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Future health and health care will be shaped by the needs of the people; people who seek the need for professional guidance and assistance in supporting and correcting their physical, mental, and moral equilibrium. With advancement of science and technology, medical science too will be influenced by technologies and innovation that are beyond one’s imagination. Analogically, the health care needs of the people will be very different from those that challenge present day health care professionals today. In this changing and evolving landscape there is one constant; the medical professionals, who work across a multitude of disciplines delivering care to patients and improving the health of the needy. The skilled workforce will need to keep abreast of developments and hone their skills and abilities. Flexibility, innovativeness, and efficiency will be the key to present and future challenges.
There can be a clear distinction between nursing work that results in a new discovery with implications for nursing practices, and the practice of nursing care that demands higher levels of expertise (Rolfe & Fulbrook, 1998). However, there are boundaries drawn which restricts the interaction between doctors and nurses in the professional sphere. While certain doctors encourage nurses to interact with them more purposefully, many others find it intrusive to their profession and shun from interacting with them. Such behaviour has hurt the doctor-nurse relationship considerably.
Stacey (2001), states that there has been considerable research undertaken to study the influence of human resource management on an organisation and its bearing on productivity, health and safety. This has led to the process of assuming along rational lines when carrying out planning within an organisation.
Therefore, there has now been a subtle departure from the traditional framework; greater focus is entrusted on the creation of better communication that can do away with the complexities in the operational sphere of that organisation (Lissack, 2002). Altmann et al. (1998), says that there is a concerted effort by researchers to form a linear pattern to deal with this complexity and contribute effectively to the development of perception in achieving organisational goals. Managers believe that it is difficult to pre-condition human behaviour, and it is also quite unpredictable.
Casual inferences regarding how transmission of facts are received or responded to, form a major part of the knowledge management model and also, how an organisation perceives this theory in solving problems related to responses that occur due to anxiety or conflict, like the case where a surgeon practicing favouritism can cause jealousy and hatred among other nurses, says Waldorp (1992). Thus we see that, there is now a stronger focus than ever before on relationships within the organisation, and the lines that they follow in their formal and informal communication. This is due to the fact that the amalgamations of these lines of communication lead to the formulation and effective application of information systems that can promote the management of complexities arising from a variety of perspectives (Shaw, 2002).
As the training supervisor, imparting training and orientation to a few newly recruited and existing nurses should form the first line of development. Training and orientation programmes help the team to get to know each other and work out in groups, identifying and correcting flaws that may be there with the nurses.
Orientation should be introduced first. The first part of the training should be to understand and get to know each other. This would mean formal introductions of new recruits to the existing workforce. Once formal introductions are made, it becomes easy for the nurses to work together in groups and help others in need.
Once this is completed, the leader should then conduct a workshop on work ethics and company policies. This is very important in the context of team performance and organisational goal. This is where each member of the team is instigated to perform to the best of their ability for which they have been recruited. The leader must be able to define the hospital’s goal and what they can expect in return. This includes salaries, incentive plans and other benefits.
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Introduction to other departmental staff can also help nurses get to know their support systems. Hospitals work under severe stressful and critical conditions, and so, managers should make the staff feel as secure and supportive as ever. Such interactions with other departments will help reduce work pressure, leading to efficiency and quality.
Training is essential to introduce new techniques or improve existing practices. Training programmes should be continuous so that no one is left with a situation they cannot control or oversee. All nurses must be given the task to handle emergencies with élan and calmness; for stress can negate practices leading to contingencies.
Impart of training in communication skills is important. In situations of criticalities, nurses must be able to communicate with doctors and among themselves clearly. This can help treat patients better and effectively. For, communication is a tool to convey a command, instruct, assess, influence, and persuade others. Communication skills help absorb information, motivate employees, and deal effectively with customers and co-workers. Good communication can significantly affect a supervisor’s success; lead to better productivity and understanding among the workers (Developing Communication Skills, 2004).
McVicar (2002) in ‘Workplace Stress in Nursing: a literature review,’ says that there is no doubt that inter- and intra-professional conflict continues to be an issue for nurses. Of these two, inter-professional conflict, especially between nurses and physicians, appears to be the biggest problem (Hillhouse & Adler 1997, and Ball et al. 2002). As mentioned a little while earlier about surgeons showing favouritism, the impact of professional conflict leading to jealousy and hatred is a source of distress, says (Kivimaki et al. 2000). In a survey conducted for the Royal College of Nursing (Ball et al. 2002), it was found that 30% of nurses went on long-term sick because of harassment and intimidation arising from sex/gender, age, race, sexuality or personal clashes (McVicar, 2002, 636-637).
A lot of research and writing has been undertaken to understand the relationship between doctors and nurses. In most cases, it is found that there are possible solutions to this problem and that it was only a matter of adjustments. Both, doctors and nurses work in a highly stresses environment and there is every possibility of differences arising out of compulsion or ‘favouritism.’ This can be overcome, and some of the possible theories are recorded below.
