Nurses' Perceptions of Interprofessional Teamwork in Labour and Delivery

Abstract

Within healthcare today, teams and teamwork have been rapidly implemented with the belief that they are capable of improving outcomes for patients, staff and the organization. However, there are also differing understandings of what teamwork means amongst healthcare providers because of differences in professional culture that influence effectiveness. In labour and delivery, it is critical that nurses and physicians work well together as part of an effective team in order to provide safe and ethical family centered maternity care. This study was a focused ethnography that examined the perceptions of nurses working in labor and delivery to understand, from their perspective, the characteristics of interprofessional teamwork, especially with physicians, and the features that facilitate or impede its effective functioning. Interviews were conducted with 10 labor and delivery nurses and time was spent observing their work and interprofessional interactions. These nurses identified relationships as a key factor in effective teamwork. Nurses also acknowledged working in a normative hierarchy, with physicians ultimately responsible for patient care decision making. These nurses navigated the traditional power structure in familiar ways by acknowledging their own autonomy when the physician was absent, by using tactical communication and by their control over certain unit resources, including new resident learning and socialization. Nurses described a very small cluster of physicians that inappropriately assert power over them, residents and their patients through the use of disrespectful behaviors. As a result, these nurses described the myriad of ways that they work to smooth and preserve the functioning of the working relationship, mainly by circumventing disrespectful behaviors and venting. Nurses revealed the major facilitators of their working relationships with physicians as time, trust and respect, credibility and social connection. The attainment of practice knowledge, as rooted in the medical aspects of care, emerged as being a major facilitator of trust and respect in this workplace. Positive relationships with physicians influenced intent to stay, workplace morale, the perception of healthy communication and good patient outcomes. Negative or unestablished relationships were perceived as having the opposite effect. This research has implications for management efforts to support and develop teamwork. The findings may also provide nurse educators with insights to better prepare nurses for interprofessional working environments.