Introduction

The collaboration of many skilled professionals is crucial for providing the most efficient and best quality of care for patients. Because this collaboration is so critical in determining patient outcomes, it is important to investigate possible issues that may affect the relationship between skilled professionals. Stereotypical sexism based on the traditional roles of a male doctor and female nurse, the increasing responsibilities of nurse practitioners, and cultural differences in nurse-doctor relationships will be investigated to evaluate their effects on nurse and doctor relationships.

Communication and collaboration between nurses and doctors (University of Minnesota, 2006)

Stereotypical Sexism

Classical gender stereotype (Goshen College, 2003)

Stereotypical sexism is prevalent in the “doctor-nurse game” (Burkhardt & Nathaniel, 2008). The traditional roles of a male doctor and female nurse suggest male dominance. This imbalance in power often results in an unhealthy relationship between doctors and nurses. Consequently, nurses and doctors fail to respect each other’s autonomy, professional skill, and capability. The unsuccessful collaboration that results from such a relationship jeopardizes the patient’s well being (Cowen & Moorhead, 2006). Therefore, stereotypical sexism must be tackled in order for nurses and doctors to form healthy relationships. When the autonomy of one dominates the other, the dangerous effects of paternalism result (Gordon, 2005). The autonomy of both nurses and doctors must be respected in order to have successful collaboration in caring for patients.

Gender and Power in Heath Care Settings

While stereotypical gender roles unquestionably affect nurse-physician relationships, it is interesting to note that the traditional role of a dominant male physician and an obedient female nurse is changing (Zelek & Phillips, 2003). The growing number of female physicians and male nurses is challenging the sexist stereotype by changing the image of gender-specific roles. As the image of the gender-specific roles change, so do the relationships. For example, the relationships between female nurses and female doctors tend to reflect more of an egalitarian relationship as opposed to the traditional doctor-dominated relationship (Zelek & Phillips, 2003). Conducted studies show “[female nurses]…were more comfortable communicating with [female physicians], yet more hostile towards them” (Zelek & Phillips, 2003, p. 1). Thus, while female nurses were more comfortable approaching female physicians, they were also more likely to scrutinize female physicians. According to one study, 80% of female physicians “have experienced unequal treatment, more intense scrutiny, or a lack of respect from nurses because they (the doctors) were female” (Zelek & Phillips, 2003, p.2). The relationship between female nurses and female doctors reflects change in the power dynamic when both professionals are women.

Male nurse and female physician(iStock Photo, 2005)

Expanding Roles of Nurse Practitioners

The expanding role of nurse practitioners in healthcare also affects nurse-doctor relationships. Nurse practitioners have started to step into doctors’ domains with their health-care practices. For example, some families have replaced their family physician with a nurse practitioner. Studies of nurse practitioners in family practice show that a “nurse practitioner can provide first contact primary clinical care as safely and effectively and with as much satisfaction for patients as can a family physician”(Gray, 1983, p. 1306).

Nurse practitioner and patient (University of Cincinnati Magazine, 2006)

As nurse practitioners take on increasing responsibilities, differences in status and power result and the relationship between nurses and doctors are affected (Siegler & Whitney, 1994). Nurse practitioners challenge the power of doctors, who society places on a pedestal because of perceived high social and economic status.

Cartoon emphasizing social stereotype of doctors and nurses (Biffsniff.com, 2008)

Cultural Differences

Cultural influences also play a part in nurse-doctor relationships. One article comparing American, Israeli, Italian, and Mexican nurse-doctor collaborative relationships proposes two different types of nurse-doctor relationship models that are evident in different cultures. One model is the hierarchical model that is typical in societies where nurses have little autonomy and physicians have total dominance in health care decisions. In this model, nurses have very little power and are often perceived to be physicians’ handmaidens.

Handmaiden role of nurses (View Images, 2004)

According to the article, the hierarchical model is more apparent in Israeli and Mexican culture than it is in American and European cultures.

The second model is the complementary model, which “places more emphasis on the importance of education, common experiences, shared autonomy, and mutual authority“(Hojat et al., 2003, p. 428). This model is more typically found in Western cultures.

Although nurse-doctor relationships vary culturally, findings have shown that “nurses desire a collaborative physician-nurse relationship more than physicians do, regardless of cultural differences” (Hojat et al., 2003, p. 432).

Conclusion

By investigating these three issues, several conclusions can be drawn. As the number of female physicians and male nurses increases, the gender-specific roles created by traditional stereotypes are gradually changing. The result is a power and status change between nurses and doctors, a change that is further evidenced in the expanding role of nurse practitioners. Additionally, nurse and doctor relationships are affected by cultural values. The hierarchical model characteristic of certain cultures represses the autonomy of nurses. Meanwhile, the complementary model emphasizes equality among health care professionals.

In essence, the nurse-doctor relationship is affected by many issues; we should take care to address these issues in order to form healthy relationships between nurses and doctors.




References


Burkhardt, M.A., & Nathaniel, A.K. (2008). Ethics and Issues in Contemporary Nursing(3rd ed.) Canada: Thompson Delmar Learning.

Cowen, P.S., & Moorhead, S. (2006). Current Issues in Nursing (7th ed.). St. Louis: Mosby Elsevier.

Gordon, S. (2005). Nursing Against the Odds: How Health care Cost Cutting, Media Sterotypes, and Medical Hubris Undermine Nurses and Patient Care. Ithaca: Cornell University Press.

Gray, C. (1983). Nurse practitioners: stepping into the doctor’s domain? Canada Medical Association Journal, 128, 1305-1309.

Hojat, M., Gonnella, J.S., Nasca, T.J., Fields, S.K., Cicchetti, A., Scalzo, A.L., et al. (2003). Comparisons on American, Israeli, Italian and Mexican physicians and nurse on the
total and factor scores of the Jefferson scale of attitudes toward physician-nurse collaborative relationships. International Journal of Nursing Studies, 40, 427-435.

Siegler, E.L., & Whitney, F.W. (Eds.). (1994). Nurse-Physician Collaboration: Care of Adults and the Elderly. New York: Springer Publishing Company.

Zelek, B. & Phillips, S. P. (2003). Gender and power: Nurses and doctors in Canada. International Journal for Equity in Health, 2, 1-5.