Author: Linda L. Herman, MD, FACEP, Program Director, Kaweah Delta HCD, Visalia, California

Tips on how to improve your relationship with the nurses.

Before writing this article I asked the nurses in the emergency department: What could I tell a resident about improving relationships with the nurses? Every one of them said that they want to be respected. They understand that the physician is in command of the team but it is still a team and all members should be treated with respect. So how do we show them that we respect them? The key is communication.

Introduce yourself to the staff when you arrive. Say good morning to everyone when you arrive. If you are assigned to a certain section of the ED let the nurses and techs know where you are assigned. Try to learn their names and call them by it. Don’t greet the nurses with “I’m here” but greet with “I’m glad that you are here.”

One of the major downsides of electronic medical records is that they give the impression that the staff don’t need to talk to each other. Putting orders in the EMR does not take the place of discussing a patient with the nurses. The nurses know things about the patient that you may not know. After seeing a patient, tell the nurses and staff what the thought process is and what the plan of diagnosis and treatment is going to be. Tell the staff what orders are going to be entered into the EMR. Give the nurses a chance to give you extra information about the patient or to ask questions. If they have suggestions about other orders to add, give them credit, and add those orders unless they are not necessary. If they are not necessary, explain the reasoning. I have learned that it saves me a lot of grief to talk to the nurses about my plans especially if I am asking them to do something that is somewhat different from what we usually do for a patient. Also, if the request is unpleasant, recognize that to the nurse and let the nurse know that you appreciate that the nurse has to do an unpleasant task.

If the nurse wants to tell you something about a patient, asks for an order, or requests that you reevaluate a patient, first give them your full attention. If you are doing something else and task-switching could cause errors, ask them to wait a minute and give them your attention. Consider the request. Usually the requests are reasonable. Usually requests such as “the patient or family has questions,” or “I think that you need to look at the patient again” are also reasonable and it would probably be beneficial to reevaluate the patient. If an order seems unnecessary, discuss it with the nurse. Ask the nurse what the goal is in giving the intended medication or doing the requested diagnostic test. Don’t be so stubborn that you don’t realize that the nurse could be right and is just helping you take care of the patient.

Never brush off a nurse’s concern, even if they are wrong. If they come to you concerned that a patient has necrotizing fasciitis when really it’s a simple cellulitis, thank them for coming to get you right away. If you are rude, demeaning, or arrogant, then the next time when it actually is a necrotizing fasciitis the nurse may feel less sure about, or may avoid talking to you right away.

Be mindful of your tone of voice and nonverbal gestures.   A person can have the best justification for their medical plan but if it is explained in certain tones, the other healthcare members may take it as sounding arrogant or insolent.  No one likes to be talked down to. Also, be polite, “please” and “thank you” go a long way.

If a staff member makes a mistake, such as giving a medication by the wrong route (the pain medication was given IM instead of IV) or ordering the incorrect test (the CT without contrast instead of the CT with IV contrast), don’t demean them. First of all, it was an honest error. They didn’t start their day wanting to make a mistake, it just happened. Remember this has or will happen to you. The members of the healthcare team are taking care of multiple patients also and small errors do occur. Consider the seriousness of the error and see if it needs to be corrected or reported. Help the team correct the error just as they will help you correct errors. Reporting the error through the hospital’s system could help effect systems-based changes to alleviate such errors in the future. Explain to the healthcare team that the intention is not to cause disciplinary action but to start a process of fixing the system that allowed the error.

If you have a disagreement with a nurse, acknowledge it. Usually the nurse is stressed and it is not personal. Tactfully ask the nurse if there was something in particular that happened that upset them. If they mention something that you have done, even if it was misinterpreted, apologize and explain. I remember one day that I was checking on patients in the waiting room because we were so busy. I found a patient that clearly had neurological deficits who had sat in the waiting room for 2 hours. I went to the nurse that was working in the intake area to see if we could get an assigned bed in the back for the patient because I was worried about a stroke. She obliged me but later we had a discussion about the interaction. She seemed to think that I was blaming her for the patient’s long wait time when I really went to her because I knew that she could facilitate movement of the patient more quickly than I could. I apologized to her for the misunderstanding even though it was not intentional.

It is difficult to overcome poor relationships with the staff once a physician develops a reputation for being unapproachable, non-communicative, or arrogant. It can be accomplished but it will take effort and intentionality on the part of the healthcare professional. The physician has to want to change. Start off by apologizing to the staff. Explain to them what effort is going to be made to develop better relationships. Start your shift with the suggestions in this paper. End the shift by asking for feedback, “Did I communicate better today, do you have any suggestions of how I can improve?”

Finally, thank everyone! Thank the patients, the interpreter, and the staff for the things that they do. When leaving the shift, thank them again.