Journal of General Internal Medicine

, Volume 24, Issue 2, pp 198–204

“What is Found There”1: Qualitative Analysis of Physician–Nurse Collaboration Stories

  • Kathleen A. McGrail
  • Diane S. Morse
  • Theresa Glessner
  • Kathryn Gardner
Original Article

DOI: 10.1007/s11606-008-0869-5

Cite this article as:
McGrail, K.A., Morse, D.S., Glessner, T. et al. J GEN INTERN MED (2009) 24: 198. doi:10.1007/s11606-008-0869-5



Effective physician–nurse collaboration is an important, but incompletely understood determinant of patient and nurse satisfaction, and patient safety. Its impact on physicians has not been described. This study was undertaken to develop a fuller understanding of the collaboration experience and its outcomes.


Twenty-five medical residents, 32 staff nurses, 5 physician and 5 nurse faculty wrote narratives about successful collaboration; the narratives were then qualitatively analyzed. Narrative analysis was the initial qualitative method iteratively employed to identfy themes. A phenomenological approach was subsequently used to develop a framework for collaborative competence.


Collaboration triggers, facilitative behaviors, outcomes and collaborative competence were the themes identified. Affect was identified in the triggers leading to collaboration and in its outcomes. Practioners typically entered a care episode feeling worrried, uncertain or inadequate and finished the interaction feeling satisfied, understood and grateful to their colleagues. The frequency of affective experience was not altered by gender, profession, or ethnicity. These experiences were particularly powerful for novice practioners of both disciplines and appear to have both formative and transformative potential. Collaborative competence was characterized by a series of graduated skills in clinical and relational domains. Many stories took place in the ICU and afterhours settings.


Despite the prevailing wisdom that nursing and medicine are qualitatively different, the stories from this study illuminate surprising commonalities in the collaboration experience, regardless of gender, age, experience, or profession. Collaborative competence can be defined and its component skills identified. Contexts of care can be identified that offer particularly rich opportunities to foster interprofessional collaboration.


collaboration competency relationship-centered practice teamwork 

Copyright information

© Society of General Internal Medicine 2008

Authors and Affiliations

  • Kathleen A. McGrail
    • 1
    • 2
    • 5
  • Diane S. Morse
    • 3
    • 4
  • Theresa Glessner
    • 2
  • Kathryn Gardner
    • 2
  1. 1.Department of MedicineUniversity of Rochester School of Medicine and DentistryRochesterUSA
  2. 2.Rochester General HospitalRochesterUSA
  3. 3.Fulbright ProgramWashingtonUSA
  4. 4.Department of Medicine and PsychiatryUniversity of Rochester Medical CenterRochesterUSA
  5. 5.RochesterUSA

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