June 15, 2016

Article Review

Healthcare-associated infections (HCAIs) are common adverse events in critical care associated with increased morbidity and mortality. Many organizational factors and working conditions have been linked to patient’s safety. One important aspect of delivery of care is nurse-physician collaboration. Effective collaboration between registered nurses and physicians has shown to reduce morbidity and mortality rates, cost of care, and medical errors (1).

Boev and Xia (2) assessed whether HCAIs in critical care namely, Ventilator Associated Pneumonia (VAP) and Central Line Associated Blood Stream Infections (CLABSIs) are related to nurse-physician collaboration. For that purpose, they performed a secondary analysis of data coming from the Nurse Perception Survey. This survey was conducted in 4 specialised ICUs, in which critical care nurses’ perceptions of their working conditions were measured. The Nurse Perception instrument was a compilation of 5 instruments assessing various aspects of working environment, including the Collaboration and Satisfaction About Care Decisions (CSACD) instrument, which measured specifically the nurse-physician collaboration dimension. Nurses Perception data were collected (n=671, mean response rate=96%) once a year during the 4.25-year study period (Jan 1, 2005 to March 31, 2009). The same period all patients outcome data (n=3610) who discharged from the research settings were also collected. 

Nurses rated overall nurse-physician collaboration as favorable with significant differences between the 4 ICUs (range of mean scores on the CSACD was 4.09 to 4.65, p<0.001). Also, ICUs with more favorable perception of nurse-physician collaboration had lower rates of both CLABSIs and VAP. More specifically for every 0.5 unit increase in nurse-physician collaboration, the rate of CLABSIs decreased by 2.98 (p=0.005) and the rate of VAP decreased by 1.13 (p=0.005). Additionally, those units with a higher proportion of certified nurses (diploma, associate’s degree, bachelor’s and higher) had a 0.44 (p=0.02) and 0.17 (p=0.01) lower incidence of CLABSIs and VAP respectively. A two-level modeling analysis revealed that amongst the unit-level variables namely: nurses’ skill mix, voluntary turnover, or nursing hours per day only the last variable was found to be a significant predictor of CLABSIs. In particular, ICUs with increased nursing hours per patient day had a 0.42 decrease in the rate of CLABSIs (p=0.05).

Boev and Xia (2) supported previous research by linking effective communication and collaboration between physicians and nurses and HCAIs in critical care. Moreover, their findings suggested that additional nurses’ professional qualifications further attributed to patients’ safety. Although the original study did not assess how physicians perceived nurse-physician collaboration, findings from this analysis imply that the ability of physicians and nurses to work together as a unified team is critical to reduce errors, improved patient outcomes and optimum care. Strategies towards collaborative practice include interprofessional education between medical residents and nurses, simulation training and maximisation of the proportion of certified nurses in hospital nursing staff (3). 

Article review submitted by Katerina Iliopoulou on behalf of the N&AHP Committee.


1.    Manojlovich M, DeCicco B. Healthy work environments, nurse-physician communication, and patient outcomes. Am J Crit Care. 2007; 16 (6):536-543.
2.    Boev C, Xia Y. Nurse-Physician Collaboration and Hospital-Acquired Infections in Critical Care. Crit Care Nurse. 2015; 35(2):66-72.
3.    C.J. Tang, S.W. Chan, W.T. Zhou, S.Y. Liaw. Collaboration between hospital physicians and nurses: An integrated literature review. International Nursing Review. 2013; 60(3): 291–302

Comment on this news