© 2006, AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses JOGNN 537

Respectful Professional Interactions Between Nurses and Physicians as an Integral Aspect of Safe Perinatal Care

This Clinical Issues series on perinatal patient safety is presented in two parts. In part 1, the focus was on op-erational and technical strategies for promoting safe care and methods to measure success. In part 2, attention is directed to interdisciplinary interactions and perinatal teamwork, an integral aspect of safe perinatal care.

The hierarchical nature of the health care system has signifi cant consequences that can lead to patient harm. Unless all members of the team are empowered to act and speak freely and openly in clinical situa-tions, potentially dangerous clinical environments are fostered and patient well-being is at risk. Some may believe that the contributions of one discipline are more important than those of all other disciplines. In some ways, nurses have enabled this view by unwar-ranted deference and appearing to be submissive, while developing alternative strategies to achieve de-sired patient outcomes. These include the “ doctor-nurse game ” and other communication work arounds. Most experienced nurses know these strategies all too well, but others, especially nurses new to the profes-sion, may be intimidated into silence and acquies-cence rather than respectful assertiveness, when it is in the best interests of our patients to speak up.

It is time to move beyond these dysfunctional, albeit intermittently effective, communication and interac-tion techniques to more healthy working relationships. The differing perspectives of members of the perinatal team enhance patient safety when the unique aspects of each discipline are supported and celebrated.

We actually have quite a bit in common. Care, com-passion, and the will to do the right thing come from the heart and soul and are not related to years of educa-tion. Knowledge of science and current standards and guidelines is not discipline specifi c. We all are account-able for keeping up to date and practicing accordingly. We all have an ethical and professional responsibility to do our best to keep patients safe from harm.

Each member of the team has an important part in providing safe care, although our roles and responsibili-ties vary. Different perspectives and contributions are just that: different, not better, and not less important. All members of the team must know that expressions of their clinical perspectives are welcomed and most im-portantly are an expected professional responsibility. The different but equal contribution of nurses to the care process and ultimate clinical outcomes should be recognized, respected, and valued as a fundamental sys-tem component of safe care. We can make this a reality by being highly knowledgeable care partners and en-gaging in respectful, appropriately assertive conversa-tions and interactions with our physician colleagues concerning clinical practices and unit operations.

The 1st article in part 2 of the perinatal patient safety Clinical Issues series is a review of the literature on communication and teamwork with a discussion of potential application of what is already known about these topics to care during labor and birth. Gaps in the literature are identifi ed and suggestions for future re-search are offered. In the 2nd article, a multicenter re-search project regarding nurse-physician interactions during labor is presented along with implications for perinatal patient safety. Finally, the challenges of im-plementing a perinatal teamwork initiative within the context of a busy clinical environment are presented in detail in the 3rd article. The promise of team training in improving clinical outcomes has yet to be docu-mented, although it would seem obvious that working together as an effective team would promote safer care. We hope that these articles will result in interdisci-plinary discussions about the current state of our pro-fessional relationships and behaviors, lead to changes in how we interact on a daily basis, and ultimately help promote safer care for mothers and babies.

Kathleen Rice Simpson , PHD , RNC , FAAN Guest Editor

CLINICAL ISSUES EDITORIAL