Nurse-physician Communication Research Articles

Stakeholders’ perceptions of how nurse-physician communication may impact patient care: protocol for a concept mapping study

ABSTRACT Effective nurse-physician interprofessional communication is important to ensure that patients receive evidence-based care and treatment. There is a gap in knowledge about how nurse-physician communication impacts patient care. We propose using concept mapping to develop an in-depth understanding of patients, nurses, and physicians’ perspectives on how physician-nurse communication affects patient care. There are six phases to concept mapping: determining the focus, generating statements, structuring statements, producing the map, interpretating the map, and map utilization. We will use ‘Ariadne’, a concept mapping software package for data collection and analysis. The study outcome will be a two-dimensional concept map providing a visual representation of how nurse-physician communication influences patient care. We will report similarity and differences among three stakeholder groups. Our research will inform the development of testable hypotheses about nurse-physician communication and patient care.

Which Factors Promote Shared Understanding Between Physicians and Nurses in Inpatient Oncology Care Settings?: A Qualitative Exploration.

Effective communication between physicians and nurses is crucial to the safety of patients, especially for those with cancer, which is a complex disease requiring multidisciplinary treatment. However, little is known about the factors that contribute to effective communication, which is defined as the development of shared understanding between two or more people. This qualitative secondary analysis was conducted to identify factors that contribute to shared understanding between physicians and nurses from video-recorded conversations that occurred between them during inpatient rounds on oncology units. We used inductive grounded theory to identify videos depicting moments of shared understanding. We then searched for preceding events to develop a preliminary conceptual model that described the factors contributing to shared understanding. Four factors emerged as contributors to shared understanding: engagement, clarification, confirmation, and resolution. These factors occurred in sequence with engagement occurring first and resolution occurring last, as the closure of a communication exchange. Existing interventions to improve communication include some of the factors identified as contributing to shared understanding (eg, closed-loop communications require clarification and confirmation). However, nurses may need to pay attention to all four factors to develop shared understanding that will promote effective communication with physicians and thereby enhance cancer care. Nurses achieve effective communication when they are assertive and avoid indirect communication. A greater awareness of body language and positioning in relation to a physician at the start of a communication exchange may increase the effectiveness of nurse-physician communication.

Nurses' heart failure discharge planning part I: The impact of interdisciplinary relationships and patient behaviors

AimThe purpose of this interpretive descriptive study was to understand bedside nurses' motivation and decision-making during discharge planning for adult patients with HF on a 48-bed telemetry step-down unit. BackgroundHeart failure (HF) discharge planning interventions have largely excluded the contributions of bedside nurses. MethodsFifteen bedside nurses were interviewed. Coding was done using NVivo and thematic analysis was completed. ResultsThis paper is the first in a two-part series which presents separate results of the interpretive descriptive study delineating the factors that impact bedside nurses' motivation and decision-making during HF discharge planning. This paper presents the major finding of nurses' high levels of motivation to do effective discharge planning despite many barriers, such as poor physician-nurse communication and patient behaviors. These nurses described being motivated when they had good communication from the interdisciplinary team and time to establish a personal connection with patients. ConclusionsOverall, findings of this study emphasized a need for interdisciplinary relationship-building between bedside nurses, patients, and physicians to be factored into the organizational culture.

Improving Physician-patient and Physician-nurse Communication and Overall Satisfaction Rates: A Quality Improvement Project

IntroductionCommunication between healthcare providers and patients is a key component associated with the quality of healthcare and patient satisfaction. Often, simple communication skills may be insufficient to sustain a successful provider-patient relationship. The aim of this project was to assess and improve patient and nurse satisfaction with physicians via improvement in physician-patient and physician-nurse communication to a level greater than 90%.MethodsInitial surveys were given to the patients and nurses on admission to the regular nursing floor to assess current satisfaction rates. Afterward, visual handouts were given that provided details about the current medical team members and the role of each team member. which were updated daily along with the medical plan. Surveys were then handed out to the patients and their nurses at the time of discharge. All surveys were conducted anonymously.ResultsA total of 26 surveys (n = 13 patients, n = 13 nurses) were collected and analyzed for a preliminary assessment. Surveys concluded that 68.8% of patients were satisfied with the patient-provider communication; similarly, 74.4% of the nurses were satisfied with the nurse-provider communication. In the next six weeks, visual handouts were implemented. During this period, surveys involving a total of 40 patients and 40 nurses were collected. The results after the intervention revealed that 93.3% of patients were satisfied with the patient-provider communication, and 94.7% of nurses were satisfied with the nurse-provider communication. Post-intervention, the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) displayed an improvement in physician communication, reaching the expected goal of 84.4%.ConclusionIneffective communication often goes undetected in many healthcare settings, causing serious effects on the health and safety of patients, and may ultimately jeopardize overall satisfaction. Literature has shown a positive correlation between patient satisfaction and improved clinical outcomes. Using visual aids and updating medical care plans on a daily basis are simple yet effective tools to improve communication. Written materials should be created in a patient-friendly manner to enhance communication, clarity, and understanding.

