Editorial
Is hysicianh.I rse
P
re ationship deteriorating? Has the professional relationship between the nurse and physician deteriorated? It has, according to Surgery in the United States, a report on the Study on Surgical Services for the United States (SOSSUS) conducted by the American College of Surgeons and the American Surgical Association. In the early part of the century, the physician and the nurse practiced in a professional partnership at the patient’s bedside. As the technology of medical care became more complex and the requirements for accurate medical records became more stringent, the nurse gradually evolved into a clerical and administrative aide: Most of her time was spent doing routine support work of a nontherapeutic nature. Many of her traditional duties were delegated to licensed vocational nurses and other nonprofessionals, who gradually assumed responsibility for evaluating signs and performing clinical functions at the bedside.’ Among other factors contributing to the change, the report lists ”the much smaller role of operating room and surgical nursing in the curriculum.” (For a more complete report on the SOSSUS comments on nursing, see the November AORN Journal, pages 811812.)
M
We asked several nurses on the Editorial Committee whether they believed there had been a “deterioration of her (the nurse’s) professional partnership with the physician.” They replied both yes and no. In specialty areas, the nurse/physician professional relationship appears strong. Janett Propst, associate director of nursing service and director of the OWRR at Trinity Lutheran Hospital, Kansas City, Mo, writes: If anything, I have seen a closer working relationship especially in the areas of critical care nursing in the intensive care unit, the coronary care unit, the oncology unit, the emergency room, and of course the operating room. I find physicians relying on nurses to assess needs of patients, make judgments, report findings, and make recommendations. Recently, on the oncology unit, I mentioned to a physician that it was great to see a unit where nurses made nursing diagnoses. He replied: “Up here, if a nurse can’t do that, she doesn’t belong.” More and more, the nurse is becoming the physician’s professional colleague instead of a highly paid babysitter. But in other areas, the traditional relationship seems to prevail. “Physicians must come to terms with this issue,” states Beth Reed, chairman of the Editorial Committee and head nurse at Moffitt Hospital, University of California Medical Center, San Francisco. “The traditional physician/handmaiden relationship must change to one of mutual respect and collaborative effort. By the same token, nurses must abandon futile attempts
AORN Jourrinl. Jnnuary 1976, Vol 23, No 1
11
to put the surgeon in his place. Each professional has an obvious as well as independent part to play in the practice of health care, but the two must collaborate for the patient to benefit.” She adds pessimistically, “In my experience, this rarely happens in the OR. Perhaps this is due in part to having emphasized the technical aspects of OR nursing in the past.” “Yes and no,” says Doris MacClelland, OR supervisor at the Naval Regional Medical Center, San Diego, Calif, in answer to our question. If you base the nurse/physician relationship on the old concept that nurses are the physician’s handmaidens, then yes, the relationship has deteriorated. Many physicians are upset because nurses do not pamper them as they did in the past. Also, many physicians feel that nurses are stealing their thunder-a good example is the preoperative visit. But looking at the relationship from another direction, the increased responsibilities of the specialty nurses demonstrate an increased awareness by physicians to the nurse/physician team concept. “I would agree,” writes Sister M Thomasine Hardesty, “that the dependent father-figure relationship has disappeared. But there is a new relationship, perhaps not as obvious, built on the mutual respect of the role each plays in caring for a patient. Emphasis is on the independent functions of the nurse.” Sister Thomasine is operating room supervisor at St George Hospital, Cincinnati, Ohio. She believes the change in the relationship is not so much because of the changing nature of medical practice, but is attributable to the “emancipated woman.” “Nurses are thinking more and more on their own,” writes Susan Brunke, clinical supervisor of special surgery, lmmanuel Hospital, Omaha, Neb. “They are looking for different personal and material rewards, but the nurse today is willing to go farther to attain the satisfaction she wants. Operating room nurses are moving closer to the patient and his care. “The best help the physician can give is to recognize that the OR nurse is a thinking,
12
knowledgeable member of the health care team, that her opinions are of value, that she is interested in the welfare of the patient, and that she has ceased to be the handmaiden to the surgeon. “Physicians,” she adds, “are not used to the new breed of nurse who speaks freely and honestly.” We concur with the SOSSUS report that there is a need to establish a mechanism for improved communication, both at an institutional and national level, between rnembers of the nursing and medical profession. There is no question that the relationship between nurse and physician is changing. Is it for better or worse? We would like to hear from nurses and surgeons alike on the changing relationship of nurse and physician including suggestions for improving it. What mechanisms could be established for improved communication? We think a positive aspect of the change is reflected in the following anecdote. The surgeon greeted the OR nurse with a cheerful, “Are you working for me today?” Gently she replied, “I think the current concept is, ‘Are you working with me today?’” What a difference a preposition makes.
Elinor S Schrader Editor Notes 1. Surgery in the United States, The American College of Surgeons and the American Surgical Association, (1975) 149.
New ANA editor Shirley H Fondiller, RN, MA, EdM, of New York City, is the new editor of The American Nurse, the official newspaper of the American Nurses’ Association (ANA). Ms Fondiller assumed her new post at ANA headquarters in Kansas City on Sept 2.
