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 With Physicians on Patient Outcomes

IMPACT OF NEW NURSES’ CONFIDENCE 2

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 literature review 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

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

practicing.
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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 when necessary, in some cases

this can prevent the patient from getting the care they need. Exploring the impact that new

nurses’ confidence has on patient care outcomes is important in order 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

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
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could also contribute to the new grad nurses 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 towards

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 were how physicians

either do not recognize or 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

nurses 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

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

patient outcomes improve as well.

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

gathered information from another profession besides nursing. Specifically, five of the journals
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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 (Bowles et al. 2016; Matziou et al., 2014; Ortiz, 2016; Pfaff et al., 2014;

Siedlecki & Hixson, 2015) used a limited sample size along with convenience sampling, creating

the potential for selection bias. 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 creates 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.

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 most was the relationship between the nurse and physician.
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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. Supportive leaders and preceptors are important in

transitioning 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 physician’s attitude towards communication with nurses, research looking at how

nursing schools are preparing students and how that correlates with their confidence, the nature

of leadership and how this affects new graduate nurse confidence in interprofessional

collaboration, and the development of confidence in interprofessional collaboration over time.

Recommendations

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

bridge the gap in physician-nurse miscommunication, analyze 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

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

Wilhelmsson & Svensson & Timpka & Faresj, 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
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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 by working together can help bring different viewpoints to

practice. Lastly, 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 them to work together with other professionals.