LAUSR

This issue of the Western Journal of Nursing Research includes our analysis of data from 665 acute care hospitals and over 1.3 million adult surgical patients showing that patients cared for in hospitals with better nurse–physician teamwork had significantly lower odds of both 30-day mortality and failure to rescue. This finding is in line with other research and affirms the many calls from the National Academy of Medicine and other organizations to improve nurse–physician teamwork to achieve the highest quality of care and clinician well-being. The question now is: What do we do? In our view, the answer for researchers is to develop and test interventions at scale. To be sure, there have been advances in intervention research on teamwork. For example, there is evidence on interventions that focus on the process of communication (e.g., education and training in communication skills, and simulation exercises), as well as interventions aimed at creating shared time and care processes like interdisciplinary rounds and unit-based physician assignments (O’Leary et al., 2012). These are a much needed and valuable contribution, but there continues to be significant variation in the quality of nurse–physician teamwork across hospitals. Why does this problem remain for so many hospitals if we know what to do to improve nurse–physician collaboration? One potential explanation highlights an opportunity for a different intervention research agenda—a focus on the work environment in which collaboration (and interventions aimed at improving collaboration) occurs. By work environment, we refer to the characteristics of hospitals that promote the highest quality of professional practice and clinical care including professional autonomy, effective leadership, an authentic voice in hospital policy, and adequate staffing and resources. Now may be the right time to create a joint research agenda among nurses and physicians focusing on changing the work environment to enhance teamwork. More and more, especially in hospital settings, nurses and physicians have a shared experience of the negative aspects of the work environment (Kutney-Lee, Wu, Sloane, & Aiken, 2013; West, Dyrbye, & Shanafelt, 2018). The growth of hospitalists and intensivists employed by hospitals (vs. independent practitioners) (Kane, 2019) means that hospital physicians are now exposed to much of the frustrating hospital bureaucracy that nurses have experienced for decades: ineffective leadership, autonomy constraints, superfluous red tape, redundant documentation burdens, limited involvement in hospital decision-making, excessive workloads, and inadequate resources. There is a need to test and implement organizational interventions that can shape these attributes to the mutual benefit of doctors and nurses. There are promising examples of evidence-based organization-wide changes that improve the work environment for nurses, but they have not been tested in a controlled trial nor have they involved physicians. For example, the Magnet hospital model is one that demonstrates both better work environments and better nurse–physician collaboration (Kramer & Schmalenberg, 2003). Most of this evidence, however, comes from cross-sectional work so the ability to draw causal inferences is limited, that is, whether improving aspects of the work environment leads to improvement in nurse–physician collaboration. An ideal study would be a place-based randomized trial to test the benefits of implementing Magnet principles, but extends those core principles beyond nurses to include physicians. The challenges for conducting a place-based trial of organization-level reform would be significant, not the least of which would be having the large number of hospitals necessary for such a study. The rewards, however, could be considerable if we learn through rigorous study how to create environments that allow nurses and physicians to practice well together.