Nursing care rationing, missed care, focus group. - Health Science ...

HEALTH SCIENCE JOURNAL® Volume 6, Issue 2 (April – June 2012)

_REVIEW_

Labour conflicts between administrative, medical and nursing personnel in the hospital Maria Maniou R.N, MSc, Laboratory collaborator, Nursing Department, ΑTEI Crete, Greece. Pananio” General Hospital of Heraklion

“Venizelio -

ABSTRACT Background: The units of benefit of health’s services as are the public and private hospitals, constitute organisms with multileveled structure where work persons (administrative, doctors, nurses, ) that differ in many sectors so that many times are not ensured the collaboration between individuals and teams. The result is that often emerge conflicts that begin from juxtaposition of different motives, between administration and personnel and the conclusion is the intense disturbance of labour environment in the hospital with likely negative consequences. The aim of this study was a review of the international bibliography in the subject of labour relations of personnel’s branch in the hospital. Methods and material: The method of this study included bibliography research from both the review and the research literature which carried out internationally and referred to the labour conflicts between administrative, medical and nursing personnel in the hospital. Results: The good labour relations between doctors and manager are related with the high satisfaction of personnel. The poor professional relations between medical and administrative personnel are connected with problems in the organisation and in the operation of the hospital. There is intensity between medical and administrative personnel because of the regularisation of medical knowledge. Also there is conflict between medical and nursing personnel and influence immediately the patient. because of non favourable conditions in which the most nurses work, low economic rewards, limited professional autonomy and limited attendance in the decision-making have unfavourable consequences in the relation between doctors and nurses. Conclusions: The good labour environment should constitute the first priority in the units where their main product is based on the factor of production. Consequently the units of benefit of health’s services owe to interest mainly for the labour environment, the labour relations and the professional satisfaction of their workers. Keywords: Labour relations, hospital, administration of human resources CORRESPONDING AUTHOR

Maria Maniou 17 Thetidos, Giofiros, Heraklion, P.O. 71304 Crete-Greece E-mail: [email protected] E-ISSN: 1791-809X

Health Science Journal © All rights reserved

Page | 234 www.hsj.gr

Quarterly scientific, online publication by Department of Nursing A’, Technological Educational Institute of Athens

INTRODUCTION

T

he good labour relations include the

individuals), common conflicts (between

output fair and reliable treatment

teams),

between

the

workers,

(authoritarian management), functional

workers to be devotional in the hospital.

conflicts - more frequent in the hospital,

Hospitals with good labour relations

conflicts

present a strategy of human resources

conflicts between formal and informal

that attributes high value in the workers

organisation.1

as

The conflicts’ reasons are questions of

environment

A is

order

conflicts

the

partakers.

in

hierarchical

healthy

labour

characterized

by

staff

-

linear

executives,

prestige and imposition, conditions of

reciprocal respect and collaboration of

work-increase

various

responsibilities’ refusal, entanglement in

branches

of

workers

and

levels

recognition. Essential condition for the

roles

excellent

the

determination of duties as well as the

attachment in the “philosophy of respect

different levels of education, provocative

of individual”. The managers will be

behavior

supposed to hear, to understand and to

discriminations,

keep their workers aware with regard to

organizational labour environment, lack

the drawings of administration as long as

of vital space and different collaborating

it concerns the organisation.

professional teams. Also, the existence of

Conflict is the situation in which the

stereotypes with regard to the nurses’

behavior

and doctors’ profession, the change of

labour

of

a

relations

person

or

is

a

team

because

toward

problematic

the

leadership, complicated

deliberately seeks to prevent objectives’

nurses’

achievement of another individual or a

woman in the nurse’s profession and the

team. It is an undesirable phenomenon

differentiation in the academician and in

that

leads

role,

of

stresses,

the

predominance

to

negative

results.

professional

the

conflicts

in

an

conflicts’ reasons are questions of the

organism are healthy and inevitable and

limited resources (lack of personnel,

can

positive

economic,

can

be

resources), lack of organisation and

constructive and have catalytic effect in

problems of administration, mentality’s

the new ideas, the progress, the positive

differences, place, and educational level

changes and the growth.

in the various hierarchical rungs.

Nevertheless,

accompanied

consequences.

The

by conflict

This conflicts

development.

of

material

and

Moreover,

technical

can be interpersonal conflicts (between Page | 235 Labour conflicts between administrative, medical and nursing personnel in the hospital


The quality of workers in a hospital,

practice

their enthusiasm, their satisfaction from

communication, in the common work

the work that executes, their experience,

and

the feeling of their fair treatment, the

management.3

in

the the

students main

in

subjects

the of

motives that are provided for them, all these influence the productivity and finally the viability of hospital.

