Nurses may also need sensitivity training

Factors to consider when communicating

Nurses need to be aware and sensitive to the unique pressures ED physicians face daily, argues Colleen Bock-Laudenslager, RN, MSN, a Redlands, CA-based consultant. "Understanding their vantage point and mentally walking in their shoes will facilitate improved teamwork and communication," she emphasizes. "Being supportive and respectful will no doubt make the work environment more positive." (See related story on dealing with difficult physician behaviors, p. 120.)

Sensitivity factors to consider:

1. The ED physician lacks control over his/her own practice. "Unlike other physician specialties, the ED physicians manage their practice in the environment of a hospital setting. "The physicians are held to many bureaucratic rules that often impede their ability to control their own work style," Bock-Laudenslager explains. "They naturally see the rules and regulations as an impediment to their professional creativity. Nurses must be sensitive to their powerlessness in controlling issues that affect them."

2. The ED operates from a dual organizational structure. "Nursing reports to nursing division and the physician chief reports to a VP for medical affairs or chief of staff," notes Bock-Laudenslager. "Not only is the structure inefficient at times, it also creates unnecessary tension, conflict, and sabotaging behavior."

Physicians see the organizational structure as an obstacle to resolving issues that ultimately affect their practice, and they are right, argues Bock-Laudenslager.

"As professionals, regardless of what the organizational chart says, we need to see ourselves reporting to each other in an effort to accomplish the tasks and effectively take care of the patient," she says.

3. The effect of managed care has dramatically altered physicians’ income capability and increased their workload. "While nurses are doing more with less, their salaries have either remained the same or improved slightly over the last few years," notes Bock-Laudenslager. "The same cannot be said for the physician population."

It is not uncommon to see physicians pursuing other business opportunities to improve their income revenue stream, Bock-Laudenslager says. "Historically, nurses have not been sensitive to these issues because of the disparity in salaries between professionals. But now, nurse practitioners in some states are appreciating starting salaries at the same level as a beginning family practice physician. As professionals, we can be sensitive to this change in their income potential."

4. Physicians have the ultimate authority for the medical management of patients in the ED. If a patient has had a bad outcome, the physician bears the ultimate responsibility. "The fear of litigation and legal exposure is often mind-boggling and oppressive," says Bock-Laudenslager. "Nurses are not considered a deep pocket for malpractice cases and should be sensitive to the burden and pressures the physicians experience throughout their shift."

5. Physicians’ medical school curriculum is limited in the area of interpersonal skill development. Physicians are often the first to tell you their training did not make provision for the development of their interpersonal skills, Bock-Laudenslager notes. "Generally, the physician spends years in school and has years of training in residency and fellowship, only to embark on a fast-paced clinical practice," she explains. "Developing their emotional intelligence does not take precedence in their busy schedules."

Nurses, on the other hand, spend hours of theory and practice learning the emotional aspects of self- and emotional-care delivery, she explains. "We can learn from each other, share our strengths and goals, and request feedback on our progress," Bock-Laudenslager stresses. "We need to partner with our physician colleagues in our journey as professionals."