Nurse-Physician Communication Team Training in Virtual Reality Versus Live Simulations: Randomized Controlled Trial on Team Communication and Teamwork Attitudes.

BackgroundInterprofessional team training is needed to improve nurse-physician communication skills that are lacking in clinical practice. Using simulations has proven to be an effective learning approach for team training. Yet, it has logistical constraints that call for the exploration of virtual environments in delivering team training.ObjectiveThis study aimed to evaluate a team training program using virtual reality vs conventional live simulations on medical and nursing students’ communication skill performances and teamwork attitudes.MethodsIn June 2018, the authors implemented nurse-physician communication team training using communication tools. A randomized controlled trial study was conducted with 120 undergraduate medical and nursing students who were randomly assigned to undertake team training using virtual reality or live simulations. The participants from both groups were tested on their communication performances through team-based simulation assessments. Their teamwork attitudes were evaluated using interprofessional attitude surveys that were administered before, immediately after, and 2 months after the study interventions.ResultsThe team-based simulation assessment revealed no significant differences in the communication performance posttest scores (P=.29) between the virtual and simulation groups. Both groups reported significant increases in the interprofessional attitudes posttest scores from the baseline scores, with no significant differences found between the groups over the 3 time points.ConclusionsOur study outcomes did not show an inferiority of team training using virtual reality when compared with live simulations, which supports the potential use of virtual reality to substitute conventional simulations for communication team training. Future studies can leverage the use of artificial intelligence technology in virtual reality to replace costly human-controlled facilitators to achieve better scalability and sustainability of team-based training in interprofessional education.Trial RegistrationClinicalTrials.gov NCT04330924; https://clinicaltrials.gov/ct2/show/NCT04330924

Ten Best Practices for Improving Emergency Medicine Provider-Nurse Communication.

The current state of scientific knowledge regarding communication between emergency medicine (EM) providers indicates that communication is critical to safe and effective patient care. In this study, we identified communication needs of EM nurses and physicians; in particular, what information should be conveyed, when, how, and to whom. Five semi-structured focus groups and one interview were conducted with nine nurses, eight attending physicians, and four residents. Questions addressed how EM personnel use and share information about patients and clinical work, what information tends to be exchanged, and what additional information would be helpful to share. Sessions were audio recorded. Transcripts were generated and analyzed using a concept mapping approach (a visual qualitative analysis technique to represent and convey synthesized knowledge). Eleven concept maps were produced summarizing: information physicians needed from nurses and vice versa; methods of communication that could be utilized; barriers or obstacles to effective communication; strategies to enhance or ensure effective communication; and environmental or situational factors that impact communication. Our main finding of this research is that communication ensures shared awareness of patient health status, the care plan, status of plan steps and orders, and, especially, any critical changes or "surprises" regarding the health of a patient. Additionally, the research identified shared information needs; communication methods, strategies and barriers; and factors affecting successful communication, and has implications for both system and training design. Key implications for emergency nursing practice from this research are distilled in 10 'best practice' strategies for improving EM nurse-physician communication.

Using Qualitative Methods to Explore Communication Practices in the Context of Patient Care Rounds on General Care Units.

