Professional Documents
Culture Documents
Abstract
The new graduate nurse often does not have a high level of confidence when they enter
of the team to communicate and collaborate can have meaningful impacts on patient care
outcomes. Because every member of the health care team is working with the patient in mind,
research shows that confidence is developed in the new graduate nurse over time, there are
several factors that can support development of new graduate nurse confidence and influence
communication between nurses and physicians and factors that influence confidence in the new
graduate nurse, as well as limitations and recommendations for future practice. It was found that
and collaboration, and role clarification are some important interventions that foster the
Introduction
communicate clearly with physicians in order to provide optimal care for patients. There are
many approaches to this including teaching the student to think critically, practicing SBAR, and
explaining to the student what orders to anticipate from the physician depending on the situation.
Professors have warned students that physicians might hang up the phone on them or can belittle
them as a nurse, especially when first practicing as a new nurse. This stigma, along with
IMPACT OF NEW NURSES’ CONFIDENCE IN COMMUNICATING 3
inexperience, can create a hesitancy and lack of confidence in nurses within their first year of
practicing.
The purpose of this literature review is to answer the question as to whether new
graduate nurses’ lack of confidence in communicating with physicians affect patient care
outcomes. This is an important question to answer because new graduate nurses may not have
this skill mastered and the result could be detrimental to patients without intervention. If the new
nurse is not able to effectively communicate with the physician, this has the potential to prevent
the patient from getting the care they need. Exploring the impact that new nurses’ confidence
have on patient care outcomes is important for the appropriate changes and steps to be made to
All of the studies discussed professional collaboration, and came to the conclusion that
collaboration is essential to providing the best care possible. In one study that explored new
interventions to support the new graduate nurses knowledge and experiences regarding
collaboration” (Pfaff & Baxter & Jack & Ploeg, 2014). If there is no interprofessional
communication, then the patient outcomes will suffer as an effect. The studies also had in
common that new nurse confidence increases with experience. As nurses gain more experience,
interprofessional collaboration will improve. All articles touched on the barriers between
the professions include the nurses’ confidence, difference in views, and the professional
IMPACT OF NEW NURSES’ CONFIDENCE IN COMMUNICATING 4
hierarchy. The difference in critical thinking skills could depend on the healthcare professional’s
role. Therefore, the physicians could be overpowering especially for a new grad nurse. This
could also contribute to the new graduate nurse’s confidence if the physician is not willing to
The views and values are also different between nurses and physicians. The nurses’
priorities are more geared to the patients, while the physicians are geared toward the diseases.
There is no one correct view and the collaboration of both views helps to provide the best
outcomes for a patient. Another barrier that the studies touched on was how physicians either do
not recognize or do not understand the role of the nurse. In one study that investigated the
physician and nursing perceptions regarding communication and collaboration found that “the
most important barrier for the establishment of good relations between these professions,
according to the physicians, was that they did not recognize the nurses' professional role”
(Matziou et al., 2014). This is limiting if the roles are not well established in an interprofessional
collaboration team because then the extent of what each profession can bring to the table will be
impaired.
Not only are physician and nurse relationships important in confidence building, but
having a leader to rely on is also crucial. It was discussed how supportive leaders and preceptors
are useful in transitioning the new graduate nurses. In one study that looked at new graduate
nurse’s confidence and the lack of experience found that positive feedback from preceptors or
patients goes a long way in building confidence (Ortiz, 2016). Use of supportive leaders and
preceptors could increase new graduate nurse confidence by having a role model that was helpful
and provided open communication. Finally, the studies noted that professional collaboration did
have an effect on nurse retention rates and recruitment. If there is positive supportive
IMPACT OF NEW NURSES’ CONFIDENCE IN COMMUNICATING 5
communication between the nurses and physicians, it creates a better work environment and
While all of the studies share a similar topic to research, only some of the journals
gathered information from another profession besides nursing. Specifically, five of the journals
analyzed (Morrow & Gustavan & Jones, 2016; Ortiz, 2016; Pfaff et al., 2014; Ulrich et al., 2010,
Wilhelmsson & Svensson & Timpka & Faresj, 2013), solely researched from the viewpoint of
nursing; whereas three of the studies include the nurse and physician’s viewpoint (Bowles et al.,
2016; Matziou et al, 2014; Siedlecki & Hixson, 2015). By involving both the nurse and the
physician in the study, these three journals acknowledge communication as a two-way process.
