Repairing the Nurse-Doctor Rivalry: How this Often-Tense Relationship Can Work for Everyone

Doctors and nurses are two of the most crucial positions on the healthcare team and have the greatest impact on patient care. To deliver patient care as effectively and efficiently as possible, they must work together harmoniously, often in high-pressure situations.

Workplace conflict is inevitable to some degree, no matter where you work. But in healthcare, there are exacerbating factors, including the often literal life-or-death stakes that are the reality in patient care. Insulting, even dehumanizing behavior from physicians, for example, has a long-documented history of degrading morale and team cohesion — not to mention clinical care itself.

A survey by The American Journal of Nursing reported that 92% of respondents had witnessed disruptive physician behaviors.

Proverbial “bad apples” are everywhere (nurses included). So it’s essential to understand this all-important interpersonal dynamic — some might say rivalry — from a historical perspective to seek meaningful solutions.

A significant power dynamic exists between doctors and nurses with a gendered component. Doctors write orders and create a plan of care for the patient, while nurses follow those orders and provide most of the actual patient care. And for most of modern medicine, doctors were men, and nurses were women.

While women physicians (and male nurses) are far more common today than in decades past, tensions still frequently flare. Dismissive, condescending, or bullying behaviors, and the conflicts and miscommunications they cause, can have life-altering consequences in healthcare. For example, one study attributed a daunting 60% of medical errors to miscommunication among staff.

Interestingly, doctors report a more positive view of doctor-nurse relations than their nursing colleagues, which undoubtedly contributes to the problem. If the relationship is dysfunctional and only one party is aware of it, miscommunications are likely to continue. The nurse and the doctor must both be aware of the troublesome dynamic they’ve entered into and feel empowered and invested in speaking up to find a solution.

Today, doctors and nurses work in an exquisitely complex, convoluted, fractured healthcare system.

Nurses are burdened by short staffing, an epidemic of workplace violence, and minimal institutional support, leading to well-publicized epidemics of burnout and departures from the profession.

Physicians — especially residents — also face tremendous rates of burnout and mental health challenges. All taken together, it’s a perfect storm for conflict.

And while most healthcare professionals (and patients) likely have at least one memory of interacting with an unprofessional nurse or doctor, workplace miscommunications can still be prevented or resolved in a healthy manner.

Conflict is most likely to occur in high-stress situations when decisions must be made quickly and implemented even quicker or when coworkers don’t know each other well. One misunderstanding can easily slide into tension, frustration, or shame, making work miserable.

We know a poor relationship between doctors and nurses harms them and their patients, but how

do you foster a healthy relationship with your healthcare peers?

Everyone has different communication and conflict styles, and nurses must learn how to collaborate with dozens of coworkers, all of whom may have different approaches to communication and conflict resolution.

One study examined the different conflict styles between physicians and nurses in the primary care setting, which included:

Compromising and avoiding were the two most common conflict resolution styles in the study.

No one conflict style is “better” than the others, and each style is capable of manifesting in productive and unproductive ways. Each can play a role in the complex, ever-changing demands of professional relationships between doctors and nurses.

For example, suppose conflict has arisen between a doctor and nurse who don’t like each other but can accomplish their patient care tasks and collaborate when necessary. In that case, they can avoid extra interactions like small talk. But if that same pair were constantly butting heads and thrust into a medical emergency, avoidance could end in catastrophe for their patient.

While the conflict resolution style and communication strategy you use will vary based on the person and situation, a few tenets usually hold true.

If you find yourself having tense or unpleasant interactions with a doctor repeatedly, try to first speak to them privately about it. Oftentimes — particularly in emergencies — we don’t know how we’re coming off. A simple conversation may be enough to enlighten them about how their words or actions are affecting you.

If that doesn’t work, try these tips.

It’s difficult to make good decisions when you’re highly stressed. While you can never control the world around you, you can control the world within you.

Stress causes a cascade of hormones in your body with physical repercussions. Your heart may race, your blood pressure rises, or your jaw clenches. When we get activated by a stressful event, our bodies enter a fight, flight or flee response.

A rude comment from a colleague or a patient yelling at you can trigger this response. It’s easy to make snap decisions and say something you don’t mean at that moment.

Suppose you find yourself getting activated by an interaction at work. First, create the space you need to regulate yourself. For example, go for a walk, tell the person you will get back to them, find a spot alone, and do some breathing exercises. These activities allow you to regulate your body and signal to your brain that you are safe.

One of the most stressful situations in nursing is calling a doctor at home in the middle of the night or giving a report on a decompensating patient. It can be scary when you’re new, but it’s essential to remember: we are all here for the patient.

A tool you may have learned in nursing school that you should use daily as a nurse is giving an SBAR report. This framework will help you organize your thoughts and give a great report without rambling or stumbling over your words. If you’re nervous, write down the details beforehand and read it like a script. This will help you feel confident communicating with the doctor, and it shows you know your stuff and value their time by being prepared.

This makes a huge difference and will help build trust and appreciation when talking with providers.

To give an effective SBAR report, each “letter” should be short, without fluff. One or two sentences at most.

If you find yourself in a situation with a doctor whose behavior is completely out of line or who rebuffed your attempts to mend things, you must use your resources.

First, start by talking to a trusted peer. A more experienced nurse on the unit may have mastered communicating with the doctor in question and have tips to share. If that’s not an option, you can talk to your nursing leadership and ask for their advice.

In the advent of a truly toxic doctor, your nurse leadership will need to reach out to that doctor’s managers. So it’s important you follow that chain of command by speaking with your manager first.

The doctor-nurse relationship has a long and sometimes fraught history, but you can build great relationships with your physician colleagues. You can build mutual trust and collaboration by seeking to understand and cultivate relationships with the doctors on your team, leading to better patient care and a more enjoyable work environment for you.

Emotional regulation is also crucial in any stressful job, and being a nurse or a doctor in any practice setting can be stressful. Lastly, using the SBAR report method when communicating with doctors can help streamline the process and minimize miscommunications or missing crucial information.