Poor communication between physicians and nurses is a significant contributor to adverse events for hospitalized patients. Overcoming communication difficulties requires examining communication practices to better understand some of the factors that affect the nurse-physician communication process. To develop a more detailed understanding of communication practices between nurses and physicians on general care units. We focused on patient care rounds as an important activity in the care delivery process for communication. Qualitative study design PARTICIPANTS: A total of 163 physicians, registered nurses, and nurse practitioners who worked on pre-specified general care units in each of four hospitals in the Midwest. On each unit, data collection consisted of 2weeks of observing and shadowing clinicians during rounds and at other times, as well as asking clinicians questions about rounds and communication during interviews and focus groups. A directed content analysis approach was used to code and analyze the data. Workflow differences contributed to organizational complexity, affecting rounds and subsequently communication practices, both across and within provider types. Nurse and patient participation during rounds appeared to reduce interruptions and hence cognitive load for physicians and nurses. Physicians adopted certain behaviors within the social context to improve communication, such as socializing and building relationships with the nurses, which contributed to nurse participation in rounds. When rapport was lacking, some nurses felt uncomfortable joining physicians during rounds unless they were explicitly invited. Improving communication requires bringing attention to three contextual dimensions of communication: organizational complexity, cognitive load, and the social context. Initiatives that seek to improve communication may be more successful if they acknowledge the complexity of communication and the context in which it occurs.

584. Use of Multi-Disciplinary Prevention Rounds to Reduce Central Line-Associated Bloodstream Infections in a Neonatal Intensive Care Unit

BackgroundDespite successful implementation of evidence-based prevention bundles, central line-associated bloodstream infections (CLABSIs) continue to occur in neonatal intensive care units (NICUs). We hypothesized that multi-disciplinary prevention rounds may be able to further reduce CLABSIs.MethodsWe implemented bedside rounds in a 39-bed tertiary NICU in November 2018 with the focus of reducing CLABSIs. Standardized rounds for all patients with a central venous line (CVL) occurred 2–3 times/week on weekdays during either the day or evening shifts. Rounds included NICU nursing leadership, the Hospital Epidemiologist and the patient’s nurse. Questions focused on the CVL maintenance bundle, reducing line access, and patient-specific CLABSI risk factors. Best practices were reinforced and solutions for identified risk factors were developed. Recommendations were communicated to the physician, as appropriate. Prevention rounds data were collected. Nurses and providers in the NICU were surveyed about their perceptions of the rounds. CLABSIs were identified by Infection Prevention using standard definitions.ResultsThe average daily NICU census was 35.6, with an average of 14 patients with CVLs/day. The average duration of rounds was 45 minutes. Recommendations to physicians, such as changing medications from intravenous to oral or line removal, were accepted 85% of the time. 74.5% of nurses and 87.5% of providers thought that prevention rounds had at least some impact on CLABSI prevention. Nurse and provider responses to the perceived impact of CLABSI prevention rounds are in Tables 1 and 2, respectively. In the 12 months prior to starting prevention rounds, the CLABSI rate was 1.53 /1000 line days and the CLABSI rate for the 6 months after starting rounds was 0.99/1,000 line days, a 65% decrease.ConclusionCLABSI prevention rounds helped reinforce evidence-based prevention practices, identified patient-specific risk factors and improved physician-nurse communication. CLABSIs in NICU were reduced. Disclosures All authors: No reported disclosures.

Simulated Paging Curriculum to Assess and Improve Communication Skills

PURPOSE: To examine the impact of a simulated paging curriculum for senior medical students on physician-nurse communication skills. BACKGROUND: New residents are expected to triage and address a high volume of clinical pages yet medical students receive little training in this important skill. Previous studies have evaluated the impact of simulated paging curricula on clinical decision making and student confidence but have not examined the effect on communication skills. METHODS: Two trained Registered Nurses (RNs) administered specialty-specific pages to 76 fourth-year medical students enrolled in 4-week residency preparation electives. For each case, RNs evaluated students’ performances on seven communication domains using previously validated 5-point semantic-differentiation scales (1=worst, 5=best) in precision, instruction, assertiveness, direction, organization, engagement, and ability to solicit information. Immediate feedback was provided to the students. RESULTS: A total of 351 pages were administered: 144 in week 1, 73 (week 2), 97 (week 3), and 37 (week 4). Students from all specialties improved communication scores throughout the four weeks. Mean communication scores increased from 4.02 to 4.26 from week 1 to week 2 (<0.0001). Improvement was most pronounced for the students going into internal medicine (3.82 to 4.25) and pediatrics (3.95 to 4.38) and less pronounced for the procedural specialties of surgery (4.26 to 4.22) and ob/gyn (4.07 to 4.18). Communication skills continued to improve in weeks 3 and 4 but with inadequate number of pages to power this comparison. DISCUSSION: Our data demonstrates that a simulated paging curriculum is a promising platform for teaching and improving physician-nurse communication skills for senior medical students.