2

Nursing culture Nursing traditionally is supported in the offer of services with respect in the

Labour environment in the hospital

heads and doctors. Nurses are organised

A hospital is a place where are met three

in a military type of organisation. Of

different “cultures”, the medicine, the

course, the role of nurses has been

nursing and the administrative culture.

improved and has changed dramatically

The culture of an organism is a total of

with the existence of academic studies

ideas and behaviors. The existence of

and the transport of knowledge from the

culture helps the workers to maintain

nurses in the doctors for subjects of care

the limits of

and treatment. A decisive role has also

the team in which they

belong in the organism.

the fact that the 90% of nurses are women and this means that many times

Medical culture The

becouse of their familial obligations are

medical

culture

in

hospital

unable to participate actively in the

traditionally is supported in the force

culture of hospital. However, nurses

and in the power. The doctors learn how

learn to be more initiated and receptive

not to show their sentiment even if this

in common work.

helps the patient. They are durable and also do not complain when they feel

Managerial or technocratic culture

exhausted. As a rule they learn to work

For many people the management is not

individualized in each patient and they

considered a profession, neither allocates

are complicated when they have to work

the scientific background of doctors. The

in teams. It is marked that the medical

managers learn from the world around

culture

practicing

is

not

single

but

varies

their

reactions

and

their

proportionally the doctor’s speciality and

reflexives daily. They are interested for

the hospitals. It exists an increasing

the total picture and the situation of ill-

tendency

consumer and accordingly the hospital

of

medical

E-ISSN: 1791-809X

education

to




and no individualized for each patient as

of intersectorial conflicts, which we will

the doctors do.

attempt to interpret.

Patient’s Culture

Labour relations between medical and

The patients transport

the

different

administrative personnel

cultures that exist in the society, play decisive role in the configuration of

According to Zupko,5 the doctors declare

labour environment in

that they are dissatisfied and miserable

the hospital.

Changes in the society cause chain

in

reactions and in the hospital. As an

continuously

example

reasons vary a part of their malaise is

the

informed

30%

of

patients

are

for the developments in the

the

owed

hospital

in

in

a

changes.

their

world Even

relation

that

if

with

the their

health via internet and the remainder

manager/governor. This malaise reflects

sources of information, so that they are

international

more exigent in the “consumption of

autonomy’s and sovereignty’s shrinkage

health

services.

3

Indubitably

tendencies

that

led

to

having

of doctors in the hospital and specifically

access in the information, they have not

afterwards the reforms that happened.

always justified requirements for the

As an example in the national system of

care that they have to receive.4

health in England (NHS) where the import of manager’s institution in 1984,

Intersectorial conflicts in the hospital

the opening of internal market from

Consequently the hospital is a place

1991

where is provided the services of health.

evaluation

The hospital is a place sentimentally

functionals as well as the control of

charged from the side of the patients and

economic activity in the hospital, created

its functionals. A common culture in the

intensities

hospital benefits an organism or a team

manager. The last two decades existed

via the promotion of collaboration and

efforts

efficiency, decreasing the uncertainty

administrative

and

confidence.

director or clinically directorial) without

Consequently are created more powerful

a satisfactory attendance. The young

cohesive bonds between the personnel,

doctors present theirselves more willing

but

are

to deal with management’s subjects. It‘s

increased the probability of appearance

a fact that doctors that worked as a

increasing

because

of

the

the

conditions

and

of

the

import

of

activity

between doctors’

of

methods’

of

health’s

doctors entanglement

activities

and in

(medical

Page | 237 Labour conflicts between administrative, medical and nursing personnel in the hospital


manager experienced labour stress and high levels of disappointment.

6

The

systematic

control

and

the

All these

restriction of expenses for the benefit of

led to a reallocation of force in the

health’s services from the doctors it

hospital and a new culture “these and

limits the manager’s autonomy and the

we”. 7

consequence

is

the

tight

economic

8

Also the

management of resources. Causes that contributes in the intensity

changes in the legislation that concerns

between medical and administrative

the doctors. These changes intend to

personnel.

decrease the offer of doctors, as it

The regularisation of medical knowledge

happens in Germany, in France and in

strengthened

between

Italy, while other reforms intend to

medical and administrative personnel.

