“Stereotypical” behaviours of Australian doctors and nurses are hampering efforts at infectious disease control in hospitals, experts are arguing.
Based on interviews with senior doctors and nurses at a major teaching hospital in Sydney, researchers say old fashioned interpretations of interprofessional relationships are alive and well, particularly when it comes to hospital infection prevention and control (IPC).
These include the old idea that doctors prioritise clinical autonomy, while nurses will “rigidly implement” rules, including those they disagree with.
“Participants from both professions painted clichéd portraits of ‘typical’ doctors and nurses and recounted unflattering anecdotes of their IPC behaviours,” they wrote in BMC Health Services Research.
“Doctors were described as self-directed and often unaware or disdainful of IPC rules; while nurses were portrayed as slavishly following rules, ostensibly to protect patients, irrespective of risk or evidence.”
With IPC often led by nursing staff, the result was advice on infection control often going ignored by doctors, they added.
The researchers, from the University of Sydney’s Marie Bashir Institute for Infectious Diseases, said many doctors objected to being reminded of IPC requirements by nurses, even in cases when the nurse had greater knowledge.
For example, one of the doctors interviewed had claimed that hand hygiene audits were “biased against doctors because the auditors were nurses”, they wrote.
Another felt that “bossy” nurses should be expected to remind doctors when hand hygiene was required to ensure compliance.
Multiple participants reported instances of doctors being rude to nurses who reminded them about IPC precautions, with comments like “I don’t care about your bloody infection control”.
“Although outright rudeness was not common, doctors were described as often dismissive or grudgingly compliant when reminded about IPC,” the authors said.
Participants attitudes towards members of the other professional also revealed “significant prejudice”, they added.
Harmful beliefs included that doctors were focused on diagnosis and “cure”; prioritising clinical autonomy and objecting to rules or advice from other professionals that might challenge their decisions.
“They are ambitious and competitive in pursuit of career goals; they support each other and ignore or seek to dominate other healthcare professionals,” the authors said.
Conversely nurses suffered under a stereotype of being driven by rules, which they implement rigidly, without concern for evidence or possible inconvenience to doctors; they are motivated by fear of the nursing hierarchy, as well as being “bossy” and vindictive.
They also seen to believe they knew “better than doctors, what is best for patients, because they spend more time with them”.
The authors added: “Our findings suggest that the ‘rules of the game’ mean that a nurse, who seeks to remind a doctor about an IPC breach, must balance the likelihood of success (the doctor’s compliance) vs failure (being ignored or humiliated) and act accordingly.”
The researchers, both senior physicians, suggested that more multidisciplinary approaches were needed to ensure doctors had a greater role in IPC practice.
Another idea put forward was for doctors to receive regular IPC training from other medical specialists, who they were more likely to listen to than nursing staff.