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The recent article on nurse-physician collaboration¹ was excellent for identifying the difference between case knowledge (the physician model) and patient knowledge (the nursing model). As an administrator over intensive care units (ICUs) for more than 10 years, I have not seen much progress in nurses with respect to feeling that their input is valued by medical staff. I agree that if a patient is being monitored for a specific illness with expected variances, collaboration is strong. Interventions are predictable and expertise in skills is valued.

With more chronic patients or with unidentifiable disease progression or behavior decompensation, however, nurses are left to figure out what to do. At times they must manage an unmanageable situation. Physicians tend not to want to be bothered with nurses’ vague interpretations. This makes nurses frustrated; they’re left feeling like handmaidens.

As the acuity of patients entering ICUs has increased, so has nurses’ case knowledge. And with nurses achieving advanced practice degrees, they are demanding more input and collaboration with physicians. I have seen that the more specialized the service line in the ICU, the more input the nurses have with physicians. Nurses generally are expected to have a certain amount of case knowledge along with patient knowledge. They learn to impart information in the plan of care without being seen as telling physicians what they think ought to be done.

Things have come a long way in the last 20 years, but other hurdles that will benefit patient care and outcomes still must be crossed. True nurse-physician collaboration remains elusive.

Melissa Durbin, RN
Lake Worth, Florida

REFERENCE

1. Stein-Parbury J, Liaschenko J. Understanding collaboration between nurses and physicians as knowledge at work. Am J Crit Care. 2007;16(5):470–478.[Abstract/Free Full Text]

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