Nurse-Physician Collaboration: Differences by Profession

Purpose:
To evaluate for a difference in the perception of interprofessional collaboration between nurses and physicians and to examine potential contributing factors and barriers specific to the academic medical center setting.

Background/Significance:
A lack of effective nurse-physician collaboration has long been recognized to adversely impact patient and organizational outcomes. Despite substantial efforts towards developing strategies to improve interprofessional collaboration, consistent realization of this ideal remains elusive. Some studies suggest that nurses and physicians have different perceptions of interprofessional collaboration and that this lack of a shared mental model hinders improvement in this arena.

Methods:
For this descriptive cross-sectional study, data were collected via electronic survey from a convenience sample of housestaff physicians (n = 29), hospitalist physicians (n = 17) and direct-care nurses (n = 47) providing care for medicine service patients in a large tertiary care academic medical center. In addition to demographic data, scores for Kenaszchuk's 14-item Interprofessional Collaboration Scale (outcome variable) were obtained. Generalized linear models were used to correlate the Interprofessional Collaboration Scale scores with predictor variables. Pairwise comparisons were examined using Tukey's Honestly Significant Difference tests.

Results:
Data analysis revealed an average Interprofessional Collaboration (IPC) sum score of 47.8±9.6(RN:42.8±8.68; housestaff:53.8±7.1; hospitalist:51.7±8.2). Regression analysis indicated that the average IPC sum scores were significantly different by group (p=0.0001). Pairwise comparisons revealed that the nurses' score was significantly lower than either the housestaff physicians' (p=0.0003) or hospitalist physicians' (p=0.0046). Analysis also showed a significant difference between the nurse and aggregate physician group(housestaff and hospitalist)(p<0.0001). Regression analysis revealed that as the number of patients per day increased, IPC scores increased across all groups (p<0.0016).

Conclusions and Implications for Practice:
The result of nurses having lower IPC scores than physicians is the opposite of what is found in related literature. Further research regarding possible predictors of IPC scores specific to this environment, such as organizational support and geographic dispersion of physicians is being conducted.