Running Head: NURSE-PHYSICIAN COMMUNICATION

Journal Article Review:

Robinson, F.P., Gorman, G., Slimmer, L.W., & Yudlowsky, R. (2010). Perceptions of Effective
and Ineffective nurse-physician communication in Hospitals. Nursing Forum, 45(3), 206216.

Davinder Bassi
xxx xxx xxx
NURS 260
Professor X
February 25, 2014

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In Canada today, there is a higher demand on our heathcare system like never before.
With the advancement of medical science and technology, there have been considerable
improvements on mortality and morbidity rates, leading to a greater elderly population requiring
more acute medical attention. Due to this increased demand on our services, patient safety and
quality of care has suffered in the absence of effective communication. In the article Perceptions
of Effective and Ineffective Nurse-Physician Communication in Hospitals, Robinson, Gorman,
Slimmer and Yudlowsky (2010) used a qualitative approach to outline what constitutes effective
and ineffective communication by facilitating three small focus groups. Each group consisted of
six registered nurses with acute care experience, six physicians or a combination of both. The
main topics of this study were, firstly, reasons for why poor communication exist, ranging from
less education around interprofessional perspectives, to the authority structure and sexism in
each profession (Robinson, Gorman, Slimmer & Yudlowsky, 2010, p.206). Secondly, by taperecording and transcribing the 60- minute sessions, comments were organized into themes.
Robinson et al (2010) were able to summarize five themes for effective communication along
with three themes for ineffective communication. Lastly, the researchers detailed strategies for
increased effective communication and decreased ineffective communication amongst healthcare
providers through additional interprofessional education (Robinson et al, 2010). I found this
article to be simplistic in methodology yet engaging, and the study was small yet informative.
Working as a clerical associate on various in-patient units for the past 20 years, I have witnessed
the effects of both types of communication. In this paper, I will discuss the benefits of effective
and detriment of ineffective communication on nursing practice with respect to better patient
outcomes, improved staff satisfaction, and useful strategies to aid nurses in all healthcare
settings.

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The first implication of effective communication on nursing practice is that of improved

patient outcomes, the fundamental purpose of healthcare. By reducing the use of ineffective
communication, there will be decreased sentinel events, decreased medication errors, leading to
reduced mortality rates and better quality of care (Burke, Boal & Mitchell, 2004, p.40). This is
possible if certain communication techniques are avoided such as humiliating colleagues, making
others feel incompetent or bullying and intimidating peers (Robinson et al, 2010). The College of
Nurses of Ontario (CNO) states such behaviour negatively affect(s) the delivery of care since
workplace bullying can erode a nurses confidence and compromise her/ his ability to foster
therapeutic relationships with clients (CNO Conflict Prevention and Management, 2009, p.5).
Robinson et al (2010) also described mutual respect and trust were important factors necessary
for better patient care. Patients were served best when the members of the profession could rely
on each other (Robinson et al, 2010). Patient outcomes also improve if we reduce our
dependence on computer systems to deliver urgent messages for treatment (Robinson et al,
2010). By adding more verbal communication with follow-up in an acute care setting, nurses are
better able to prioritize the ever-changing care needs of their patients. Efficiency in implementing
physicians orders reduces patient recovery time, resulting in shorter length of hospital stays.
This in turn, saves valuable healthcare dollars.
A second implication of effective communication to nursing practice is improved job
satisfaction. This is achieved primarily through collaborative problem solving (Robinson et al,
2010). The use of teamwork enables the entire healthcare team to share responsibility, decisionmaking and power in the patients care which, in turn, develops a sense of empowerment and
respect amongst the professionals involved (Burke et al, 2004, p.42). To achieve this, there must
be a clear understanding of the nursing professions roles and responsibilities (Robinson et al,

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2010). When physicians are aware of the full scope of nursing practice only then, can they be
aware of what nurses contribute to the healthcare team thus, utilize effective communication to
its fullest potential. It is by improving nurse-physician communication that it is not only a
remedy for diminished job satisfaction, its also an elixir for improving care (Burke et al, 2004,
p.41). Likewise, the CNO guidelines state professional relationships are based on trust and
respect, and result in improved client care (CNO Professional Standards, 2009, p.12). Using this
collaborative practice model across Canada also ensures the efficient use of health human
resources most effectively during a time of shortage (Potter & Perry, 2010, p.136). Not only
must other professionals understand the role of the nurse, but nurses must demonstrate
knowledge of and respect for each others roles, knowledge, expertise and unique contribution to
the health care team (CNO, Professional Standards, 2009, p.12). This promotes a healthy work
environment fostering respect and appreciation to thrive among all heathcare disciplines and a
positive outcome in recognizing each others strengths and what (they) bring to the table
(Robinson et al, 2010). Unfortunately, nursing satisfaction also varies by ineffective
communication. Robinson et al (2010) reported a higher incidence of miscommunication where
English was not the first language. These linguistic or cultural barriers are also what lowers the
potential for job gratification. Nurses know all too well the effects of specific comments they
receive, or the lengths to which they go to in order to understand some physician orders. Many
seek out the help of colleagues because they may be apprehensive about clarifying treatment. I
have even seen some nurses ask me, the clerical, to page and speak to the physician in order to
clarify the orders, knowing I cannot document any telephone orders. But I understand now why
they would ask me: I was always comfortable speaking to whoever the physician was, which
made it possible to communicate effectively (Robinson et al, 2010). The nurses who would ask

