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

BACKGROUND: Effective communication between nurses and physicians is central to the clinical care of nursing home residents. Anecdotal evidence suggests that communication between the groups is unsatisfactory, but no empirical 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 the direct clinical care of nursing home residents completed a 12-item questionnaire designed to elicit perceptions about potential communication barriers. Five specific categories of barriers were identified. These included nurse competence, time burden of calls, necessity of calls, professional respect, and language comprehension. Responses were compared using t test analysis. RESULTS: Significant differences in perceived communication barriers were identified. Physicians, but not nurses, perceive nursing competence to be a significant barrier. Nurses perceive physicians to be unpleasant. Both physicians and nurses perceive that physicians do not value nurses' opinions. Neither 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 physicians is consistent with existing data from other clinical settings. Differences in awareness about scope of practice and regulatory requirements between the groups may offer a partial explanation for the discordant perceptions. Perceptions by nurses (but not physicians) of unpleasantness and/or disrespect during telephone encounters may reflect the broader ongoing differences in professional culture, social status, and gender inequality between the two groups. Further clarification of the causes of barriers to effective communication is essential in order to plan appropriate interventions.