A Grounded Theory Study to Understand Nurse and Resident Physician Communication Dynamics

Abstract

Communication between nurses and physicians frequently occurs in the delivery of care to patients in the acute healthcare setting. In an environment where a person's life and well-being depends upon accurate communication, it becomes an essential component of care delivery and care coordination among health professionals. Investigations of how physician-nurse relationships contribute to the physician's value of nursing and nursing communication do not exist. The purpose of this study is to uncover how nurses and resident physicians relate as members of the healthcare team and how nursing communication is valued. This study followed Constructivist Grounded Theory to develop a substantive theory that explains how relationships influence nurse and resident physician communication. Interviews were conducted with 15 internal medicine resident physicians at an academic medical center in a southeastern state. The overarching theme for this study was getting things done, which was comprised of three theoretical categories: shifting communication, accessing nurse's knowledge, and determining the team. The relationship between these theoretical categories create a context for understanding how communication between nurses and resident physicians influences teamwork and health care delivery. For resident physicians in this study the relationship with nurses is built on a basic foundation of getting work done. Nurses are not perceived as having discipline specific knowledge that contributes to patient care planning. Rounding patterns illustrate how the nurse is prevented from contributing unique knowledge to the plan of care for patients. The patriarchy that has traditionally influenced the relationship between nurses and resident physician continues to exist today. Further, resident physicians are unaware of the scope of nursing practice and see the nurse as a source for data and executor of prescribed orders. The findings from this study will inform how interprofessional education and practice must focus on relationships that are built on acknowledging the uniqueness of each individual on the patient care team.