The Communication Gap Between Nurses and Other Healthcare Professionals

When it comes to healthcare and receiving aid at hospitals, clinics, and other health centers, the communication between doctors and the nursing staff is paramount to ensure that patients receive the very best care possible. In a place where there are often hundreds — if not thousands — of patients both admitted and released on a daily basis, teamwork is essential in order to cover the vast and hectic demands that often swamp most health centers. Each member of these facilities has an important role to play and, in order to play it properly, he or she must rely on others — often blindly.

Hospital Hierarchy

Health centers usually follow a strict medical hierarchy in which the doctors are managed by a presiding Medical Director. In the said hierarchy, the director presides over the heads of department, and these, in turn, also have their own subordinates, who also have their own subordinates, and so on. Similarly, the nursing staff also obeys their own hierarchy, which is headed by the Chief Nursing Officer, followed by the Director of Nursing, Nurse Manager, and so on.

The heads of each hierarchy usually perform administrative roles, coordinating and overseeing all the operations performed by the staff, while also managing the flow of both inbound and outgoing patients. Similarly, the heads of departments also oversee activities, but in a more microenvironment, which is limited to their own specialization (pediatrics, orthopedics, oncology, etc.). Attending physicians, hospitalists, residents, interns, and other medical professionals affiliated with the institution will usually be the ones directly interacting with patients and providing services to diagnose and treat their ailments.

In the nursing profession, the hierarchies are usually more generalized, designed to provide care to the entire hospital instead of having a head of department for each pavilion. The nursing staff is usually presided by the Chief Nursing Officer (CNO) or, in some cases, the Director of Nursing, which perform mostly administrative roles to coordinate the efforts of the nursing staff. They must, however, also remain on call and directly provide care to patients when they are required. As was mentioned above, both CNO and Director of Nursing are charged with coordinating the nursing staff, which can usually consist of hundreds of Registered Nurses, depending on the size of the hospital and the number of patients they handle. The Registered Nurses make up most of the workforce of this department, and consists of individuals have their certifications to provide assistance to doctors and provide routine care to patients. Furthermore, they are tasked with the continuous monitoring of the patient’s condition, allocating treatment plans, and keeping track of vital patient information. In this sense, nurses are usually the first responders in case of an emergency, and are tasked with providing critical care until the presiding doctor arrives, should it be necessary.

Knowing this, it quickly becomes obvious that hospitals, like any other institution, organization, or big company, relies extensively on proper coordination between their different departments and staff in order to function adequately. This coordination, in turn, relies on effective communication between each and every member of the staff. Through good communication, the staff can effectively aim their efforts towards a common goal. In this manner, the staff can satisfy patient demand, with every staff member supporting each others’ actions in case of an emergency.

But what happens when communications go awry, creating a gap between medical and nursing personnel?

A Medical Miscommunication?

Researchers at the University of Colorado have recently discovered a communicational gap between doctors and other personnel, which may significantly contribute towards patient readmission, as well as negatively impact the care each hospitalized individual receives. The problem, as reported by the aforementioned researchers, in focused mostly in the miscommunication between clinicians and home health care agencies (HHC), the latter of which is charged for the treatment and monitoring of outgoing patients as they are discharged from the facility and sent home to recuperate. Said patients usually consist of elderly patients that may struggle to take care of themselves on account of a recent medical procedure, or simply due to old age.

The report was published in the Journal of General Internal Medicine, and brings into light a number of challenges perceived in the physician - HHC relationship, citing specifically miscommunications between treatment plans, including medication lists, miscommunications regarding the person to be responsible for writing up patient care orders, impossible or difficult access to patient records, and hesitation from hospital staff to interact and remain accountable towards said home healthcare agencies.

The research, which was headed by Christine D. Jones, MD, MS, assistant professor at the University of Colorado School of Medicine, involved 6 groups consisting of HHC personnel, from 6 different agencies, where they were asked to gauge their experiences working with patients which were discharged from any referring hospital.

The results, as expected, suggested that miscommunications between the staff and HHC personnel are the among the leading causes of patient aggravation while recuperating at home, as most of them are elderly, and require the utmost care and precise communication in order to receive proper healthcare services. Some HHC nurses confessed that they are encouraged to resolve issues on their own, instead of calling the hospital to inquire about specific patient’s orders and treatment plans. Others have noted that they have gotten into trouble with certain institutions when inquiring after a certain physician and, when they manage to get a hold of the hospital staff, they receive no information alongside claims that the patient was never admitted into the hospital at all.

Another important issue mentioned in the report revolves around the bureaucracy required to issue HHC services as, in most cases, it is easier for most doctors to maintain the patient under the watchful eye of the hospital’s nursing staff instead of issuing HHC services as per the patient’s insurance provider requires. Furthermore, when the patient is issued HHC services, the medication lists are usually mixed up or outright wrong due to the long line of specialists that can be involved in the treatment of a single patient.

To these factors, the report concludes with the following suggestions:

• HHC agencies should have access to the patient’s medical records, as well as having a direct line of communication with physicians, or hospital specifically dedicated to this purpose

• Legislation which allows primary care physicians to directly issue HHC services would definitely cut down on the amount of bureaucracy required for the patients to receive said services. There is a bill pending for said law, but it has not been acted on by Congress as of yet

• Hospital clinicians must remain accountable for HHC orders until a primary care physician is available to respond and assist HHC nurses with their questions and concerns