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Discrepant attitudes about teamwork among critical care nurses and physicians
Eric J Thomas1, J Bryan Sexton, Robert L Helmreich
1University of Texas-Houston Medical School, Department of Medicine, Division of General Internal Medicine, USA.
Objective:
To measure and compare critical care physicians' and nurses' attitudes about teamwork.
Design:
Cross-sectional surveys.
Setting:
Eight nonsurgical intensive care units in two teaching and four nonteaching hospitals in the Houston, TX, metropolitan area.
Subjects:
Physicians and nurses who worked in the intensive care units.
Measurements And Main Results:
Three hundred twenty subjects (90 physicians and 230 nurses) responded to the survey. The response rate was 58% (40% for physicians and 71% for nurses). Only 33% of nurses rated the quality of collaboration and communication with the physicians as high or very high. In contrast, 73% of physicians rated collaboration and communication with nurses as high or very high. By using factor analysis, we developed a seven-item teamwork scale. Multivariate analysis of variance of the items yielded an omnibus ( [7, 163] = 8.37; p <.001), indicating that physicians and nurses perceive their teamwork climate differently. Analysis of individual items revealed that relative to physicians, nurses reported that it is difficult to speak up, disagreements are not appropriately resolved, more input into decision making is needed, and nurse input is not well received.
Conclusions:
Critical care physicians and nurses have discrepant attitudes about the teamwork they experience with each other. As evidenced by individual item content, this discrepancy includes suboptimal conflict resolution and interpersonal communication skills. These findings may be the result of the differences in status/authority, responsibilities, gender, training, and nursing and physician cultures.