification from physicians without fear. Also, improved communication skills make them confident in asking questions whenever they are stuck. To achieve a collaborative healthcare workforce, it is important that all healthcare organizations implement communication training programs so that they can control the quality and extent of training offered to these nurses. Although more researchers have concentrated on the attitude of nurses as the main factor affecting their communication with physicians, communication in healthcare can be affected by several other factors. Such factors may include technological failure and comprehension problems. Studies should be conducted on these two areas so that medical errors and patient safety can be promoted in all healthcare organizations.
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