Barriers to effective communication in skilled nursing facilities: Differences in perception between nurses and physicians

BACKGROUND: Effective communication between nurses and physicians is centra l to the clinical care of nursing home residents. Anecdotal evidence sugges ts that communication between the groups is unsatisfactory, but no empirica l data exist with which to validate assumptions. The purpose of this pilot study was to compare perceptions of potential communication barriers among nurses and physicians in four California nursing homes. METHODS: Registered nurses (n = 59), and physicians (n = 47) involved in th e direct clinical care of nursing home residents completed a 12-item questi onnaire designed to elicit perceptions about potential communication barrie rs. Five specific categories of barriers were identified. These included nu rse competence, time burden of calls, necessity of calls, professional resp ect, and language comprehension. Responses were compared using t test analy sis. RESULTS: Significant differences in perceived communication barriers were i dentified. Physicians, but not nurses, perceive nursing competence to be a significant barrier. Nurses perceive physicians to be unpleasant. Both phys icians and nurses perceive that physicians do not value nurses' opinions. N either group perceived language expression, language comprehension, or time burden of phone calls to be barriers to communication. CONCLUSIONS: Issues related to the perceived competency of nurses by physic ians is consistent with existing data from other clinical settings. Differe nces in awareness about scope of practice and regulatory requirements betwe en the groups may offer a partial explanation for the discordant perception s. Perceptions by nurses (but not physicians) of unpleasantness and/or disr espect during telephone encounters may reflect the broader ongoing differen ces in professional culture, social status, and gender inequality between t he two groups. Further clarification of the causes of barriers to effective communication is essential in order to plan appropriate interventions.