Date of Award
Doctor of Philosophy (PhD)
Matthew D. McHugh
Interest in the relationship between nurses and physicians has been increasing over the past few decades. Teamwork between the two disciplines was first studied in the 1970s and interest surged again in the 1980s, when evidence suggested that better teamwork saved more lives. This study presents a cross-sectional analysis linking 2006-2007 nurse survey data, hospital administrative data, and patient discharge data. The study sample comprised of 665 hospitals, 1,321,904 patients, and 29,391 nurses. Logistic regression models were used to assess the association between higher levels of nurse-physician teamwork and patient outcomes (30-day mortality and failure-to-rescue). Regression models were also used to examine whether any associations between nurse-physician teamwork and patient outcomes depends upon the level of other modifiable characteristics of hospital nursing (nurse staffing and education levels) in acute hospital settings. Final analysis revealed decreased odds of both 30-day mortality (OR = 0.943, 95% CI 0.930,0.958) and failure-to-rescue (OR = 0.939, 95% CI 0.925, 0.953) for surgical patients cared for in hospitals with better nurse reported nurse-physician teamwork, adjusting for hospital structural characteristics and patient characteristics. In addition, there was a significant interaction between nurse staffing and nurse-physician teamwork on surgical patient 30-day mortality, and failure-to-rescue rates. There was also a significant interaction between nurse education and nurse-physician teamwork on surgical patient 30-day mortality, and failure-to-rescue rates. Our analysis found a trend of decrease in odds of death and failure-to-rescue for hospitals with both higher nurse-physician teamwork scores and lower patient-per-nurse ratios. Similarly, there is a trend of a decrease in odds of death and failure-to-rescue in hospitals with higher nurse-physician teamwork scores and higher proportion of BSN educated nurses. In order for initiatives to improve interprofessional teamwork to have greater impact on patient outcomes, nurse staffing and nurse education need to be at sufficient levels.
Kang, Xiao Linda, "Association of Nurse-Physician Teamwork and Hospital Surgical Patient Mortality" (2016). Publicly Accessible Penn Dissertations. 1801.