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

Yeong-Ju Lee; Jee-In Hwang

doi:10.11111/jkana.2019.25.2.73

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

Original Article

J Korean Acad Nurs Adm 2019;25(2):73-82.

Published online: 17 January 2019

DOI: https://doi.org/10.11111/jkana.2019.25.2.73

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

Yeong-Ju Lee¹, Jee-In Hwang^2,

¹The Inje University Paik Hospital of Korea

²College of Nursing Science, Kyung Hee University

Corresponding author: Hwang, Jee-In College of Nursing Science, Kyung Hee University, 26 Kyungheedae-ro, Dongdaemoon-gu, Seoul 02447, Korea. Tel: +82-2-961-9398, Fax: +82-2-961-9145, E-mail: jihwang@khu.ac.kr

Received 29 October 2018 Revised 21 January 2019 Accepted 21 February 2019

This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Cooperative behaviors, Interprofessional relations, Physician-nurse relations, Medical errors

REFERENCES

1. Pronovost PJ, Thompson DA, Holzmueller CG, Lubomski LH, Dorman T, Dickman F, et al. Toward learning from patient safety reporting systems. Journal of Critical Care. 2006; 21(4):305–315. https://doi.org/10.1016/j.jcrc.2006.07.001.

2. Henneman EA. Unreported errors in the intensive care unit: a case study of the way we work. Critical Care Nurse. 2007; 27(5):27–34. quiz 35.

3. Mujumdar S, Santos D. Teamwork and communication: an effective approach to patient safety. World Hospitals and Health Services. 2014; 50(1):19–22.

4. House S, Havens D. Nurses' and physicians' perceptions of nurse-physician collaboration: a systematic review. Journal of Nursing Administration. 2017; 47(3):165–171. https://doi.org/10.1097/nna.0000000000000460.

5. Tang CJ, Chan SW, Zhou WT, Liaw SY. Collaboration between hospital physicians and nurses: An integrated literature review. International Nursing Review. 2013; 60(3):291–302. https://doi.org/10.1111/inr.12034.

6. Collette AE, Wann K, Nevin ML, Rique K, Tarrant G, Hickey LA, et al. An exploration of nurse-physician perceptions of collaborative behaviour. Journal of Interprofessional Care. 2017; 31(4):470–478. https://doi.org/10.1080/13561820.2017.1301411.

7. Sollami A, Caricati L, Sarli L. Nurse-physician collaboration: A meta-analytical investigation of survey scores. Journal of Interprofessional Care. 2015; 29(3):223–229. https://doi.org/10.3109/13561820.2014.955912.

8. Hong JY, Kim OH, Lee EK. The relationship among nurse-doctor collaboration, job autonomy and organizational commitment. Journal of Korean Academy of Nursing Administration. 2009; 15(4):601–609.

9. Ushiro R. Nurse-Physician Collaboration Scale: Development and psychometric testing. Journal of Advanced Nursing. 2009; 65(7):1497–1508. https://doi.org/10.1111/j.1365-2648.2009.05011.x.

10. Dougherty MB, Larson EL. The nurse-nurse collaboration scale. Journal of Nursing Administration. 2010; 40(1):17–25. https://doi.org/10.1097/NNA.0b013e3181c47cd6.

11. Ma C, Shang J, Bott MJ. Linking unit collaboration and nursing leadership to nurse outcomes and quality of care. Journal of Nursing Administration. 2015; 45(9):435–442. https://doi.org/10.1097/nna.0000000000000229.

12. Bowles D, McIntosh G, Hemrajani R, Yen MS, Phillips A, Schwartz N, et al. Nurse-physician collaboration in an academic medical centre: The influence of organisational and individual factors. Journal of Interprofessional Care. 2016; 30(5):655–660. https://doi.org/10.1080/13561820.2016.1201464.

13. Rosenstein AH. Nurse-physician relationships: Impact on nurse satisfaction and retention. The American Journal of Nursing. 2002; 102(6):26–34.

14. Tschannen D, Kalisch BJ. The impact of nurse/physician collaboration on patient length of stay. Journal of Nursing Management. 2009; 17(7):796–803. https://doi.org/10.1111/j.1365-2834.2008.00926.x.

