Unsafe doctor–nurse interactions in the process of implementing medical orders: A qualitative study

Abstract

AimThis study aimed to explore challenges faced by clinical nurses in the process of implementing medical orders.DesignA qualitative study using inductive content analysis.MethodsSemi‐structured individual interviews were carried out with 17 participants including nurses, nurse managers and medical doctors who were purposefully selected. The collected data underwent inductive qualitative content analysis.ResultsThe main research finding was the category of ‘unsafe doctor–nurse interaction’. It included three subcategories: ‘conflicts in documenting and executing orders’, ‘not accepting the nurse's suggestions for writing and correcting orders’ and ‘failure to accept the responsibility of orders by the doctor’. Challenges in the professional relationship between doctors and nurses cause mistrust and conflict. They also enhance nurses' concerns about professional and legal issues in the workplace and endanger patient safety.

A grounded theory of the implementation of medical orders by clinical nurses

“…Challenges faced by the nurses in performing medical orders encompassed demanding workloads, doctors disregarding legal instructions, altering orders without notifying nurses, and nurse managers exerting pressure for comprehensive documentation, all jeopardizing nurses’ job credibility. The challenges posed by high workloads and fatigue have been identified as significant factors contributing to lapses in implementing medical orders, neglecting the reassessment of orders, and failing to adequately document them [ 6 , 9 , 27 ]. Emphasizing particular aspects of the nursing work environment, including adequate staffing and resources, encouraging nurses’ involvement and career progression are crucial for enhancing the quality of patient care.…”