decrease the government monopoly of

This happened via methods that allow

institutes, as it happens in the United

the measurement of medical work for

Kingdom, in Belgium and in Spain. 9

administrative aims. Metres like this

All

have been used in a lot of countries

administrative

included

Kingdom,

institution of manager in the hospital, so

Germany, Australia and Holland as a

that the doctors react negatively. In

basis for likely compensations of health’s

England exists a tendency to accuse each

institutes after charges of patients. This

government because the managers are

metres determine how the doctors will

supposed to be named by the Minister of

be supposed to attend their patients in

Health. Many times the doctors declare

the individualised level for each patient

that the managers do not understand

(eg medical protocols-clinical protocols,

them and that they are isolated from the

guidelines) and the course of patients

medical profession. In general exists a

into the system (eg determined “paths”

suspiciousness as long as it concerns the

ill-prescribed “patient” pathways, use of

legality of entanglement of management

information

in the clinical work.

the

USA,

of

intensity

United

feedback-feedback

these

strengthened personnel

the

role

and

of the

utilization data). The managers and the

In England important role plays the fact

nurses support the regularisation while

of short alternation of administrative

the doctors are negative.

personnel, the 22% of managers changed

Moreover, there is more attention in

in three years and the result was the

economically subject in health services.

suspicion from medical personnel that

E-ISSN: 1791-809X




the promises that are given will not

their manager that is advocates of team

materialised by the next managers. This

work .11

fact discourages the doctors to deal with

In

the administrative role because this role

concerned the modernisation of NHS in

is considered to be not attractive and

England

with risk.

questionnaire

An

additional

completion

from

1092

of

clinical

manager’s

were again proved more optimistic as

depreciation from the doctors. Doctors

long as it concerns their relations with

say that the managers do not have the

doctors 12

is

the

the

that

directors and managers, the managers

relations

for

with

research

bad

professional

reason

corresponding

mental faculty to see the difference between hospitals and supermarket or

Repercussions of intersectorial conflicts

doctors and funds.10

between

medical

and

administrative

personnel in the hospital Researches:

the

professionals

opinion

about

of

the

health’s

changes

–

It has been realised that the poor professional relations between medical

reforms

and

In a research that was carried out in

connected

3065 doctors, nurses, heads nurses,

organisation and in the operation of the

medical

hospital.

directors

and

manager,

in

administrative with The

personnel

problems

good

are

in

labour

the

relations

England, Wales, Australia and in the

between doctors and manager are related

New Zealand were made questions with

with the high satisfaction of personnel.

regard to the labour environment in the

At

hospital,

reciprocal

environment where are facilitated the

confidence - common work and the

recording and the report of errors. On

autonomy of clinical professions. The

the

results elect the dimension of opinions

environment that is inspired from stress,

between

and

fear, frequent alternations and voices

heads

have unfavourable consequences for the

the existence of

medical,

administrative

nursing

personnel.

The

the

same

other

of

time

hand

health’s

is

the

created

bad

a

labour

nurses and followingly the managers are

benefit

more receptive in the various changes

patients. Also, it harms the health of the

and reforms. On the other hand, doctors

patients and the personnel’s with likely

insist to work individually contrary to

extensions

in

the

services

wider

of

system

the

of

health.13,14 Page | 239 Labour conflicts between administrative, medical and nursing personnel in the hospital


participate in a program that is provided Ways of approach and improvement of

by various academic centres in Israel.

labour environment between medical

Corresponding programs exist also for

and administrative personnel

the nurses.17 It is impossible all the doctors to become manager but the

The high quality of health’s services is

follow-up of seminars in the hospital, in

supported

academic

in

communication

the

productive

(partnership)

institutions,

or

distance

between

learning would be very beneficial for

doctors and managers and also in the

them.18 At the same time the managers

preparation of doctors to undertake

should learn more about the medicine.

leading

The

roles.

Each

profession

must

managers

need

to

be

leaders,

recognize the possibilities of the other

contacts, mediators and more generally

profession and not to face this situation

they have to know how to manage the

competitively.

crises.19

The

improvement

of

clinical leadership presupposes better

The improvement of labour environment

practice

the

can be achieved via the creation of

and

communication’s

for

the

methodology

of

doctors

in

management

network

between

activation in order the clinical leadership

doctors and manager, with discussions,

to become more attractive.15,16 As an

common

example

attacks

the

imperial

college

of

spirit, and

evasion

of

personal

observation

of

University of London in collaboration

engagements.20

with the medical faculty of the same

that the managers and the doctors need

university

where

of

to be capable to develop a vision and

medicine

can

management

objectives - aims via the suitable strategy

(bachelor) for one year. It is a very

in order to achieve their mission. This is

popular

was

possible with the common approaches as

established in 1999, where the graduates

long as it concerns the autonomy of each

of

horizons.