Through this format, the studies argue that in order to draw conclusions with accuracy, both
sides of communication must be evaluated evenly. The other five journals, on the other hand,
did not gather data interprofessionally, but rather, believed that their efforts would be better spent
When analyzing the limitations in the studies chosen, there are a few threats to validity.
First, multiple studies used a limited sample size along with convenience sampling, creating the
potential for selection bias (Bowles et al. 2016; Matziou et al., 2014; Ortiz, 2016; Pfaff et al.,
2014; Siedlecki & Hixson, 2015). This does not allow an accurate representation of the whole
population’s feelings, yet the studies draw a generalized conclusion. Second, the studies only
include nurses in the hospital setting and do not take into account the variety of settings a nurse
can work in while still being in continual communication with physicians. Third, the authors of
this literature review create a limitation because we are current student nurses. This presumably
creates a bias to side more towards the nurses’ stances when reviewing the studies and drawing a
Conclusion
element when it has the ability to affect the outcomes of patients. The interprofessional
relationship that was focused on the most was the relationship between the nurse and the
physician. According to the literature, there is a barrier in communication between nurses and
physicians. This barrier is due to the difference in views, professional hierarchy, and the lack of
physicians’ recognition and or understanding of the role of a nurse. This may not always be the
case at all healthcare facilities, but it is the main theme that was found in the literature. New
graduate nurses’ lack of confidence can further affect interprofessional communication and
collaboration, which can in turn affect patient outcomes. A factor that combats this barrier is
being equipped with supportive leaders and preceptors for new graduate nurses. Having a leader
that is helpful and able to demonstrate how to provide open communication can increase the new
graduate nurse confidence in communicating with other members of the interprofessional team.
Direction of future research should target physicians’ attitude towards communication with
nurses. Additionally, future research should look at how nursing schools prepare students and
how that correlates with their confidence, the nature of leadership and how this affects new
Recommendations
Recommendations include but are not limited to: empowering nurse managers to help
bridge the gap in physician-nurse miscommunication, analyzing the training of preceptors to help
transition the new nurse into practice, utilizing the differences in critical thinking as a strength
rather than a weakness, and providing interprofessional education to new graduate nurses
IMPACT OF NEW NURSES’ CONFIDENCE IN COMMUNICATING 7
(Morrow et al., 2016; Ortiz, 2016; Pfaff et al., 2014; Ulrich et al., 2010, Wilhelmsson et al.,
difference. This could help bring about education and policies on how to effectively
preceptors and focusing on the effects of communication with other interprofessionals can help
preceptors know what information is important to teach new nurse to help transition them into
practice. Utilizing the differences in critical thinking of physician and nurses as a strength rather
than a weakness can help bring different viewpoints to practice. Finally, interprofessional
education is important for the whole team to provide safe and effective communication in the
hospital, and training new graduate nurses in interprofessional communication can help prepare
References
Bowles, D., McIntosh, G., Hemrajani, R., Yen, M.S., Phillips, A., Schwartz, N., … Dow, A. W.
https://doi.org/10.1080/13561820.2016.1201464
Matziou, V., Vlahioti, E., Perdikaris, P., Matziou, T., Megapanou, E., & Petsios, K. (2014).
https://doi.org/10.3109/13561820.2014.934338
Morrow, K. J., Gustavson, A. M., & Jones, J. (2016). Speaking up behaviours (safety voices) of
Ortiz, J. (2016). New graduate nurses' experiences about lack of professional confidence. Nurse
Pfaff, K. A., Baxter, P. E., Jack, S. M., & Ploeg, J. (2014). Exploring new graduate nurse
Siedlecki, S. L., & Hixson, E. D. (2015). Relationships between nurses and physicians matter.
https://doi.org/10.3912/OJIN.Vol20No03PPT03
Ulrich, B., Krozek, C., Early, S., Ashlock, C. H., Africa, L. M., & Carman, M. L. (2010).
Improving retention, confidence, and competence of new graduate nurses: Results from a
IMPACT OF NEW NURSES’ CONFIDENCE IN COMMUNICATING 9
http://www.nursingeconomics.net/cgi-bin/WebObjects/NECJournal.woa
Wilhelmsson, M., Svensson, A., Timpka, T., & Faresj, T. (2013). Nurses' views of
doi:10.3109/13561820.2012.711787