A Qualitative Study of Hospitalist and Nonhospitalist Work Relationships with Staff Nurses

1University of Chicago, Chicago, IL
2University of Chicago, Chicago, IL

Meeting: Hospital Medicine 2009, May 14-17, Chicago, Ill.

Abstract number: 63

Background:

Hospitalists have the potential to interact with inpatient staff nurses more frequently than physicians who also provide ambulatory care. Despite the existence of this specialty for more than a decade and its burgeoning numbers, the impact of the hospitalist model on the relationship of physicians with inpatient staff nurses has yet to be rigorously examined.

Methods:

Qualitative methodology was used on 2 medical surgical units in an urban academic medical center. Attitudes about nurse‐physician work relationships were obtained via one‐on‐one, face‐to‐face semistructured interviews. Ten inpatient nurses, 4 hospitalists, and 6 nonhospitalist physicians participated. Interviews lasted about 60 minutes (range 25–150 minutes), were transcribed verbatim, and were analyzed inductively and deductively using directed content analysis methods.

Results:

Both groups of physicians and the nurses expressed several important differences between hospitalist and nonhospitalists in nurse–physician work relationships. The primary difference was in the hospitalists' communication patterns with the nurses. Although not structured or planned, hospitalist physicians had very proactive patient‐centered communication with the nurses. They exerted a great amount of effort to locate the nurses in order to review the patient's plans face to face and to ensure timely changes in care were made. The hospitaiists expressed high value in a close working relationship with staff nurses as a way to provide higher quality care and to improve their work flow. In contrast, nonhospitalist attending physicians work in a supervisory role to resident physicians and were generally not involved in direct patient care; as such, their work flow was not strongly affected by their relationship with nurses. For nonhospitalist physicians, communication was rare. In addition to communication patterns, the amount of time per year in the hospitalist role influenced work relationships with nurses. Non hospitalists were most often assigned to inpatient care for 1 month per year, which was deemed inadequate for establishing collaborative relationships. In contrast, hospitalists were assigned to direct inpatient care between 3 and 12 months a year. Because of their increased presence on the inpatient units, nurses and hospitalists had greater familiarity with each other. This led to increased informal social exchange, patient‐centered communication, and trust. The majority of the nurses expressed a strong preference for working with hospitalists.

Conclusions:

The combined factors of the structure of the hospitalist role and hospitalists' communication patterns promoted favorable relationships with nurses. Both nurses and hospitalists physicians felt that these stronger work relationships positively influenced patient outcomes and efficiency.

Author Disclosure:

K. Lopez, none; C. Whelan, none.

To cite this abstract:

Lopez K, Whelan C. A Qualitative Study of Hospitalist and Nonhospitalist Work Relationships with Staff Nurses. Abstract published at Hospital Medicine 2009, May 14-17, Chicago, Ill. Abstract 63. Journal of Hospital Medicine. 2009; 4 (suppl 1). https://www.shmabstracts.com/abstract/a-qualitative-study-of-hospitalist-and-nonhospitalist-work-relationships-with-staff-nurses/. Accessed July 16, 2019.

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