Background: A lack of effective physician-nurse collaboration has long been recognized to adversely impact patient and organizational outcomes. Despite substantial efforts towards developing strategies to improve interprofessional collaboration (IPC) in the acute care setting, consistent realization of this ideal remains elusive. Some studies have suggested that nurses and physicians have different perceptions of IPC and this lack of a shared mental model hinders improvement in this arena. We sought to evaluate for a difference in the perception of IPC between nurses and physicians and identify any potential contributing factors and barriers.
Methods: Data were collected from 47 nurses, 29 housestaff physicians and 17 hospitalists providing care for medicine service patients in a large tertiary care academic medical center between June and November, 2014. Via an electronic survey, we gathered responses for the 14-item IPC scale, a reliable and valid measure of individual perceptions of the level of collaboration in a healthcare environment. Each IPC item is scaled from 1-5 (strongly disagree – strongly agree). The IPC sum scores were calculated as the outcome variable (range: 14-70). Generalized linear models were used to correlate the IPC scores with the other variables. Pairwise comparisons were examined using Tukey’s Honestly Significant Difference test (HSD).
Results: Data analysis revealed an overall average IPC sum score of 47.8.7+9.60 (nurse: 42.8±8.68; housestaff: 53.8.1±7.08; hospitalist: 51.7±8.23). The result of generalized linear regression indicated that the average IPC sum scores were significantly different by group (F(2,90)=18.9, p<.0001). Pairwise comparisons revealed that the average sum score of nurses was significantly lower than either the housestaff physicians (p<0.0001) or hospitalist physicians (p=0.0006). Analysis also revealed that the average number of patients per day between the two physician groups (housestaff and hospitalist) and nurses were significantly different (F(2,89)=34.7, p<.0001). A generalized linear regression was used for the examination of effect of number of patients per day on the IPC average sum scores. As the number of patients per day increased, IPC scores increased (F(1,90)=14.5, p=0.0003).
Conclusions: While we observed that nurses had lower IPC scores than did the physicians, other results in the literature have found the opposite result. This variation suggests there may be unique environmental influences impacting physician-nurse collaboration ratings in different settings. In addition, IPC scores increased with patient census, perhaps suggesting that busier practitioners rely more on collaboration. Given the known relationships between effective physician-nurse collaboration and superior patient outcomes, further examination of possible predictors of IPC scores is warranted, such as job satisfaction, characteristics of nurse and physician leadership, and geographic co-location of physicians with nursing units.