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Journal List > J Korean Acad Nurs Adm > v.25(2) > 1120022

Lee and Hwang: Relationships of Nurse-Nurse Collaboration and Nurse-Physician Collaboration with the Occurrence of Medical Errors

Abstract

Purpose:

The aim of this study was to examine degrees of nurse-nurse collaboration and nurse-physician collaboration, and investigate their relationships to the occurrence of medical errors.

Methods:

A cross-sectional questionnaire survey was conducted with 264 nurses in a university hospital. The questionnaire included five-component nurse-nurse collaboration and three-component nurse-physician collaboration scales. Data were analyzed using independent t-tests, ANOVA, x2 tests, and multiple logistic regression.

Results:

Mean score for nurse-nurse collaboration was 2.8 out of 4.0, and for nurse-physician collaboration, 3.4 out of 5.0. There were significant differences in the nurse-nurse and nurse-physician collaboration scores by nurses’ preference to workplace and work unit. A significant difference was found in the nurse-nurse collaboration scores by job position. Fifty-seven (21.60%) nurses responded that they had experienced a medical error in the last six months. Logistic regression analysis revealed that nurse-physician collaboration was a significant factor associated with nurses’ error experience. Nurses with higher scores for the nurse-physician relationship component were less likely to experience medical errors.

Conclusion:

Findings from this study show that nurse-nurse and nurse-physician collaboration were moderate. Negative relationship between nurse-physician collaboration and the occurrence of medical error indicates that enhancing nurse-physician collaboration would contribute to improving patient safety.

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Figure 1.
Conceptual framework for this study.
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Table 1.
Nurse-Nurse Collaboration, Nurse-Physician Collaboration and Medical Error Occurrence by Participants' Characteristics (N=264)
Variables Categories n(%) Nurse-nurse collaboration Nurse-physician collaboration Occurrence of medical errors
M±SD t or F (p) M±SD t or F (p) Yes No x2 (p)
n(%) n(%)
Gender Male 12 (4.55) 2.82±0.27 0.45  3.36±0.67 -0.41 4(7.02) 8(3.86) 1.02
Female 252 (95.45) 2.79±0.23 (.655) 3.43±0.56 (.684) 53 (92.98) 199 (96.14) (.296)
Age (year) 20~29 134 (50.76) 2.77±0.23 2.94  3.39±053 0.62  43 (75.44) 91(43.96) 19.18
30~39 98 (37.12) 2.79±0.23 (.055) 3.47±0.57 (.540) 13 (22.81) 85(41.06) (<.001)
≥40 32 (12.12) 3.09±0.23 3.43±0.64 1(1.75) 31(14.98)
Marital status Unmarried 169 (64.02) 2.79±0.24 -0.01 3.42±0.55 -0.24 45 (78.95) 124 (59.90) 7.04
Married 95 (35.98) 2.79±0.22 (.994) 3.44±0.58 (.810) 12 (21.05) 83(40.10) (.008)
Education level 3-year College 107 (40.50) 2.80±0.25 0.64  3.39±0.56 0.92  17 (29.83) 90(43.48) 3.74
4-year University 151 (57.20) 2.78±0.22 (.527) 3.44±0.56 (.400) 39 (68.42) 112 (54.11) (.154)
≥Graduate school 6 (2.30) 2.87±0.27 3.67±0.49 1(1.75) 5(2.41)
Religion Yes 125 (47.30) 2.79±0.22 -0.02 3.40±0.55 -0.65 28 (49.12) 97(46.86) 0.09
No 139 (52.70) 2.79±0.24 (.988) 3.45±0.57 (.514) 29 (50.88) 110 (53.14) (.767)
Income per month (10,000 won) 100~299 133 (50.38) 2.98±0.22 0.11  3.42±0.51 0.16  43 (75.44) 90(43.48) 18.45
300~349 84 (31.82) 2.99±0.25 (.893) 3.41±0.62 (.853) 8(14.04) 76(36.71) (<.001)
≥350 47 (17.80) 3.00±0.22 3.47±0.60 6(10.52) 41(19.81)
Clinical experience (month) ≤36 69 (26.14) 2.81±0.23 1.35     3.44±0.55 0.59  35 (61.40) 34(16.42) 47.46
37~60 38 (14.39) 2.73±0.26 (.259) 3.33±0.55 (.619) 5(8.77) 33(15.94) (<.001)
61~120 66 (25.00) 2.77±0.22 3.40±0.55 9(15.79) 57(27.54)
≥121 91 (34.47) 2.81±0.23 3.47±0.58 8(14.04) 83(40.10)
Clinical experience in current job (month) ≤36 117 (44.32) 2.82±0.24 1.57 3.43±0.56 0.18 38 (66.67) 79(38.16) 14.90
37~60 38 (14.39) 2.75±0.25 (.196) 3.37±0.57 (.910) 5(8.77) 33(15.94) (.002)
61~120 63 (23.86) 2.79±0.22 3.45±0.57 9(15.79) 54(26.09)
≥121 46 (17.42) 2.75±0.18 3.43±0.55 5(8.77) 41(19.81)
Preference to current workplace Yes 104 (39.39) 2.83±0.25 2.14  3.53±0.53 2.35 22 (38.60) 82(39.61) 0.02
No 160 (60.61) 2.77±0.22 (.034) 3.36±0.57 (.020) 35 (61.40) 125 (60.39) (>.999)
Work unit Medical warda 65 (24.62) 3.04±0.23 7.11 3.21±0.61 4.57 17 (29.83) 48(23.19) 19.35
Surgical wardb 79 (29.92) 3.05±0.23 (<.001) 3.50±0.51 (.004) 28 (49.12) 51(24.64) (<.001)
Intensive care unitc 76 (28.79) 2.91±0.20 a>c, 3.47±0.54 d>b>a 7(12.28) 69(33.33)
Others*d 44 (16.67) 2.94±0.24 b>c 3.54±0.53 5(8.77) 39(18.84)
Shift pattern Rotating shift 257 (97.35) 2.79±0.23 -1.54 3.42±0.56 -1.41 55 (96.49) 202 (97.59) 0.21
Fixed shift 7 (2.65) 2.93±0.22 (.125) 3.72±0.52 (.160) 2(3.51) 5(2.41) (.646)
Job position Staff nurse 199 (75.38) 2.77±0.23 -3.01 3.39±0.55 -1.91 53 (92.98) 146 (70.53) 12.14
Manager 65 (24.62) 2.86±0.23 (.003) 3.54±0.58 (.057) 4(7.02) 61(29.47) (<.001)

