Running head: IMPACT OF NEW NURSES’ CONFIDENCE IN COMMUNICATING 1

Impact of New Nurses’ Confidence in Communicating with Physicians on Patient Outcomes

Abby Erasmus, Emma Weeber, Jordyn Hursh, and Mikalah Jones

James Madison University

IMPACT OF NEW NURSES’ CONFIDENCE IN COMMUNICATING 2

Impact of New Nurses’ Confidence in Communicating with Physicians on Patient Outcomes

Abstract

The new graduate nurse often does not have a high level of confidence when they enter

the workforce, leading to barriers in interprofessional communication and collaboration. Ability

of the team to communicate and collaborate can have meaningful impacts on patient care

outcomes. Because every member of the health care team is working with the patient in mind,

eliminating barriers to interprofessional communication and collaboration are key. While

research shows that confidence is developed in the new graduate nurse over time, there are

several factors that can support development of new graduate nurse confidence and influence

their ability to contribute to interprofessional collaboration. This paper addresses barriers to

communication between nurses and physicians and factors that influence confidence in the new

graduate nurse, as well as limitations and recommendations for future practice. It was found that

presence of supportive leadership and preceptors, education on interprofessional communication

and collaboration, and role clarification are some important interventions that foster the

confidence of new graduate nurses.

Introduction

Throughout nursing school, there is a strong emphasis on training student nurses to

communicate clearly with physicians in order to provide optimal care for patients. There are

many approaches to this including teaching the student to think critically, practicing SBAR, and

explaining to the student what orders to anticipate from the physician depending on the situation.

Professors have warned students that physicians might hang up the phone on them or can belittle

them as a nurse, especially when first practicing as a new nurse. This stigma, along with
IMPACT OF NEW NURSES’ CONFIDENCE IN COMMUNICATING 3

inexperience, can create a hesitancy and lack of confidence in nurses within their first year of

practicing.

The purpose of this literature review is to answer the question as to whether new

graduate nurses’ lack of confidence in communicating with physicians affect patient care

outcomes. This is an important question to answer because new graduate nurses may not have

this skill mastered and the result could be detrimental to patients without intervention. If the new

nurse is not able to effectively communicate with the physician, this has the potential to prevent

the patient from getting the care they need. Exploring the impact that new nurses’ confidence

have on patient care outcomes is important for the appropriate changes and steps to be made to

improve patient care and safety.

Synthesis of the Literature

All of the studies discussed professional collaboration, and came to the conclusion that

effective communication results in more effective patient care. Therefore, professional

collaboration is essential to providing the best care possible. In one study that explored new

graduate nurse confidence in interprofessional collaboration determined that “specific

interventions to support the new graduate nurses knowledge and experiences regarding

collaborative practice, are essential for enhancing the confidence in interprofessional

collaboration” (Pfaff & Baxter & Jack & Ploeg, 2014). If there is no interprofessional

communication, then the patient outcomes will suffer as an effect. The studies also had in

common that new nurse confidence increases with experience. As nurses gain more experience,

interprofessional collaboration will improve. All articles touched on the barriers between

physician and nurse in interprofessional collaboration. The barriers of communication between

the professions include the nurses’ confidence, difference in views, and the professional
IMPACT OF NEW NURSES’ CONFIDENCE IN COMMUNICATING 4

hierarchy. The difference in critical thinking skills could depend on the healthcare professional’s

role. Therefore, the physicians could be overpowering especially for a new grad nurse. This

could also contribute to the new graduate nurse’s confidence if the physician is not willing to

listen to what they are saying.

The views and values are also different between nurses and physicians. The nurses’

priorities are more geared to the patients, while the physicians are geared toward the diseases.

There is no one correct view and the collaboration of both views helps to provide the best

outcomes for a patient. Another barrier that the studies touched on was how physicians either do

not recognize or do not understand the role of the nurse. In one study that investigated the

physician and nursing perceptions regarding communication and collaboration found that “the

most important barrier for the establishment of good relations between these professions,

according to the physicians, was that they did not recognize the nurses' professional role”

(Matziou et al., 2014). This is limiting if the roles are not well established in an interprofessional

collaboration team because then the extent of what each profession can bring to the table will be

impaired.