15. Boev C, Xia Y. Nurse-physician collaboration and hospital- acquired infections in critical care. Critical Care Nurse. 2015; 35(2):66–72. https://doi.org/10.4037/ccn2015809.

16. Ma C, Park SH, Shang J. Inter- and intra-disciplinary collaboration and patient safety outcomes in U.S. acute care hospital units: A cross-sectional study. International Journal of Nursing Studies. 2018; 85:1–6. https://doi.org/10.1016/j.ijnurstu.2018.05.001.

17. Hwang JI, Park HA. Relationships between evidence-based practice, quality improvement and clinical error experience of nurses in Korean hospitals. Journal of Nursing Management. 2015; 23(5):651–660. https://doi.org/10.1111/jonm.12193.

18. Cho EH, Chin DL, Kim SH, Hong OS. The relationships of nurse staffing level and work environment with patient adverse events. Journal of Nursing Scholarship. 2016; 48(1):74–82. https://doi.org/10.1111/jnu.12183.

19. Lee EJ. Reporting of medication administration errors by nurses in South Korean hospitals. International Journal for Quality in Health Care. 2017; 29(5):728–734. https://doi.org/10.1093/intqhc/mzx096.

20. Hughes R. Patient safety and quality: an evidence-based handbook for nurses. AHRQ publication no. 08-0043. Rockville, MD: Agency for Healthcare Research and Quality, U.S. Dept. of Health and Human Services;2008.

22. The Joint Commission. Sentinel event statistics released for 2015. The Joint Commission Perspectives. 2016; 36(4):10.

23. Polit DF. Statistics and data analysis for nursing research. 2nd ed. Upper Saddle River, N.J.: Pearson Education;2010.

24. World Health Organization. Conceptual framework for the international classification for patient safety: final technical report. Geneva: World Health Organization;2009.

25. Dorrian J, Lamond N, van den Heuvel C, Pincombe J, Rogers AE, Dawson D. A pilot study of the safety implications of Australian nurses' sleep and work hours. Chronobiology International. 2006; 23(6):1149–1163. https://doi.org/10.1080/07420520601059615.

26. McCauley K, Irwin RS. Changing the work environment in ICUs to achieve patient-focused care: the time has come. Chest. 2006; 130(5):1571–1578. https://doi.org/10.1378/chest.130.5.1571.

27. Rosenstein AH, O'Daniel M. Disruptive behavior and clinical outcomes: Perceptions of nurses and physicians. The American Journal of Nursing. 2005; 105(1):54–64. quiz 64-55.https://doi.org/10.1097/00006247-200501000-00008.

28. Messmer PR. Enhancing nurse-physician collaboration using pediatric simulation. Journal of Continuing Education in Nursing. 2008; 39(7):319–327. https://doi.org/10.3928/00220124-20080701-07.

29. Hewitt T, Chreim S, Forster A. Sociocultural factors influencing incident reporting among physicians and nurses: Understanding frames underlying self- and peer-reporting practices. Journal of Patient Safety. 2017; 13(3):129–137. https://doi.org/10.1097/pts.0000000000000130.

30. Soydemir D, Seren Intepeler S, Mert H. Barriers to medical error reporting for physicians and nurses. Western Journal of Nursing Research. 2017; 39(10):1348–1363. https://doi.org/10.1177/0193945916671934.

21. Kim MS. Influence of shift work on sleep quality, daytime sleepiness, and perceived errors in nursing work among hospital nurses [master's thesis]. Jinju: Gyeongsang National University;2013.

Figure 1.

Conceptual framework for this study.

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)
			M±SD	t or F (p)	M±SD	t or F (p)	n(%)	n(%)	x² (p)
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 ward^a	65 (24.62)	3.04±0.23	7.11	3.21±0.61	4.57	17 (29.83)	48(23.19)	19.35
	Surgical ward^b	79 (29.92)	3.05±0.23	(＜.001)	3.50±0.51	(.004)	28 (49.12)	51(24.64)	(＜.001)
	Intensive care unit^c	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
Variables	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	t	p
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
Variables	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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