Seventeen years ago Nursing 91 led off a major survey report on nurse/physician relationships with this quote. “Of over 1,100 nurses responding to a recent survey, only 43% reported feeling satisfied with their relationships with physicians, and 68% doubted that physicians understood nursing responsibilities.” Believe it or not in 2008, the old "doctor-nurse game,” first described by Stein in 1967, continues to exist (Nursing 2007, Volume 37, Number 1). Is this age-old struggle between the sexes; or something that has been engrained in our female workforce? Many female nurses, despite believing their expertise to be more appropriate in a particular situation, still feel the need to defer to physicians. Some nurses have learned and still choose, consciously or unconsciously, to preserve and protect the physicians' traditionally "superior “professional status by deferring to them at all times.
The issues raised in the survey were based in part on an earlier essay in The New England JournalOf Medicine (Feb.22, 1990) called "The Doctor-Nurse Game Revisited." Written by three physicians, it describes a rigid hierarchy that places physicians firmly in charge. Even though nurses regularly offer expert advice about patient care issues, they were expected to defer to physicians. By engaging in this characteristic behavior, nurses and physicians prevented open conflict, but they also avoided direct communication with each other.
In the last 16 years, much has changed in the health care environment; many realize multidisciplinary collaboration and open communication are crucial in achieving positive patient outcomes; however sexism in healthcare continues to flourish despite good intentions, studies and buzz words. In fact, the Institute for Healthcare Improvement (IHI), the Centers for Medicare and Medicaid Services (CMS) and the Joint Commission on Accreditation for Healthcare (JCAHO) all recognize the need to prevent medical errors through enhanced communication. JCAHO reports over 70% of the 2,455 reported sentinel events occurred because of communication problems between caregivers. Respectful dialogue between professions is well recognized; yet poor communication between nurses and physicians is named as the most important factor causing dissatisfaction in nursing today. Nurses consistently reported feeling frustrated and dissatisfied with working relationships that devalue their professional worth.
Communication failures occur largely due to power/gender issues and dismissive attitudes of physicians. Physicians continue to view their role as superior to those of nurses and don’t understand nor value the role of nursing opinion or judgment. Physicians who do not value nursing, may be slow to respond to nursing concerns, leaving the nurse feeling devalued, unappreciated, frustrated and angry - so they avoid communicating.
Many male physicians, especially older physicians still see themselves in control, and female subordinates present to do their bidding. Many nurses report a majority of male physicians exercise control over large groups of female nurses; in this situation, being male automatically confers superior power. Compounding this situation is the large number of female nurses migrating from countries where sexism is accepted, and nurses are viewed as “handmaidens.”
Male nurses have reported that physicians treat them with greater respect then their female peers. I have seen this with my own eyes. I have worked along side male and female nurses; I have seen physicians ridicule female nurses, ask them if they are stupid, or simply dismiss them as being ‘below’ them, not deserving recognition or collaborative conversation. I have never seen a male nurse treated disrespectfully; no matter how poor his care, or flawed his reasoning. I have not witnessed a physician ridicule, swear over the phone or spew blatant condemnation toward a male nurse; yet this behavior is tolerated towards female nurses regularly. On the flip side I have heard physicians brag and exude great thankfulness to male nurses for their ”help,” or tell family members how wonderful a job John is doing, all the while ignoring a female nurse who has worked just as hard.
Don’t get me wrong I’m not male bashing ... or physician bashing here. Everyone, male or female deserves to be treated with kindness and respect. Nurses should be valued for their expertise and hard work. We should move away from an adversarial “us versus them” relationship between nurses and physicians, and work harder on a collaborative, respectful association regardless of gender.