¶ … physicians and Registered nurses is an important one, which shapes the healthcare environment. Patients rely on physicians and nurses to provide their healthcare needs. The purpose of this discussion is to provide a description of current research, synthesis, demonstrations and other projects that have resulted in positive nurse physician relationships. More specifically the discussion will focus on the relationship between the two as it relates to increases in nurse satisfaction, decreases in nurse turnover, better working environment, and better patient outcomes with an emphasis on patient safety. Descriptions

The shortage of registered nurses that has occurred in recent years, has place special attention on the need for nurses and the relationship between physicians and registered nurses. According to the journal International Labour Review, "Many health care systems are experiencing shortages of trained medical personnel. Both developed and developing countries appear to be facing a serious shortage of nurses (and physicians). Developed countries, however, are in a better position to attract health care professionals from abroad, thereby exacerbating the shortage in less developed countries (Clark & Clark, 2003)."

The shortage of nurses places a special burden on the healthcare systems ability to retain nurses. In many cases, the work environment is a contributing factor in a nurse leaving the profession. In particular, the relationship that a registered nurse has with the physicians is critical. Registered nurses are under a great deal of stress because they are forced to work long hours and deal with difficult situations. This stress is compounded when the nurses and physicians have a bad relationship. Stress is reported as one of the leading health and safety problems that affect nursing and therefore patients (Clark & Clark, 2003).

A report published by the Ontario Medical Association (OMA) sought to shed more light on the relationship between registered nurses and doctors. The report published in November of 2002, was written in response to doctors who wished to work with RN's in their practices (The working relationship between physicians and registered ..., 2002). The article reports that the first area of concern between in the relationship between nurses and doctors involve collaboration. The report asserts that in an ideal situation the RN and the physician should work in the same facility (The working relationship between physicians and registered ..., 2002). The report also admits that in some cases the collaborating doctor may be located at a different facility (The working relationship between physicians and registered ..., 2002). The article asserts that 'Many physicians have suggested that the RN (EC) work under the "supervision" of the physician. Given the legislated independent action of the RN (EC), this term presents a problem for the development of the working relationship between physicians and RN (EC)s. The vocabulary used to describe the working relationship between physicians and RN (EC)s is important. The OMA suggests that physicians consider the working relationship to be an "association" between the physician and RN (EC), and not one where the RN (EC) is "under the supervision" of the physician (The working relationship between physicians and registered ..., 2002)."

In the realm of collaboration the article also contends that physicians should gather an understanding of what the registered nurse is able and willing to do in relation to the patient (The working relationship between physicians and registered ..., 2002). The report asserts that in an ideal situation the RN interacts with the patient in the same manners as the physician. In doing this, the RN is able to decrease the workload of the physician (The working relationship between physicians and registered ..., 2002).

Another area of the relationship between Registered nurses and physicians is consultation. The report contends that the standards of practice for RN's asserts that "The RN (EC) is accountable for establishing a working relationship with a physician for the purpose of consultation (The working relationship between physicians and registered ..., 2002)." Furthermore the standards explain that consultation involves a succinct request by an RN for a specific doctor to be involved in the care of a patient for which the RN at the time of the request for consultation, has primary responsibility (The working relationship between physicians and registered ..., 2002)."

The article contends that there are different facets to consultation including the consultation between the RN and the physician and the consultation between an RN and a specialist (The working relationship between physicians and registered ..., 2002). The report asserts that RN's should only refer a patient to the collaborating physician...

The report contends that such a referral is out of the scope of the duty of an RN (The working relationship between physicians and registered ..., 2002).
Other issues discussed in the article include liability, medical records, on-call services and workload. The article asserts that RN's and physicians can have a very fruitful relationship that has positive outcomes for the nurse and the doctor. The article asserts that when doctors and RN's follow the guidelines created by the Ontario Medical Association they can work well together and establish a working environment that is conducive with the adequate care of patients. Such a collaboration is imperative for the safety of patients because the RN's are aiding in reducing the workload for physicians>This in turn leads to less work related stress which can encourage more accurate diagnosis and treatment for patients.

The relationship between nurse and physician was studied and published in the International Journal of Public Administration. The article describes the results of the comprehensive healthcare project. The project took place over a 12-year period and involved Afghan refugees living in Peshewar, Pakistan. The article explains that 'This project was based on the 'health development and community participation' concept and applied to a collection of 40-000 Afghan refugees. The purpose of the project is to develop self-sufficiency among the refugees. Mercy International Switzerland (MI) acting as the external agent took the motivation of implementing, persuading, training and driving, as well as providing support for the refugees. An important aspect of the whole program was the training of some refugees in the necessary skills to become nurse practitioners (Al-Almaei et al. 2000)."

In this project there were several groups of nurses that were selected and trained for 6 months to become nurse practitioners (Al-Almaei et al. 2000). For the purposes of this project a cross-sectional study took place. The study involved three nurse practitioners who were selected from a group of eight (Al-Almaei et al. 2000). The skills the nurses acquired were assessed against the diagnostic and treatment skills of a general practitioner and a consultant family physician (Al-Almaei et al. 2000). The study also evaluated the relationship that was forged between the nurses and the physicians. Within the confounds of this study the general practitioner and consultant were blind to the study. There were 100 patients involved in the study and they had to give their consent before participating (Al-Almaei et al. 2000). The patients were first examined by the nurse and then the general practitioner and finally the physician (Al-Almaei et al. 2000).

The authors explain that the levels of agreement between nurses and the physicians were measured using KAPPA statistic. Utilizing this statistic was important because "The KAPPA coefficient explicitly deals to see the degree of conformity by examining the proportion of responses in the two agreement cells (yes/yes, no/no) in relation to the proportion of responses in these cells which would be expected by chance, given the marginal distribution. A KAPPA of 75% or more may be taken to represent excellent agreement and values 40-74% indicate fair to good agreement, less than 30% is considered as poor agreement (Al-Almaei et al. 2000)."

The results of the study indicated that there was strong agreement between the nurses, the GP and the consultant. The study found that the nurses were more likely to be in agreement with the general practitioner than with the consultant (Al-Almaei et al. 2000). The authors explain that this difference exist because the consultant was a visitor and received medical education in the UK (Al-Almaei et al. 2000). However, the GP and the nurses were exposed to the same environment. In both cases, the nurses and physicians agreed more with diagnosis than with treatment. The authors assert that this difference is a result of the training that was received. They contends that "treatment reflects the provider's training, experience and availability of certain drugs (Al-Almaei et al. 2000)."

The study also reports that there were differences between the level of agreement that the individual nurses had with the doctors. The authors explains that

"Nurse A had more agreement than Nurses B & C. This level of agreement differs slightly between the 3 nurses probably from the amount of training during nursing school. Nurses who agreed more with the GP and consultant had higher grades in school. In all, the performance of the nurses showed that they had achieved a statistically significant agreement between consultant and GP on most of the health problems in both diagnosis and treatment. Furthermore, the difference…