Doctor nurse relations: Who to blame?

Shams Ud Duha
This article is going to be a layman’s attempt to explain and signify the relationship between two crucial actors in the theatre of health care: a doctor and a nurse. The little experience that I gather through teaching at a medical institute; I have, very well, understood the necessity and emergency of maintaining a professional and amicable relationship between these two key players in providing quality health care to patients.

But does the current situation reflect my understanding of setting up equal opportunities for both of the players? Do these two counterparts respect and trust each other to the extent of considering the scenario an acceptable one? If all the answers to my questions are ‘no’, then, what are the problems that are responsible for not being the case which we, all, are so badly expecting for our own sake?
If it is unanimously agreed that better health care is the direct outcome of better doctor-nurse relationship, what drawbacks are liable for not making it into the reality and on the part of whom we may blame?

Are our doctors illogically not paying the due respect to the nurses or are our nurses not skilled or educated enough to deserve trust and respect from the doctors? When it comes to ensure the quality care for the patients, we must hammer out both of the issues.     

Let us imagine two ‘yet to come’ but expected realities: the doctors find confidence in nurses’ delivery of services and nurses do not feel marginalized in interacting with the doctors. These two scenarios are highly expected but still imaginary. How can we bring about or ensure these changes in the healthcare services?

It might be true that most of the nurses are still diploma nurses and their knowledge is not up to the mark to work efficiently with the doctors. But how long will we ourselves or the doctors themselves allow this to happen? What will be the use of their instruction to be carried forward by the nurses if the nurses are not well educated and skilled? So, in a way, what will be the use of their education without educating the nurses?

It is more of a responsibility of the doctors to educate and enlighten the nurses not for the sake of the nurses but for the sake of themselves and for the sake of the effective healthcare. In order to do that, empowering nurses and building a friendly environment for exchanging experience and knowledge is very important on the part of the doctors.

On the other hand, should the nurses take it for granted that they will always be mistreated by the doctors? Should they only focus on the mistreatment rather than focusing on the shortcomings that they have for improvement. Theodora Sirota in her article ‘Nurse/physician relationships: Improving or not?’ wrote:

‘It is not surprising that nurses and physicians still have relationship problems because these conflicts are rooted in human factors such as personalities, attitudes, feelings, and communication styles. For things to change, nurses have to approach the problem directly and initiate strategies to improve things, rather than merely complaining about them.’

When asked to share his opinion, Shamim Ahmed a public health professional and development economist from WaterAid raised his concern regarding client-provider relationship in the public health sector of Bangladesh. He said, "In a country like Bangladesh, where number of doctors is inadequate to serve the huge number of population, nurses can take an effective role. Nurses, paramedics, midwives are crucial for ensuring appropriate health services in both urban and rural areas.

Role of a nurse is very critical in hard to reach areas where doctors don't want to go and serve most of the times. However, to ensure a state of the art in maintaining excellent client-provider relationship, a friendly and understandable relationship between the doctors and nurses are needed. But in here, most of the time we see lack of communication between these two professionals and an invisible hierarchical relationship prevails which is not desirable."

In bridging the gap, both professionals should come forward to maintain the equilibrium. I have seen many doctors who cooperate emphatically with their nurse colleagues and that is very close to the ideal situation. I have also seen many nurses who have come to the desired level to comply with their doctor colleagues. But the changes could not have been massive due to the inaction on the part of both the doctors and nurses to improve the scenario.

If this trend continues, we may have another world nurses day next year but we may not have the changes that we so dearly strive for. We may blame each other, but unless we take action, we will be in the same place as we were before. (Reprint)
   
The writer can be reached at duha.shams@gmail.com