Interview with Pat Samples by Holly LeMaster

This is the third in a five-part series on physician leadership.

What’s the impact of physician and nurse leaders partnering effectively—or not? Some of the literature is beginning to show that, since the advent of EMR, nurses and physicians are working more in parallel to one another versus in true collaboration. They don’t actually have to be in the same place at the same time anymore to “talk about” the patient. So a lot of the work I do with nursing leaders and physicians is about getting them back in the room together. We cannot deliver good care if the physician and the nurse aren’t partnering. That’s true at the front line, at middle management, and the executive level. Physicians and nurses must partner in the delivery of care. That’s all there is to it. We’ve let the EMR separate us, and we’ve got to get back to collaborating on patient care. There’s a lot of thinking outside the box and brainstorming about how to do this. What’s the vision? How are you going to get there? What behaviors are you willing to tolerate? How is the medical director going to support their nursing leader, and vice versa?

I recently went into an organization where the medical director was struggling with relationships and was highly frustrated. As I observed him go through his day, it became apparent to me that the nursing leader and the physician leader weren’t on the same page. As a result of understanding this, what I’ve come to do in most organizations is to ask the physician right away: who is your nursing leader and where are you two headed together? You must be going in the same direction, especially if you’re trying to drive a service line or a fast-paced procedure area. You must align your approaches to operational issues, skill mix, and strategic direction. It has to be an intentional conversation.

These relationships are often dysfunctional due to processes which aren’t ideal. But there’s a natural magnet between physicians and nurses that’s been depolarized by the EMR. We need to get back in there and fix it, for the best interest of the patient. Nurses spend more time with the patient, they know more about the social issues—information the physician needs. The two leaders need collaboration and role clarity. What you don’t want to happen is for the medical director to get bogged down in too much operational detail—it skews their perspective and they begin to have discussions with employees that they shouldn’t be having. The trick is learning how to use the power of the physician to leverage relationships and processes in the appropriate places. We do a lot of work around that.