Hardships in Workplace

Hardships in Workplace

Introduction

Hardship in the workplace is not a new subject for many physicians or nurses. Collaborative nurse-physician communication can lessen the hardships in hospitals. Knaus, Draper, Wagner, and Zimmerman (1986) and Baggs et al. (1999) have demonstrated that frequent, effective nurse-physician communication is linked to patient survival in intensive care units. Dysfunctional nurse-physician communication is linked to medication errors (Kohn, Corrigan, & Donaldson, 2000; Leape, 1994), patient injuries (Page, 2004), and patient deaths (Tammelleo, 2001; 2002). The Code of Ethics for Nurses (American Nurses Association, 2001) and state nursing practice acts mandate individual nurse accountability for patient advocacy to ensure no harm. However, the recent Institute of Medicine studies, To Err is Human: Building a Safer Health System (Kohn et al., 2000), Crossing the Quality Chasm: A New Health System for the 21st Century (Committee on the Quality of Health Care in American, 2001), and Keeping Patients Safe: Transforming the Work Environment of Nurses (Page, 2004) hold the organization in which these professionals practice accountable for adverse patient events resulting from ineffective nurse-physician communication.

Communication and Hardships

The organization provides the context in which nurse-physician communication occurs. The organization determines the structure in which these professionals interact, the professional development opportunities of the employed nurses, the group and individual power dynamics, and the cultural norms of behavior. The organization decides the number and required qualifications of direct care staff, the availability of role modeling to refine communication skills, the authority of the nurse when involved in a conflictive interaction with a physician, and the valuing of nurses' independent practice. Organizational theory is useful in guiding an analysis of the relationship between nurse-physician communication and the organizational context using the structural, human resource, political, and cultural perspectives of organizational behavior (Bolman & Deal, 1997). This discussion will allow identification of management interventions to create an organizational context supportive of collaborative nurse-physician communication.

The structural perspective of organizational behavior originated in the 1920s. The fundamental assumption of the structural perspective is that behavior is rational and directed at concrete goals. According to this perspective, employees' behavior is determined by prescribed organizational roles. A role consists of activities, expectations, and relationships to other organizational roles. Therefore, the key to an effective organization is designing roles and grouping the roles in a manner that will accomplish organizational goals. Nursing frequently redesigns activities of roles and the grouping of roles to improve patient care delivery. Ancillary nursing staff members have been redesigned from nursing assistants to patient care assistants to multi-skilled workers. The process of care has changed from functional nursing to team nursing to primary nursing to modular nursing. All of these changes have been structural changes involving redesigned roles and the reconfiguration of role relationships.

When designing an organizational structure or a patient delivery system, the classical design decisions which must be made are (a) division of labor, (b) delegation of authority, and (b) departmentalization (Ivancevich & Matteson, 2002). Division of labor refers to assigning various tasks and responsibilities to identified roles; the more specialized ...