Getting work done: a grounded theory study of resident physician value of nursing communication

ABSTRACTPoor communication between nurses and physicians results in patient injury and increased healthcare costs. While multiple attempts have been made to improve communication between the two professions, evidence confirms little progress has been made. Previous research focused on standardizing communication processes and protocols between nurses and physicians rather than examining the relational component of these human interactions. The purpose of this study was to explore physician valuing of nursing communication in the context of patient care. Interviews were conducted with 15 internal medicine resident physicians. A constructivist grounded theory approach was used to develop the substantive theory of Getting Work Done. Getting Work Done incorporated three major categories: discerning the team, shifting communication, and accessing nurse knowledge and abilities. Hierarchical behaviors and language, and nurse collusion in both, characterized nurse-physician communication and situated the nurse outside the decision-making team. Complex work environments further devalued nurse-physician communication. Interprofessional education and practice must advance the unique and essential role of all health care professionals such that mutual valuing replaces hierarchical actions with collaborative systems for determining the most effective approaches to patient care.

Contextual Barriers to Communication Between Physicians and Nurses About Appropriate Catheter Use.

Indwelling urinary and vascular catheters are a common cause of health care-associated infections. Interventions designed to reduce catheter use can be ineffective if they are not integrated into the workflow and communication streams of busy clinicians. To characterize communication barriers between physicians and nurses and to understand how these barriers affect appropriate use and removal of indwelling urinary and vascular catheters. Individual and small-group semistructured interviews were conducted with physicians and nurses in a progressive care unit of an academic hospital. Common themes were identified, analyzed, and then organized using a conceptual framework of contextual barriers to communication: organizational, cognitive, and social complexity. Several barriers to communication between physicians and nurses contributed to inappropriate use and delayed removal of catheters. Workflow misalignment between clinicians was a barrier associated with organizational complexity, issues with electronic medical records and pagers were associated with cognitive complexity, and strained relationships between clinicians and rigid hierarchies were associated with social complexity. Communication is contextual, and improving physician-nurse communication about appropriate catheter use may require innovations that address the identified contextual barriers.

Inpatient Cross-Cover Consensus Recommendations for Medical and Surgical Residents: A Delphi Analysis.

Residents regularly care for hospitalized patients for whom they are not the primary provider (cross-cover), often without guidance. We identified and defined components of safe cross-cover care. Sixty medical and surgical faculty physicians and chief residents from the Midwest were invited to participate in a Delphi study analyzing the appropriateness of cross-covering residents evaluating patients at bedside, deferring issues to the primary team, documenting a note, contacting the attending, and communicating with nurses. The first survey was free text, and responses were categorized. In the second survey, physicians rated categorized responses based on appropriateness using a 5-point Likert scale. High consensus was defined as ≥ 80% agreement, approaching consensus as 51% to 79% agreement, and nonconsensus as ≤ 50% agreement. Results were analyzed by specialty and cross-cover experience in the past year using Pearson χ2 test or Fisher exact test. Forty respondents (67%) completed the first survey and 30 (50%) completed the second. Responses led to 46 categories. Twenty-eight items (60%) achieved high consensus, 8 (17%) approached consensus, and 10 (22%) did not achieve consensus, with no difference based on specialty or experience. Responses with 100% consensus included: residents should evaluate a patient at bedside whenever asked by the nurse; documentation should occur for change in level of care, death, code, or rapid response team activation; and physician-nurse communication should be respectful and closed loop. This regional physician panel reached consensus on 28 elements important in cross-cover care, which can be used for training and future studies.

Cross-Coverage Care at a Crossroads.

Cross-Coverage Care at a Crossroads.

Evaluating Nurse-Physician Communication With a Rubric: A Pilot Study.

Poor communication is a leading cause of sentinel events. The aims of this pilot study were to determine whether the ISBAR (Identification, Situation, Background, Assessment, and Recommendation) Interprofessional Communication Rubric (IICR) was a reliable tool among nurses and to examine the communication performance of new graduate nurses in a hospital-based simulation center. The IICR demonstrated reliability among raters in this setting (rs = .91). The new graduate RNs' communication performance scores were low, warranting continued professional development. The IICR may be used to guide continued education and development for nurse-physician communication. [J Contin Educ Nurs. 2019;50(4):163-169.].

