Thursday, September 19, 2013

DOCTORS AND NURSES, AN AGE-LONG ROMANCE IN SHAMBLES


In her very inspiring presentation on TEDtalk, ‘The Danger of a Single Story’, sublime and quintessential writer, Chimamda Adichie alluded to the fact that the point at which we begin to tell a story has a huge impact on the effect it produces. So without any prejudice to the history of doctor/nurse relationship, I intend to discuss this age-long romance in the light of the fate it has rolled into in twenty-first century. Suffice it to say that the relationship between these two professional groups in the health sector has never been symmetrical. Doctors are firmly rooted at the top of the health team, and even though nurses, especially in this dispensation of professional growth, often offer expert advice about patient care, they, like other health workers, have always been expected to defer to doctors. Thus, it is not remotely surprising that nurses are asking for a ‘divorce’ in their ageless marriage with doctors, and their voices have become louder in this century. The impact of this especially in a fragile economy like ours is far-reaching, and could bring the health sector on its wobbling knees.

In this century, much has changed in the health care environment. The knowledge gap between doctors and nurses is closing especially in the developed economies where there is almost a desperate need for cheaper primary healthcare providers than doctors. In serious-minded climes, the now well recognized fact that interdisciplinary collaboration and good communication are crucial to patient care has led to the formation of  institutional frameworks that seek to reduce relational friction between the various key players in healthcare delivery for the good of the patient and the professionals in the healthcare sector as well. The Nigerian situation, however, is a parody of the global trend where nurses have joined hands with other health worker in the so-called Joint Health Sector Union (JOHESU) to insist that their bit in healthcare delivery is equally important or even greater than that of doctors. That is a risky political solution to a professional malice.

Nursing and medicine are inseparably intertwined. Patient outcome is directly related to the diagnostic and treatment skills of the doctor alongside the nurse’s observational skills and ability to communicate the right information to the appropriate professionals. In some settings, doctors are involved in the training of nurses, just as nurses help the young doctors through certain skills during their soft years on the wards. In principle, both fields of study do not conflict. The problem lies in the practice! The fracture in the relationship between doctors and nurses is rooted in human factors such as personalities, attitudes, feelings, and communication styles. In the next paragraphs, I will explore a few of these factors contributing to the souring doctor/nurse relationship and suggest ways to for the wife to return to her husband.

For reasons we can all recall, the field of medicine has an enormous historical prestige which it has carried through different civilizations. This prestige easily rests on the shoulders of a medical graduate, albeit alongside a huge responsibility. The same predisposes the average doctor to pride and breeds jealousy and admiration daily along his path. Hence disruptive behaviour among doctors towards other members of the health team is not uncommon. Such disruptive behaviours may come in form of outright disregard of clinical opinions of nurses, publicly correcting or denigrating a nurse on the bedside, etc. Sometimes, it is sheer impatience with a not-so-experienced young nurse doing a procedure especially by older doctors. The doctor has gotten away with some of these, and enjoyed an age-long subservience from the nurses on the wards. The nurses are beginning to lose it. This particular factor is magnified in female-doctor/female-nurse relationship.

Again, there is the subtle class issue. Previously, most nurses come from lower social classes than most doctors. Their remunerations, which have come off research materials as related to their job satisfactions, are widely apart. However, this is also changing as the class backgrounds of those entering nursing and medicine tend to be more equal now. A more important factor, however, is the difference in educational level between most nurses and the doctors who work with them. Current reports attest to a mild "acceptance" by some nurses that the power level between nurses and physicians will always be unequal because doctors generally have more education than most nurses. It is a common saying that nurses are trained, but doctors are educated. This in my considered opinion is where the balance of power is, and until the nurses approximate that gap, their divorce notice to doctors will remain self-ridicule.

Furthermore, it is a researched truism that poor communication between nurses and physicians is the most important factor causing dissatisfaction with nurse/doctor working relationships. Communications failure between doctors and nurses does not only weaken their working relationship, but it also has fatal implications on the patients. It is related in a predictable way to the dismissive attitude of doctors towards nurses, the differing levels of educational attainment as well as the social standing of the two closely related professional groups.

It is instructive to note that the chaos that has befallen doctor/nurse relationship is virtually absent in the private sector. There is no gainsaying the fact that private health facilities record better patient outcomes than their public counterparts. Maybe public health institutions should borrow a leaf from them. Articles such as this usually end with a call for all professionals in health sector to respect one another and work coherently for the good of the patient. That’s all!





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