She poured hot tea over one of the patients, and a nurse was hurt in the fracas whilst trying to contain her.’. 2009 Feb;24(2):198-204. doi: 10.1007/s11606-008-0869-5. Mattsson, Bengt Unfortunately, they soon discovered that they had switched one medically dominated field for another, in which GPs referred to them patients with complex problems and left them to their own devices, without the support of a psychiatric team. a over 75% of the nurses questioned are satisfied with their relationships with doctors, b half of the nurses questioned thought that they were on an an equal footing with doctors, c most CPNs would prefer to work in a primary care setting, d nurse stress and burnout is greater in in-patient settings. Changes in the workplace are reflected in professional and institutional norms (e.g. This is particularly true in the in-patient setting and in the treatment of people with serious mental illnesses, where it becomes the dominant dyad, affecting other multidisciplinary interactions and, in particular, the nature of the association with patients. Many studies and literature reviews have touched upon the dynamics of the doctor-nurse relationship in a hospital setting. Patients and their families are also major players in the current culture of litigation, and the consequent emphasis on risk management can induce defensive practices on the part of both doctors and nurses. 2013. Although this model still carries some validity, modern changes in nurses’ roles, particularly the introduction of clinical nurse specialists, nurse consultants and modern matrons, indicate major shifts in influential positions which are now fairly well established (Department of Health, 2003a Although the decision to admit rests finally with doctors, it is helpful to make explicit that different staff will be able to contribute different knowledge to the decision-making process. There is some suggestion that nursing turnover, especially in metropolitan districts, is increasing, making it even more likely that doctors will ‘hold the history’ of patients. Modern psychiatry now takes place in a number of different locations in addition to the acute in-patient ward. Nurses feed into this denial by not openly challenging the doctors’ omnipotence. I recently started a new job where I get a first hand look at this (I am only a student) and it is very depressing. Psychiatric practice depends to a substantial degree on a good understanding between nurses and doctors. for this article. BMC Nurs. • Make sure that your clinical decisions are well understood by others and that you have covered all contingency plans and set review dates, • When giving instructions make sure that you address them to the senior nurse, who will delegate to other nurses if necessary, • Do not volunteer nurses to carry out a task without asking them first, • If you pick up early signs of disgruntlement, particularly with any decisions that you have made, don’t let things fester, thinking that the problem will go away: be prepared to be criticised and to make changes to your clinical judgements when appropriate, • When delegating, do not presume that nurses are there to carry out menial tasks or that they are less busy than you are: it might take the same time to explain what you want done, as to do it yourself; some tasks, such as finding out information or sending invitations to care programme approach meetings, can be carried out by administrative or clerical staff, • Create a culture in which all team members are encouraged to contribute and air their views, • Discuss with nurses how they can take a leading role in ward reviews, organising priorities for discussion and timetabling of invitations to outside agencies and carers, • Be prepared to muck in when there is a crisis: this may involve active participation in the control of a patient who is aggressive or agitated, • Ensure that safety is high on your agenda; attend health and safety meetings with nurses, • Let nurses know well in advance when you will and will not be available, • When serious incidents occur, such as an unwarranted physical assault on a member of staff or a suicide on the ward, attend and lend support at the debriefing session, share feelings openly with staff involved and present an united front when having to address these issues with managers, patients and carers, • Acknowledge and give recognition to nurses’ skills when the opportunity arises, and publicise them to outside agencies and management, • Emphasise the team approach, the need for collaboration and mutual dependency on each other’s skills; refer to yourself as a member of the team, • Be prepared to support nurses when they have arrived at decisions and independent judgements in your absence, even if you have reservations about them or they have had negative consequences; review judgements fairly in open, frank discussion in circumstances where all staff can feel comfortable, • Have regular staff meetings, preferably chaired by nurses, and be prepared to take action when required; meet with the nurse manager and other senior staff to discuss policy, philosophy of care and management issues, • If possible, organise away-days with the in-patient team, with workshops and interactive sessions, attended when appropriate by an external facilitator; this will give everyone time to think about topics that you do not have time to deal with during everyday practice, • Be aware that your main role is to contain anxiety in a very stressful environment and one that exerts a considerable emotional strain on the nursing staff; it is expected that senior doctors will ‘sort it out’ and that they ultimately carry clinical responsibility, The following areas present opportunities for practical arrangements for joint working, • Joint training updates on, for example, control and restraint techniques in the management of violent, aggressive patients; resuscitation, management of anaphylactic shocks and epileptic seizures; child protection issues; benefits and housing; mental health law; human rights, • Joint assessments, in crisis resolution teams, community mental health teams, at the point of admission to hospital, on prison visits, in the out-patient clinic and during a domiciliary visits, • Joint opportunities for therapeutic interventions, for example in ward settings in in-patient groups, in family work or in consultations with outside agencies and services, • Work on programmes dealing with adherence to medication regimes, • Care programme approach plans and meetings, • Joint clinical audits examining areas of clinical practice, • Arranging for nurses to train junior doctors in their initial placements on acute wards, or in their first forays into community care, • Arranging for doctors to train junior nurses in aspects of clinical assessments, diagnosis and treatments, • Joint presentations and publications on clinical practice.
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