Inter professional nurses-physicians collaboration and its effects on nurse's team activities

Inter professional collaboration and team work between nurses is crucial for improving patient outcome and quality of care. This study aims to study the inter professional collaboration between nurses-physicians and its effects on nurses team activities at Tanta University Hospitals. Data were collected by using two tools. Tool 1: Jefferson scale) 2009) of Attitude toward Physician-Nurse Collaboration andmodified byAyman El sous(2017). It Includes has six subscales that measure (a) nurse-physician collaboration (8 items) (b) doctors authority (2 items) (c) shared education (3 items) (d) Nursing role in patient care (2 items) (e) disconnecting communication between nurses-physician (4 items).(f) Nurse-physician communication (4 items) responses ranged from 1-5 score. Tool 2: measures team activities scale was used to assess nurses team activities interactions, modified by the researcher based on Thompson)(2007), these included 15 items. Responses was measured in five liker scale ranging from (5) all of the time to none of the time (1). Results and conclusion revealed that the total scores indicted that nurses have more positive attitudes towards nurse-physician inter professional collaboration than physicians. Also, the result reveals that 67% of nurses have high attitude level toward nurses team activities attitudes.Recommendations: Based on the results of the present study recommended that Initiating and developing mutually respectful inter-professional relationships between nurses and physicians. Also, encourage continuing in-service-training program and workshop these with a focus on teamwork and communication.

Abstract WP499: Effective Communication Between Nurses and Physicians Leads to Better Patient Outcomes!

Background: Open lines of communication are essential amongst multidisciplinary team members to ensure that patients are receiving quality care. Lack of communication can lead to poor patient outcomes, low morale, and create mistrusting relationships. A review of evidence has shown that when nursing staff and physician staff communication is seamless there is an increase in patient outcomes. Patient satisfaction, outcomes, and length of stay are expectations in our Comprehensive Stroke Center. The quality of care that patients receive can be determined by the relationship between physicians and nursing staff. Purpose: The purpose of this study is to improve nurse-physician communication during a 6 month period and to identify areas of need with goals to increase patient satisfaction scores and decrease the length of stay of Stroke patients. Action: Daily physician and nursing staff rounds with patients were reconstructed in order to classify responses for patients discharged from Comprehensive Stroke Center from January 2018 to June 2018 based off scores from our Hospital Consumer Assessment of Healthcare Providers (HCAHP) Survey. The questions posed concerning physicians and nursing staff are parallel, and it is imperative that they are both on the same page. Stroke unit nurses were trained and given an in -service by the unit educator in Plan Do Act Check format and rounding tool was implemented. A Stroke Capacity Notification System was continued and fortified to communicate with physician staff and nursing leadership pertaining information on census, transfer, and discharge status of patients via text message every four hours. Results: Communication between physician and nursing staff revealed that engagement scores increased by 11% based on Press Ganey engagement survey. HCAHP Scores increased by 85%. There was a 12% overall decrease in length of stay of stroke population due to collaborative initiative. Practice Implication: Implementation of the daily interactive team rounds and texting will decrease the length of stay, improve physician- nursing communication, and improve patient satisfaction as well as quality of care.

For single-source feedback, including the mean and percentile rank on feedback by nursing staff does not improve physician-nurse communication amongst anesthesiologists as compared to the raw score alone

ABSTRACTBackground: Audit and feedback has increasingly become part of the medical professional landscape as a means to improve quality of practice. While many performance evaluation tools exist, there remains a paucity of research that assesses the relative effectiveness of the various components of assessment and feedback. Using a single-source framework, we investigated the value of a percentile rank score as a feedback tool to promote individual improvement.Method: Ninety peri-operative nurses completed an initial survey assessing the communication skills of 30 anesthesiologists at London Health Sciences Centre using a five-point Likert scale. Physicians were randomized to receive either only their score, or their score compared to the mean along with their percentile rank. An identical survey asking peri-operative nurses to re-evaluate each anesthesiologist’s communication skills was sent 3 months later, yielding 76 responses.Results: Regardless of whether or not anesthesiologists received feedback that contained individual scores only or individual scores along with the group mean and percentile rank, there was no significant impact on perceived communication from peri-operative nurses.Conclusions: A percentile rank score was an ineffective component within single-source assessment and feedback to improve peri-operative communication.