Not only are physician and nurse relationships important in confidence building, but

having a leader to rely on is also crucial. It was discussed how supportive leaders and preceptors

are useful in transitioning the new graduate nurses. In one study that looked at new graduate

nurse’s confidence and the lack of experience found that positive feedback from preceptors or

patients goes a long way in building confidence (Ortiz, 2016). Use of supportive leaders and

preceptors could increase new graduate nurse confidence by having a role model that was helpful

and provided open communication. Finally, the studies noted that professional collaboration did

have an effect on nurse retention rates and recruitment. If there is positive supportive
IMPACT OF NEW NURSES’ CONFIDENCE IN COMMUNICATING 5

communication between the nurses and physicians, it creates a better work environment and

patient outcomes improve as well.

While all of the studies share a similar topic to research, only some of the journals

gathered information from another profession besides nursing. Specifically, five of the journals

analyzed (Morrow & Gustavan & Jones, 2016; Ortiz, 2016; Pfaff et al., 2014; Ulrich et al., 2010,

Wilhelmsson & Svensson & Timpka & Faresj, 2013), solely researched from the viewpoint of

nursing; whereas three of the studies include the nurse and physician’s viewpoint (Bowles et al.,

2016; Matziou et al, 2014; Siedlecki & Hixson, 2015). By involving both the nurse and the

physician in the study, these three journals acknowledge communication as a two-way process.

Through this format, the studies argue that in order to draw conclusions with accuracy, both

sides of communication must be evaluated evenly. The other five journals, on the other hand,

did not gather data interprofessionally, but rather, believed that their efforts would be better spent

focusing on the nurse’s perspective.

When analyzing the limitations in the studies chosen, there are a few threats to validity.

First, multiple studies used a limited sample size along with convenience sampling, creating the

potential for selection bias (Bowles et al. 2016; Matziou et al., 2014; Ortiz, 2016; Pfaff et al.,

2014; Siedlecki & Hixson, 2015). This does not allow an accurate representation of the whole

population’s feelings, yet the studies draw a generalized conclusion. Second, the studies only

include nurses in the hospital setting and do not take into account the variety of settings a nurse

can work in while still being in continual communication with physicians. Third, the authors of

this literature review create a limitation because we are current student nurses. This presumably

creates a bias to side more towards the nurses’ stances when reviewing the studies and drawing a

conclusion founded on this potential bias rather than on the research.

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Conclusion

Effective communication is an important aspect in any relationship, and it is a crucial

element when it has the ability to affect the outcomes of patients. The interprofessional

relationship that was focused on the most was the relationship between the nurse and the

physician. According to the literature, there is a barrier in communication between nurses and

physicians. This barrier is due to the difference in views, professional hierarchy, and the lack of

physicians’ recognition and or understanding of the role of a nurse. This may not always be the

case at all healthcare facilities, but it is the main theme that was found in the literature. New

graduate nurses’ lack of confidence can further affect interprofessional communication and

collaboration, which can in turn affect patient outcomes. A factor that combats this barrier is

being equipped with supportive leaders and preceptors for new graduate nurses. Having a leader

that is helpful and able to demonstrate how to provide open communication can increase the new

graduate nurse confidence in communicating with other members of the interprofessional team.

Direction of future research should target physicians’ attitude towards communication with

nurses. Additionally, future research should look at how nursing schools prepare students and

how that correlates with their confidence, the nature of leadership and how this affects new

graduate nurse confidence in interprofessional collaboration. Last, looking at the development of

confidence in interprofessional collaboration over time is important.

Recommendations

Recommendations include but are not limited to: empowering nurse managers to help

bridge the gap in physician-nurse miscommunication, analyzing the training of preceptors to help

transition the new nurse into practice, utilizing the differences in critical thinking as a strength

rather than a weakness, and providing interprofessional education to new graduate nurses
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(Morrow et al., 2016; Ortiz, 2016; Pfaff et al., 2014; Ulrich et al., 2010, Wilhelmsson et al.,

2013). Empowering nurse managers to help bridge the gap in physician-nurse

miscommunication by expressing there is an issue to proper supervisors that can make a

difference. This could help bring about education and policies on how to effectively

communicate between members of the interprofessional team. Analyzing the training of

preceptors and focusing on the effects of communication with other interprofessionals can help

preceptors know what information is important to teach new nurse to help transition them into

practice. Utilizing the differences in critical thinking of physician and nurses as a strength rather

than a weakness can help bring different viewpoints to practice. Finally, interprofessional

education is important for the whole team to provide safe and effective communication in the

hospital, and training new graduate nurses in interprofessional communication can help prepare

new graduate nurses to work together with other professionals.

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