profession and the regularisation of work

health

(measurement and evaluation of clinical

the

graduates

study

department

medicine

Moreover,

extend in

which their

Israel,

the

The experience shows

management is granted as speciality and

activity).

diploma to the doctors by the equivalent

In

Health

17.000

paradoxical that the profession of doctor

year

while theoretically is one of the most

Ministry.

doctors,

25

Between

candidates

E-ISSN: 1791-809X

each

the

United


Kingdom

exists

the



powerful,

into

practice

feel

Nowadays, the relations between doctors

bureaucracy and

and nurse are continuously developed

the pressure that they have to face. In a

because of recent changes including the

case study that was given in a hospital of

fact that the nurses are not only female

Norway,

professionals of health were

and also because many of them are

asked how they manage the conflicts in

graduates of academic faculties. At the

their working place. They answered that

same time the commercialisation of

they

medical care shook the world.

feeble because of the

use

evasion

or

persuasion

the

following

concealment and

doctors

approaches, of

conflict,

negotiation.21

Researches: relations between medical

Reciprocal estimate and approach would

and nursing personnel

lead to a harmony situation that would

In a research that was carried out in

be good for the two teams but much

2002 and concerned nurses, doctors and

more the patients.

22

administrative network

of

employees hospitals,

in

the

a

big

majority

Labour relations between medical

reported that exists disjunctive behavior


of doctors in their working areas, that influences negatively the nurses and the

Retrospection in the relations between medical and nursing personnel The labour relations between medical and nursing personnel in the hospital need attention because they are the most complicated and influence immediately the patient. In the past was considered datum that exists an absolute agreement between the branches, in a hierarchical and introvert relation impregnated in preventions, where the doctors were superior and the nurses subjugated. An article of a psychiatric newspaper in 1967, the relation was presented as a game, fight of force, where the doctors “handled” the nurses as “their pieces” 23

rest of the personnel even on issues of health preventing them from common work and influencing the course of patients. This is supported by additional studies that the communication and collaboration

between

nurses

and

doctors have important effect in the environment of work and in the clinical course of patients.24 In a questionnaire of 69 questions that examined

the

effect

of

medical

sovereignty in the hospital and was supplemented by 133 nurses in Australia and 108 nurses in the Britain resulted that the majority of nurses declare disappointment

with

their

job,

feel



unbearable pressure from the doctors

patients than the doctors and often have

and

essential proposals in order to change

face

intense

psychological

problems.25

the therapeutic metres. Sometimes, the doctors ignore the proposals of the

Reasons of conflicts between medical

nurses, this fact shows that they do not


want the feedback with result the nurses

The non favourable conditions in which

to feel bad. It is a fact that the most

the most nurses work, low economic

nurses are completely worked out, but

rewards, limited professional autonomy

they

and limited attendance in the decision-

appreciate their knowledge and their

making have unfavourable consequences

qualifications.

in the relation between doctors and

Moreover,

nurses. If the relations are positive, the

differences

nurses it is more likely to feel satisfied

professional burn out, the lack of self-

with their environment of work. The

confidence that characterizes a lot of

labour satisfaction maintains the internal

professionals of health and the problems

balance of nurses, prevents the labour

that are not common with the working

overstrain (job burnout) and helps in the

place, as the marital problems, the

high productivity.

narcotics, the alcoholism, the stress, the

Other obstacles in the collaboration

economic

between doctors and nurses are the lack

mentality of nurses to accuse the other

of

for problems that exist in nursing26

communication

and

reciprocal

feel

that

the

important in

the

problems

doctors

role income

and

do

not

plays

the

and

the

finally

the

respect. The studies that have been carried out show that the members of

The results of collaboration between

the particular branch see their selves

doctors and nurses

“mainly

their

The environment of collaboration in the

science” and not as members of a total in

relation between doctors and nurses has

which they do not exist limits between

positive effect in theirselves and in the

the various sciences. Nowadays, nurses

patients. As long as it concerns the

want to be more independent and also

patients, the collaboration contributes in

want to have professional competences

the satisfaction of doctors and nurses, in

and responsibilities for the care of

the positive development of patient’s

as

representatives

of

patient. They dedicate more time in the

E-ISSN: 1791-809X




health and in the reduction of medical errors. As long as it concerns the nurses, the collaboration

contributes

in

their

satisfaction, in the reduction of labour

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