Is the Nurse-Doctor Rivalry Real?
In an ideal world, all professionals would effortlessly coexist in the workplace, but just like in any other field, conflict often arises among staff members in the healthcare industry.
One type of conflict specific to the healthcare industry is the so-called "nurse-doctor rivalry." This clash between the two types of healthcare professionals has grown from its historical roots to evolve within the modern workplace. Although it may not play out in all healthcare settings, doctors and nurses overwhelmingly admit to witnessing behaviors stemming from the rivalry.
In this guide, we spoke to doctors and nurses about their experiences with the nurse-doctor rivalry. These experts share insight into the topic and offer advice on how to alleviate the conflict or avoid it altogether.
The Relationship Between Nurses and Doctors
To fully understand the relationship between these two professionals, you need to go back in time -- about 170 years -- to when the modern nursing profession began.
Florence Nightingale established the first nursing schools in 1850s-era England. Women primarily took on nursing roles during this time, which carries on as a stereotype to this day. The prevailing mindset during that era considered female nurses to be assistants to male doctors.
Even in the 1950s and 1960s, "the nursing role was considered subordinate to the physician, who demonstrated a more paternal relationship where nurses would be expected to literally give up their seat to the physician when (he) entered the unit," said Nicholas McGowan, a critical care nurse who manages the Critical Care Academy.
"This is entirely different today, of course," McGowan added. "Nurses are more educated in an established profession and are regarded as 'colleagues' and 'team members' who are trained to critically think and question physicians' orders."
Still, division between the professions continues today, particularly between physicians and nurses at the advanced practice level of nursing.
Unfortunately, although the relationship between nurses and doctors has evolved since the 19th century, fissures still appear in the workplace today.
In 2009, a survey found that almost 98% of respondents reported seeing behavior problems between doctors and nurses within the previous year. About 85% of respondents said they experienced degrading comments and insults. Other common behaviors included yelling, cursing, and inappropriate joking.
Although that survey published its results about a decade ago, experts maintain that these behaviors persist in the workplace -- and these days, they even pop up on social media. When it comes to advanced practice nurses (APNs), many in the healthcare industry still believe that nurse practitioners (NPs) do not provide the same level of care as physicians.
"As the education, salary, and practice level of the nurse advances, the more likely there is for conflict and rivalry among physicians," McGowan said.
That said, not all doctors and nurses experience this rivalry at their healthcare facilities.
"That just wasn't part of my 20+ year career," said Cynthia Thurlow, NP and CEO/founder of the Everyday Wellness Project. "Most MDs, nurses, APNs got along and shared a common theme...helping and serving others."
How This Conflict Affects the Workplace
The consequences of any conflict between doctors and nurses can sometimes directly affect the quality of patient care, employee job satisfaction, and employee wellbeing, according to a 2014 report from the Internet Journal of Healthcare Administration.
"The unfortunate consequences of the nurse-doctor rivalry is that it contributes to a toxic environment which can make you not want to go to work," said Dr. Daniel Paull, an orthopedic doctor in Colorado. "Also, the patient can sometimes be stuck in the middle of this, and their care may suffer as a result of battling egos."
Healthcare facilities can mitigate these conflicts by implementing strict policies against workplace conflict and addressing negative conflict early on, the report concluded.
Paull echoes that sentiment: "There needs to be a zero-tolerance policy... as hospitals can be a hotbed for toxic activity," he said.
McGowan also emphasizes the importance of actively encouraging communication and cooperation between all levels of healthcare staff.
"It is vital for healthcare settings to establish healthy work environments and systems that encourage true collaboration between interdisciplinary team members," McGowan said.
Advice for New Nurses Navigating the Nurse-Doctor Relationship
Nurses and doctors alike advise recently-graduated nurses to communicate with doctors and comfortably ask them questions. Establish a friendly and respectful relationship early, and it will remain easier to carry those types of professional relationships throughout your career.
"Seek out opportunities to learn," Thurlow said. "I always had nice relationships with MDs, even as a new ER RN, because I was always willing to ask questions, be collegial, and further my knowledge."
Remember: you and the doctors are ultimately on the same side.
"Most doctors want to work with you to deliver the best care for their patients," Paull said. "Just know that you guys are on the same team and have the same goals. While there are some doctors who are just plain mean, they usually are in the minority. If you happen to be in a place where everyone is nasty, get out and find a better job where people respect each other."
Meet Our Contributors
Nicholas McGowan, BSN, RN, CCRN, holds 10 years of experience in cardiovascular, surgical intensive care, and neurological trauma nursing. He served as president of the AACN Inland Empire Chapter and led over 500 members in the Southern California region. Nicholas also piloted the rapid response program for one of the largest healthcare organizations in the nation. He now manages the Critical Care Academy and consults with regional healthcare organizations.
Cynthia Thurlow is a globally recognized expert in nutrition and intermittent fasting and CEO/founder of the Everyday Wellness Project. As a 20+ year NP, she has also performed twice as a TEDx speaker, with her second talk on intermittent fasting reaching over 6 million views. She has been featured on ABC, FOX5, KTLA, CW, and in Medium and Entrepreneur. She's also the host of Everyday Wellness podcast, which was listed as "20 Podcasts That Will Help You Grow in 2020" by Entrepreneur magazine.
Dr. Daniel Paull, MD, currently practices at Easy Orthopedics in Colorado. He received his undergraduate degree from NYU and his MD from University of Miami Miller School of Medicine.
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