John Stuart Mill (1973), reflecting on Holden’s ‘Mental and moral powers,’ (1991) says that “the human faculties of perception, judgement, discriminative feeling, mental activity, and moral preference are exercised only in making a choice.” Robbed of such attitude, humans are no different than machines. This is precisely what one sees in doctor-nurse relationships today. He goes on to say that he hopes one day, that nurses will break away from this cliché and exercise their mental and moral powers to authenticate autonomous nursing practices.
Sweet and Norman (1995), say that a lot of research went into analyzing doctor-nurse relationships in the 1960s to 80s. Through interviews and observations, researchers tried establish the social roles and power relationships; thereby validating Stem's theory. Examining further the relationship between doctors and nurses, Hofiing et al (1966) tried to determine whether nurses were influenced by doctors to carry out improper medical procedures. In the study, “22 nurses were instructed by telephone to administer an obvious overdose of an unfamiliar (placebo) medication to a patient.” It was observed that except for one, all other nurses would have administered the dose as instructed. This clearly showed that nurses were more careful in avoiding any sort of confrontation with the doctor, rather than care for the patient. Such behaviour restricted nurses' initiative and resourcefulness.
Allen (1997), in ‘The Nursing-Medical Boundary: a Negotiated Order?’ quotes from Svensson’s, ‘Sociology of Health and Illness, wherein he says that in situations where there is a doctor-nurse interaction, it is best to adopt a negotiated order perspective theoretical framework. For this purpose, it is advisable to analyse the interview data obtained through taped recordings. Svensson came upon this theory after he analysed certain “interview data with nursing staff from surgical and medical wards in five Swedish hospitals.” Through his observation, Svensson was able to identify key changes in the health care context which he says, created a ‘negotiation space’ for nurses, which resulted in the evolution of new working relationships between them and doctors. “In examining the relationship between negotiation processes and other structural context, Svensson addressed a theme that has generated considerable interest among critics and supporters of the negotiated order perspective.” Allen further draws attention to a study drawn on data generated on a surgical and medical ward in a UK District General Hospital. Through his analysis, Allen contributes to this debate on doctor-nurse interaction, where “the sociological understanding of their professional relationship features inhibited face-to-face inter-occupational negotiations which resulted in the modification of the formal division of labour between nursing and medicine” (Allen, 1997).
Svensson (1996) says that in every ward, “norms and rules of inter-professional communication are developed between doctors, nurses and other care personnel, who follow a rule on what form of negotiations should be entertained.” The cap on such negotiations abdicates a nurse’s right to question a doctor’s action. While many nurses in the study maintained that they seldom faced restrictions in asking doctors on their opinion and thoughts on certain medical treatment, many others did say that they were careful in their discussions, especially if it was on ‘medical terms.’ While some doctors may feel at ease in responding to their queries, most doctors may feel that their professionalism is being questioned. They ‘wrap up' thinking that ‘their toes are being trodden on.’
Grey & Connolly (2008) says that “were there greater autonomy in nursing practice, nurses would be accountable, both personally and professionally. They would show more responsibility in endorsing ethical conduct consistent with their professional practice, and at the same time at a professional level, exercise discretionary powers to the ultimate benefit of the patient.” Discretionary responsibility implies that:
- The recognition of a patient’s wants may not necessarily be consistent with a patient's needs
- Abstaining from collusion with noncompliant patients
- Supporting a patient’s right to refuse treatment until a complete psychological exploration is undertaken
- Understanding the psychological ramifications of informed consent from a practitioner and a recipient’s point of view
- Maintaining appropriate personal and professional boundaries
- Fostering collegiate relationships with the medical fraternity grounded on egalitarian principles (Grey & Connolly, 2008).
A fall out between doctors-nurses can be catastrophic if not dealt with carefully. However, there are certain codes which nurses must abide with during their employment. While there have been cases of negligence and poor quality services offered to patients, the Nursing & Midwifery Council introduced certain codes which must be followed by those nurses who practice in the UK.
The Code Standards of conduct, performance and ethics for nurses and midwives mandates that “patients under one’s care must be able to trust you with their health and well-being.” For this, a nurse must:
- Make patient’s care utmost important; treat them as individuals and not patients and respect their dignity
- Work as a team to protect and promote the health and well-being of all those under their care; be it the patient, their family, or the community
- Provide a high standard of practice and care at all times
- Be open and honest, act with integrity and uphold the reputation of the profession
- Be accountable for their actions
- Act lawfully, whether these laws relate to their professional or personal life
- Support those who care for themselves in improving and maintaining their health (Nursing & Midwifery Council, 2008)
In the process of assessing the professional nursing boundary, a host of research papers were identified and referenced. While it can be said that doctor-nurse relationship is paramount to quality medical treatment and healthcare, quite a lot needs to be done to repair the damage. Nurses should be made to be accountable for their actions and in the right spirit; it should make them more interactive with doctors in the professional sphere. Nurses can learn a lot from doctors and assist them in contingencies, if and when they arise. While many doctors find nurses’ queries to be intrusive and irritating, many others do interact with them. As observed by Svensson, the key to changes in doctor-nurse relationship lies in a ‘negotiation space’ for nurses, which will result in the evolution of a new, healthy, working relationship.
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