*Emergency room, operating room, delivery room, dialysis room; a, b, c, d=Post-hoc Scheffé test.

Table 2.
Pearson Correlations between Nurse-Nurse Collaboration and Nurse-Physician Collaboration (N=264)
Variables   NNC CM CO SP COO PRO NPC SI DMC RNP
  r (p) r (p) r (p) r (p) r (p) r (p) r (p) r (p) r (p) r (p)
NNC 1                  
CM .75 (<.001) 1                
CO .68 (<.001) .37 (<.001) 1              
SP .63 (<.001) .26 (<.001) .21 (<.001) 1            
COO .70 (<.001) .46 (<.001) .28 (<.001) .39 (<.001) 1          
PRO .79 (<.001) .51 (<.001) .47 (<.001) .37 (<.001) .45 (<.001) 1        
NPC .50 (<.001) .36 (<.001) .29 (<.001) .36 (<.001) .39 (<.001) .39 (<.001) 1      
SI .53 (<.001) .43 (<.001) .35 (<.001) .27 (<.001) .41 (<.001) .42 (<.001) .85 (<.001) 1    
DMC .41 (<.001) .30 (<.001) .20 (<.001) .33 (<.001) .34 (<.001) .32 (<.001) .95 (<.001) .71 (<.001) 1  
RNP .46 (<.001) .30 (<.001) .29 (<.001) .37 (<.001) .33 (<.001) .34 (<.001) .86 (<.001) .64 (<.001) .74 (<.001) 1

NNC=Nurse-nurse collaboration; CM=Conflict management; CO=Communication; SP=Shared processes; COO=Coordination; PRO=Professionalism; NPC=Nurse-physician collaboration; SI=Sharing of patient information; DMC=Decision-making process on the cure/care; RNP=Relationship between nurse and physician.

Table 3.
Nurse-Nurse Collaboration and Nurse-Physician Collaboration by the Occurrence of Medical Errors (N=264)
  Variables   M±SD Experience of medical errors   
Yes No t p
M±SD M±SD
Nurse-nurse collaboration 2.99±0.23 2.97±0.21 3.00±0.24 -0.83 .405
Conflict management 3.30±0.36 3.32±0.39 3.29±0.35 0.65 .518
Communication 3.00±0.31 2.93±0.30 3.02±0.31 -2.01 .046
Shared processes 2.76±0.29 2.72±0.24 2.77±0.30 -1.41 .163
Coordination 2.85±0.37 2.88±0.35 2.84±0.37 0.63 .530
Professionalism 3.03±0.31 3.00±0.30 3.04±0.32 -0.77 .443
Nurse-physician collaboration 3.43±0.56 3.27±0.49 3.47±0.57 -2.45 .015
Sharing of patient information 3.68±0.47 3.57±0.43 3.72±0.47 -2.15 .032
Decision-making process on the cure/care 3.30±0.70 3.17±0.60 3.33±0.72 -1.63 .104
Relationship between nurse and physician 3.29±0.69 3.02±0.66 3.37±0.68 -3.46 .001
Table 4.
Results of Logistic Regression Analyses for the Occurrence of Medical Errors (N=264)
Variables Model 1 Model 2
OR 95% CI p OR 95% CI p
Age (year) 0.85 0.70~1.03 .090 0.87 0.72~1.05 .153
Marital status (=yes) 1.74 0.58~5.22 .323 1.66 0.55~5.07 .371
Income per month (10,000 won)
300~349 0.75 0.23~2.49 .643 0.85 0.26~2.79 .786
≥350 4.90 0.73~32.95 .102 5.17 0.76~34.94 .092
100~299 (reference)
Clinical experience
37~60 months 0.15** 0.05~0.51 .002 0.14** 0.04~0.50 .002
61~120 months 0.23* 0.06~0.92 .037 0.18* 0.04~0.76 .019
≥121 months 0.55 0.06~5.37 .606 0.42 0.04~4.28 .462
≤36 months (reference)
Clinical experience in current job 1.00 0.99~1.01 .008 1.00 0.99~1.01 .904
Work unit
Medical ward 0.47 0.20~1.14 .094 0.53 0.22~1.29 .160
Intensive care units 0.14*** 0.05~0.39 <.001 0.16** 0.05~0.44 .001
Others 0.18** 0.05~0.63 .008 0.21* 0.06~0.72 .014
Surgical ward (reference)
Job position (=manager) 0.32 0.04~2.62 .288 0.30 0.04~2.37 .252
Nurse-nurse collaboration 0.63 0.09~4.33 .642     .412
Communication     0.58 0.16~2.12
Nurse-physician collaboration 0.40* 0.18~0.89 .025     .959
Sharing of patient information     1.03 0.38~2.79
Nurse-physician relationship     0.43* 0.21~0.87 .018
 

*p<.05, **p<.01, ***p<.001; OR=Odds ratio; CI=Confidence interval.

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