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Effective nurse-physician collaboration is rooted in mutual respect and positive dialogue. This may sound like a simple, easily achievable goal, yet dissatisfaction among nurses (and physicians) remains common.

In an effort to improve interdisciplinary communication and interaction, Thomas Jefferson University in Philadelphia recently established the Jefferson Center for InterProfessional Education (JCIPE), which is dedicated to improving patient care through coordination, implementation, and evaluation of a team-based curriculum.

JCIPE's centerpiece project is the Jefferson Health Mentors Program, which rolled out in September, says codirector Christine Arenson, MD, associate professor in the Department of Family and Community Medicine and director of the Division of Geriatric Medicine.

Multidisciplinary learning model

The two-year program is required for all first-year health profession students, which includes those studying medicine, nursing, physical therapy, and occupational therapy. The students are grouped into teams of at least two medical students and one nursing student, and each team is partnered with a person living with a chronic condition, who serves as the "patient mentor."

Each visit with their patient mentor is focused on what the teams are studying at that time within their individual curriculums. Their first visit is a guided life history so they understand that "a patient with a chronic condition is a person first," Arenson explains. During their second visit, the students obtain a complete medical history as required by their individual disciplines. This way, Arenson says, team members learn what is common and what is unique about each discipline's approach to the patient.

Team-building is key

One of the principal goals of the Jefferson Health Mentors Program is effective team-building, says JCIPE codirector Molly Rose, RN, PhD, a professor in the Jefferson School of Nursing. "Just as they get to know their mentors as a person, they also get to know each other as people who are in a different discipline," she says. "Because they must work as teams, there is a lot of communication, which is one of the basic concepts related to collaboration and improving physician-nurse relationships."

"The purpose of this program is to improve patient care, safety, and outcomes," says Arenson. "For all of the professions to do that well, they must learn to work together. We don't want them to feel reticent when it comes to calling upon another discipline or asking questions related to the patients they are seeing."

Medical literature is rich with data demonstrating the value of effective team-building, Arenson and Rose conclude.

Not always an easy lesson

"It's also clear from the business literature that people don't just automatically become teams," Arenson says. "They actually have to learn how to function in team roles. That's why we thought it was extremely important from the earliest stages of their education."

Indeed, nurses often find collaboration difficult, observes Gina Aya Nelson, RN, MSN, patient care manager at Scripps Memorial Hospital in La Jolla, Calif., and coauthor of a research report on nurse-physician collaboration on medical/surgical units published in the February 2008 issue of MedSurg Nursing.

The most common complaints among nurses include a perceived lack of respect and poor communication with the physicians with whom they work. Nelson says this is particularly true among relatively inexperienced graduate nurses who are still learning their way around.

Nelson admits to having experienced occasional conflicts with physicians over the course of her professional career, and as a nurse manager she also must deal with physician complaints from her staff.

"Sometimes the interacton is negative between nurses and physicians," she says. "But when you get both sides of the story, the common theme is they both want to do what's best for the patient, but they're unable to see each other's views on it."

Adds Arenson: "I think there continues to be less understanding than would be ideal on the part of physicians regarding the expertise and scope of practice of professionals outside of medicine. And there is compelling evidence in the safety literature about what happens when team members feel they have to defer to the physician, and they're not able to express their opinion. That's a common source of medical errors."

Proactive approach to conflict

While researching her report on nurse/physician collaboration, Nelson learned the University of Kentucky requires medical students to work an eight-hour shift with nurses so they can better understand the nurse's role in patient care. "The school is unique in that approach, and I think it's a good approach to improving the collaborative relationship," Nelson says.

It's an important issue because unresolved conflict can adversely affect a nurse's ability to do his or her job. It might even cause a nurse to leave the profession.

Experience, Nelson says, often is the best instructor.

"I've found that as you become more experienced, you're more inclined to sit down with a physician and say, 'This is where I'm coming from. Let me understand where you're coming from, and let's make sure we're doing the right thing for the patient,' " she says. "I also think nurses tend to be more assertive as they gain experience."

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Don Vaughan is a freelance healthcare writer. To comment, e-mail editorPA@nursingspectrum.com.