AORN Journal, January 1976, Vol23, N o 1
Is hysicianh.I rse
P
re ationship deteriorating? Has the professional relationship between the nurse and physician deteriorated? It has, according to Surgery in the United States, a report on the Study on Surgical Services for the United States (SOSSUS) conducted by the American College of Surgeons and the American Surgical Association. In the early part of the century, the physician and the nurse practiced in a professional partnership at the patient’s bedside. As the technology of medical care became more complex and the requirements for accurate medical records became more stringent, the nurse gradually evolved into a clerical and administrative aide: Most of her time was spent doing routine support work of a nontherapeutic nature. Many of her traditional duties were delegated to licensed vocational nurses and other nonprofessionals, who gradually assumed responsibility for evaluating signs and performing clinical functions at the bedside.’ Among other factors contributing to the change, the report lists ”the much smaller role of operating room and surgical nursing in the curriculum.” (For a more complete report on the SOSSUS comments on nursing, see the November AORN Journal, pages 811812.)
M
We asked several nurses on the Editorial Committee whether they believed there had been a “deterioration of her (the nurse’s) professional partnership with the physician.” They replied both yes and no. In specialty areas, the nurse/physician professional relationship appears strong. Janett Propst, associate director of nursing service and director of the OWRR at Trinity Lutheran Hospital, Kansas City, Mo, writes: If anything, I have seen a closer working relationship especially in the areas of critical care nursing in the intensive care unit, the coronary care unit, the oncology unit, the emergency room, and of course the operating room. I find physicians relying on nurses to assess needs of patients, make judgments, report findings, and make recommendations. Recently, on the oncology unit, I mentioned to a physician that it was great to see a unit where nurses made nursing diagnoses. He replied: “Up here, if a nurse can’t do that, she doesn’t belong.” More and more, the nurse is becoming the physician’s professional colleague instead of a highly paid babysitter. But in other areas, the traditional relationship seems to prevail. “Physicians must come to terms with this issue,” states Beth Reed, chairman of the Editorial Committee and head nurse at Moffitt Hospital, University of California Medical Center, San Francisco. “The traditional physician/handmaiden relationship must change to one of mutual respect and collaborative effort. By the same token, nurses must abandon futile attempts
AORN Jourrinl. Jnnuary 1976, Vol 23, No 1
11
to put the surgeon in his place. Each professional has an obvious as well as independent part to play in the practice of health care, but the two must collaborate for the patient to benefit.” She adds pessimistically, “In my experience, this rarely happens in the OR. Perhaps this is due in part to having emphasized the technical aspects of OR nursing in the past.” “Yes and no,” says Doris MacClelland, OR supervisor at the Naval Regional Medical Center, San Diego, Calif, in answer to our question. If you base the nurse/physician relationship on the old concept that nurses are the physician’s handmaidens, then yes, the relationship has deteriorated. Many physicians are upset because nurses do not pamper them as they did in the past. Also, many physicians feel that nurses are stealing their thunder-a good example is the preoperative visit. But looking at the relationship from another direction, the increased responsibilities of the specialty nurses demonstrate an increased awareness by physicians to the nurse/physician team concept. “I would agree,” writes Sister M Thomasine Hardesty, “that the dependent father-figure relationship has disappeared. But there is a new relationship, perhaps not as obvious, built on the mutual respect of the role each plays in caring for a patient. Emphasis is on the independent functions of the nurse.” Sister Thomasine is operating room supervisor at St George Hospital, Cincinnati, Ohio. She believes the change in the relationship is not so much because of the changing nature of medical practice, but is attributable to the “emancipated woman.” “Nurses are thinking more and more on their own,” writes Susan Brunke, clinical supervisor of special surgery, lmmanuel Hospital, Omaha, Neb. “They are looking for different personal and material rewards, but the nurse today is willing to go farther to attain the satisfaction she wants. Operating room nurses are moving closer to the patient and his care. “The best help the physician can give is to recognize that the OR nurse is a thinking,
12
knowledgeable member of the health care team, that her opinions are of value, that she is interested in the welfare of the patient, and that she has ceased to be the handmaiden to the surgeon. “Physicians,” she adds, “are not used to the new breed of nurse who speaks freely and honestly.” We concur with the SOSSUS report that there is a need to establish a mechanism for improved communication, both at an institutional and national level, between rnembers of the nursing and medical profession. There is no question that the relationship between nurse and physician is changing. Is it for better or worse? We would like to hear from nurses and surgeons alike on the changing relationship of nurse and physician including suggestions for improving it. What mechanisms could be established for improved communication? We think a positive aspect of the change is reflected in the following anecdote. The surgeon greeted the OR nurse with a cheerful, “Are you working for me today?” Gently she replied, “I think the current concept is, ‘Are you working with me today?’” What a difference a preposition makes.
Elinor S Schrader Editor Notes 1. Surgery in the United States, The American College of Surgeons and the American Surgical Association, (1975) 149.
New ANA editor Shirley H Fondiller, RN, MA, EdM, of New York City, is the new editor of The American Nurse, the official newspaper of the American Nurses’ Association (ANA). Ms Fondiller assumed her new post at ANA headquarters in Kansas City on Sept 2.
AORN Journal, January 1976, Vol23, N o 1
