MAY 1992. VOL S 5 . NO 5 AORN JOURNAL

Editorial

‘Physician bonding’ - an insult to both physicians and nurses

orgive my naivete, but I always accepted F without question that nurses’ primary responsibility was to their patients. Period. Patient care is the core of all educational pro- grams designed to prepare registered nurses. Most nurses accept quality patient care as the core of the nursing profession, most patients expect it, and most physicians appreciate that value as well. No questions asked. Right’? Well, maybe. A Washington, DC, marketing research firm says otherwise.

In a “red book” available only to its cus- tomers, The Advisory Board Company strongly recommends that hospitals establish a “physi- cian bonding” sys tem. Trans la ted , that euphemism means that nurses should bond with physicians for the sole purpose of keeping them happy, returning customers. This is not a joke; it is a 1990s answer to customer satisfaction.

Incredulous, you say? Well, it gets worse. Results of a long-term study conducted by The Advisory Board Company “discovered” that a hospital must assure physician satisfaction with its services if it wants to keep the physician’s business. In its report, the company provides a hypotheti- cal calculation showing potential revenue of approximately $3 mil- lion if only 20 physicians decide to shift their business to a hospital because of its “superlative service quality for physicians.”

The recommendations all cen- ter on enhancing physician loy- alty through personalized nurs-

ing care, easy (ie, on-time) OR access, and instant information access. Nowhere in those recommendations is quality patient care dis- cussed.

According to this consulting firm. personal- ized nursing care is provided to physicians by “attending nurses” whose sole job is to act as the physicians’ advocates in the hospital and to clear away “frustrations.” An attending nurse does not provide any patient care but instead remains readily accessible to the physician, car- ing for his or her every whim. The nurse’s goal is to increase the physician’s sense of control over the hospital environment and to teach other nurses (who presumably are caring for patients) how to satisfy the physician’s needs. The suggestion that physicians need or want professional nurses to be dedicated to them in this way is an insult to members of both the nursing and medical professions.

The company sees two great advantages to this system. It views the position of attending nurse as a formal way of signaling to physi-

cians that they are the hospital’s first priority. It also promotes the concept of attending nurses serving as “shock absorbers” for physicians-a per- ceived value of the highest order.

With unabashed nerve, the report lists 10 duties attending nurses could perform. Among those duties are tasks such as continually updating physician preferences; being accessible when physicians want to make rounds or

Pat Niessner Palmer anytime the physician wants a “run

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down” on patients; and acting as liaison with others to resolve conflict. The company stops short of suggesting nurses stand when a physi- cian enters the room.

On-time access to the operating room is another goal to be achieved to keep physicians happy. Even though the “study” acknowledges that most delays are caused by inaccurate esti- mates of procedure time and surgeons who are late, the company recommends a computer scheduling system and establishment of “OR pit crews” to eliminate “slothful cleanup.” How the computers will engender physicians’ good- will is yet to be understood. 1 suspect the oppo- site would result. As far as the pit crews are concerned, their goal is to achieve perfect turnaround times by rushing in at the end of a case, Indianapolis 500-style, to impress sur- geons.

Given all the serious and complex problems in today’s health care delivery system, this lat- est set of recommendations leaves me angry and frustrated. I am angry that a consulting firm is making money by putting down the nursing profession under the guise of physician satis- faction. The mere thought that some hospital administrator might believe this nonsense makes me livid.

The reputation of a hospital depends on quality patient care, not the presence of physi- cian bonding. Quality patient care is enhanced by true collaborative practice, not by one pro- fessional catering to the other at the expense of patients who depend on their professional care.

PAT NIESSNER PALMER, RN, MS

EDITOR DEPUTY EXECUTIVE DIRECTOR

Hospitals ’ Educational Requirements Vary Recent data from the American Hospital Association show that hospitals’ educational requirements for RNs vary. Most hospitals require only licensure as an RN for staff nurse positions. According to an article in the Dec 9, 1991, issue ofAHA News, about 31% of US hospitals require at least a bachelor’s degree for head nurse and supervisor positions. More than 32% require at least a bachelor’s degree for assistant or associate nurse administrators.

Only 0.8% of hospitals require a master’s degree for their head nurses; 1.9% require a master’s degree for supervisors. Master’s degrees are more likely to be required at high- er levels. About 27% of hospitals require a master’s degree for the assistant or associate nurse administrator. A master’s degree is required for about 45% of chief nurse execu- tive positions.

full-time RNs in hospitals have bachelor’s degrees in nursing or in another field.

The same survey shows that only 23.9% of

Laser Treatment for Hemangiomas Benign hemangiomas and related vascular tumors now can be treated successfully with several types of lasers, according to a January 1992 Medical News Alert press release from University of California, Davis, Medical Center.

these tumors during their first year were forced to live with them until they disappeared, usual- ly when they were about eight years old. These tumors appear in one of every 1,500 infants and, according to the release, can become extremely large and disfiguring.

Although vascular tumors can appear any- where on a child’s body, at least half of them develop in the head and neck area, including below the larynx, around the trachea, and in the brain. Because of complications that can arise, the treatment of these tumors often requires an interdisciplinary approach to care, according to the release.

Until recently, children who developed

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