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me to speak on their behalf, (thus on behalf of their patient), did not have the same rapport with
physicians, or, just were not as comfortable due to personal cultural biases (ie. physician of
opposite gender). After reviewing this article, I have come to realize why I enjoyed doing an
added task of speaking to the doctors for these nurses: I would feel the same sense of pride and
confidence in my role and an integral part of our healthcare team that they may have been
lacking.
This articles third and final implication to nursing practice significant to both effective
and ineffective communication is the strategies developed to increase and reduce each,
respectively. Robinson et al (2010) consider the use of straightforward unambiguous
communication the most common theme necessary for effective communication. Orders need to
be given with clarity and precision, as well as be verifiable for accuracy (Robinson et al, 2010).
A nurse can then expedite the treatment with confidence and efficiency. It is also imperative that
physicians speak in a calm and supportive demeanor especially under stress (Robinson et al,
2010). In Emergency, I recall seeing doctors, nurses and respiratory therapists performing in
Code Blue situations on various nights. The times of most controlled demeanor were usually the
times of most stress: a very busy shift or a very serious case. Now I understand the purpose was
to keep the entire team focused and implementing the rapid orders coming in succession from the
lead physician. Another strategy to ensure effective communication involves readback/ hearback
of all telephone and verbal orders from physicians (Schuster & Nykolyn, 2010, p.187). If the
receiver writes down the message first, then reads it back to the sender for verification, it can
help to avoid errors from informational gaps and miscommunications(Schuster & Nykolyn,
2010, p.187). I am able to verify that this method is used in our department and almost always
has additional orders added, changed or clarified after the readback. I, then, always see my nurse

NURSE-PHYSICIAN COMMUNICATION

carry the order(s) through with confidence. Another excellent communication strategy is that of
the Situation-Background-Assessment-Recommendation (SBAR) instrument (Schuster &
Nykolyn, 2010, p.188). The SBAR tool for communication is designed to force the sender and
receiver to move through a discussion in a predictable, logical flow and is independent of
differences in communication styles between nurses and physicians (Schuster & Nykolyn,
2010, p.188). It reduces any cultural differences that may exist, therefore lowers the risk of
ineffective communication. More importantly, this tool develops critical thinking skills as the
person initiating the conversation knows to indicate the problem, provide an assessment, and
indicate appropriate treatments (Schuster & Nykolyn, 2010, p.188). Lastly, frequent and regular
interprofessional rounds aid the healthcare teams collaboration and ensure that all providers
practice to the full potential of their role and competencies (Potter & Perry, p.136). In turn,
nurses, physicians, and allied health care workers all become more comfortable with each other,
and are able to build a respectful, trusting relationship conducive to better patient care.
Upon reviewing the article Perceptions of Effective and Ineffective Nurse-Physician
Communication in Hospitals, the authors Robinson et al (2010) were able to narrow down to five
themes for effective communication and three themes for ineffective communication. Although
the focus groups were small in size, I agree with the authors in that the themes were significant
findings (Robinson et al, 2010). My discussion of each of the themes related to their implication
to communication as it applied to nursing practice. As a student nurse, I do believe that we still
have the ability to make a difference when we are in our clinical setting by continuing to learn
the skills to make a great nurse. We should not feel intimidated by the professionals around us as
it becomes a form of ineffective communication. By developing positive professional
relationships, using the readback/ hearback method and the SBAR tool, we will be on the right

NURSE-PHYSICIAN COMMUNICATION

track to developing effective communication skills. In combination, these tools will improve our
patient outcomes, with positive results ultimately reducing their hospital length of stay. By doing
so, we will have attained our common goal as health care providers: delivering optimal care.

NURSE-PHYSICIAN COMMUNICATION

References
Burke, M., Boal, J., & Mitchell, R. (2004). Communicating for Better Care: Improving nursephysician communication. American Journal of Nursing, 104(12), 40-47.
College of Nurses of Ontario. (2009). Practice Standard: Conflict Prevention and Management.
Toronto, ON: Author.
College of Nurses of Ontario. (2009). Practice Standard: Professional Standards. Toronto, ON:
Author.
Potter, P.A. & Perry, A.G. (2010). Canadian Fundamentals of Nursing (Revised 4th ed.).
Toronto, ON: Elsevier Canada
Robinson, F.P., Gorman, G., Slimmer, L.W., & Yudlowsky, R. (2010). Perceptions of Effective
and Ineffective nurse-physician communication in Hospitals. Nursing Forum, 45(3), 206216.
Schuster, P. & Nykolyn, L. (2010). Communication for Nurses: How to Prevent Harmful Events
and Promote Patient Safety. Philadelphia, PA: F. A. Davis Company.