Perceptions of rural hospital leaders regarding factors that influence interpersonal communication and collaboration between registered nurses and physicians

Recent health care reform has had a profound impact on the historically unique nurse-physician relationship, particularly in the rural hospital setting. Hospital leaders within these unique environments are responsible for ensuring optimal coordination of care and services, much of which is dependent on effective nurse-physician interpersonal communication and collaboration. Because little information is known about their perceptions regarding the nurse-physician interpersonal relationship, an exploratory study of 18 hospital leaders at 6 rural hospital sites utilizing a grounded theory approach was undertaken in order to identify factors they consider influential to the nurse-physician interpersonal communication and collaboration process. Greater regulation and control in response to health care reform, the professional ability of nurses and gender were identified as leading factors influencing the nurse-physician interpersonal communication and collaboration process. Although rural leaders at all hospital sites reported having a formal process in place that encourages resolution of communication problems at the lowest level possible, most acknowledged that nurses and physicians have a difficult time doing so. Many rural leaders at most hospital sites believed that feelings of connectedness in rural communities favorably influence nurse-physician interpersonal communication and collaboration. Finally, the responses of rural leaders within the same hospital site to questions related to nurse-physician interpersonal communication and collaboration did not appear to reflect any disciplinary-specific differences. Recommendations are offered regarding how rural hospital leaders might affect organizational change relative to improving the nurse-physician interpersonal communication and collaboration process.