The influence of effective communication, perceived respect and willingness to collaborate on nurses' perceptions of nurse–physician collaboration in China

BackgroundNurse-physician collaboration is a critical prerequisite for high-quality care. Previous researchers have addressed multiple factors that influence collaboration. However, little of this research has explored the influence of interactional factors on nurses' perception of nurse-physician collaboration in China. AimsTo examine the influence of interactional factors (effective communication, perceived respect and willingness to collaborate) on nurses' perception of nurse-physician collaboration. MethodsA cross-sectional survey of 971 registered nurses in nine hospitals was conducted. An author-designed interactional factor questionnaire and the Nurse-Physician Collaboration Scale were used to collect data. Multiple regression analysis was used. ResultsNurse-physician collaboration was identified as at a moderate level (mean = 3.93 ± 0.68). Interactional factors (effective communication, perceived respect and willingness to collaborate) were identified as relatively moderate to high (mean = 4.03 ± 0.68, mean = 3.87 ± 0.75, mean = 4.50 ± 0.59, respectively). The results showed that effective communication, perceived respect and willingness to collaborate explained 57.3% of the variance in nurses' perception of nurse-physician collaboration (Adjusted R2 = 0.573, F = 435.563, P < 0.001). Perceived respect (β = 0.378) was the strongest factor relevant to nurses' perception of nurse-physician collaboration, second was effective communication (β = 0.315), and the weakest factor among these three factors was willingness to collaborate (β = 0.160). ConclusionNurses' perceptions of collaboration were relatively positive, mainly in Sharing of patient information; however, improvements need to be made regarding Joint participation in the cure/care decision-making process. Effective communication, perceived respect and willingness to collaborate significantly affect nurses' perception of nurse-physician collaboration, with perceived respect having greater explanatory power among the three interactional factors. It is necessary for hospital managers to develop strategies to build professional respect for nurses, facilitate effective nurse-physician communication and improve nurses' willingness to collaborate.

Novel use of communication technology to improve nurse-physician communication, teamwork, and care coordination during bedside rounds

ABSTRACTBackground: Inter-professional bedside rounding has been used to reduce communication deficits and improve patient outcomes. Our objective was to evaluate nurse and physician participation in inter-professional bedside rounds and perceptions of communication, teamwork, and care coordination, through a quality improvement (QI) intervention.Method: A web-based survey was completed by attending and resident physicians and nurses working on the general medical wards of an academic-affiliated Veteran’s Health Administration Hospital (VHA). Responses were assessed using the chi-square statistic. Qualitative responses were grouped into themes for analysis to guide the intervention. A pre-existing electronic communication device was utilized in a novel way by resident physicians to facilitate nursing participation in bedside rounds. Perceptions of communication, teamwork, and care coordination between nurses and physicians prior to and after introduction of the electronic communication device were assessed. Direct observation was used to assess nursing presence during physician team rounds.Results: Following the intervention, both nurses and physicians agreed more nurses were alerted by physicians when rounds began and better communication between nurses and physicians occurred. However, technological barriers limited sustainability. Nursing presence on rounds increased from a baseline of 16.5% to 36% post-intervention.Conclusions: Implementation of a voice-activated, communication device on rounds facilitated improvement in perceptions of communication, teamwork, and care coordination, which may ultimately impact cultural change and patient outcomes.

Effective Communication between Nurses and Doctors: Barriers as Perceived by Nurses

Effective communication among healthcare providers is the key driver for the success of the healthcare system. All the decisions related to patient care depend on effective communication among healthcare providers. Communication and teamwork are the backbones of the organization and helps to safeguard patients’ safety. The study aimed to identify the contributing factors to the communication gap between doctors and nurses at selected private hospitals in Malaysia. The study used a qualitative method with an explorative and descriptive design to elicit the experience of 24 staff nurses from six private hospitals in Kuala Lumpur, Malaysia. A semi-structured interview was conducted to collect the data. The data were analysed using Colaizzi's method for thematic data analysis. The findings of the study suggested three categories as the factors to be responsible for the nurse-physician communication gap as perceived by nurses. The three categories are nurses work readiness; work environment and physician attributes. The respondents also suggested measures to overcome the communication barrier among nurses and physicians. In conclusion, a healthy nurse-physician communication is a vital factor in determining patient safety and quality of care.