Abstract
Objective: To test an intervention to enhance collaborative communication among nurse and physician leaders (eg, nurse manager, medical director, clinical nurse specialist) in two diverse intensive care units (ICUs).
Background: Collaborative communication is associated with positive patient, nurse, and physician outcomes. However, to date, intervention-focused research that seeks to improve collaborative communication is lacking.
Methods: A pretest-posttest repeated measures design incorporated baseline data collection, implementation of the intervention over 8 months, and immediate and 6-months-post data collection.
Findings: Communication skills of ICU nurse and physician leaders improved significantly. Leaders also reported increased satisfaction with their own communication and leadership skills. In addition, staff nurse and physician perceptions of nursing leadership and problem solving between groups increased. Staff nurses reported lower personal stress (eg, more respect from co-workers, physicians, and managers), even though they perceived significantly more situational stress (eg, less staffing and time).
Conclusion: Study findings provide evidence that nurse-physician collaborative communication can be improved.
Collaboration between nurses and physicians is a key factor in intensive care unit (ICU) outcomes. 1-3 By conducting prospective, multisite studies, Knaus, Shortell, and colleagues 2-4 established that in ICUs in which there is poor collaborative communication among nurses and physicians, ineffective leadership, poor nurse staffing, less technological availability, and greater diagnostic diversity, patient risk-adjusted mortality and length of stay is increased as much as 1.8-fold. Likewise, significantly higher nursing turnover, lower perceived ability to meet family needs, and lower perceived technical quality of care exist in the units. Observational, interview, and statistical data from the same multisite studies suggest that unit leadership creates the environment for collaborative communication among healthcare providers and that nurse and physician leaders play a key role in ICU outcomes.
In a series of studies Baggs and colleagues found associations between increased nurse-physician collaboration and a lower risk of the negative patient outcomes of readmission to the ICU and risk-adjusted mortality. 1,5 The researchers also found enhanced professional relationships, enhanced learning, increased nurse satisfaction with decision making, and decreased nurse job stress. 6-8
Other researchers have found significant associations between higher nurse-physician communication and the positive patient outcomes of lower risk-adjusted mortality and higher satisfaction. 9 Positive nursing outcomes include increased satisfaction, enhanced professional relationships, 10 and lower turnover. 9,10 Physician outcomes include enhanced learning and professional relationships 7,10 and enhanced research utilization. 11
To date, intervention-focused research that seeks to improve collaborative communication is lacking. The purpose of this study was to test an intervention to enhance collaborative communication among nursing and physician leaders (eg, nurse manager, physician director, clinical nurse specialist) in two diverse ICUs. Collaborative communication was defined as nurses and physicians working together cooperatively-sharing responsibility for problem solving, conflict management, decision making, communication, and coordination-to improve unit outcomes (adapted from Baggs 12). Figure 1 presents the aims of the study.