HEALTH POLICY AND SYSTEMS Nurse-Physician Relationships in Ambulatory Oncology Settings

Purpose: The purpose of this study was to explore nurses’ perceptions of nurse-physician relationships in ambulatory oncology settings, which are linked to patient safety. Design: This cross-sectional, descriptive study analyzed survey data collected in 2010 from oncology nurses employed in ambulatory settings. The sampling frame was the nurse licensure database in one state in the Southeastern United States. Nurses completed the Practice Environment Scale of the Nursing Work Index (PES-NWI), reported on the quality of care in their setting, and commented on factors that promoted or inhibited high-quality care delivery. Methods: Data analysis used three study variables: empirically derived values from the PES-NWI, a scale of nurse-reported quality of care in their setting, and open-text comments about features in their workplace that promoted or hindered high-quality care. After categorizing open-text comments, analysis of variance was used to evaluate differences in PES-NWI subscales by comment category. Chi-square test statistics were calculated to examine differences in overall practice environment and quality of care by comment category. Results: Nurses reported their relationships with physicians as generally favorable. Qualitative findings suggest two themes that influence how nurses characterize their working relationships with physicians: (a) physician behaviors and (b) structural factors. Both PES-NWI scores and quality of care were rated significantly higher by nurses who wrote favorably about physicians. Conclusions: Favorable nurse-physician relationships in ambulatory settings may reflect positive workplaces and promote high-quality care. Clinical Relevance: Consistent with findings from inpatient units, nursephysician relationships are important to the quality of ambulatory oncology care. Systematic measurement and attention to reported deficits in these relationships may promote higher quality care.