CHAPTER ONE

INTRODUCTION

1.1    BACKGROUND OF THE STUDY

A system is made up of several parts which functions in various ways to work as an entity. An example of this is the health care service delivery system. In this, there are various categories of professionals and personnel who work hand in hand to perform various specialized duties for the effective dispensation of healthcare services.  These professionals include: doctors, nurses, pharmacists, radiographers, and medical laboratory scientists etc. they all carry out their duties which directly or indirectly are related to patients care (Kalish & Erb, 1987). Where there is friction between any components of a system, there is a drag. A sustained drag could cause a breakdown of the system. This research work will examine the inter-relationship between doctors and nurses as it affects patients care. Doctors and nurses are two major health workers in the hospital who have continued to attract attention. Nurses are closer to doctors than all other health workers. Wolinsky (1980), referred to other health workers as allied health workers. The closeness of doctors and nurses is brought about by their frequent contact with patients in the hospital.

According to Fagin and Garalick (2004), the relationship between doctors and nurses is a special one. This is because smooth working relationship between doctors and nurses is essential for effective and efficient delivery of health care services. Where this is overlooked, it is at the detriment of the patient’s care and increased cost to the health care system. This is sadly the trend in developing countries such as Nigeria (Albert, Goldman, Kilroy & Pikke, 1992). The relationship that exists between doctors and nurses has long been the focus of on going debate. In the past, it was assumed that there was clear agreement between the two professions that the relationship was hierarchical, with doctors being superior to nurses (Sheth & Mallipedi, 1997). This was further enforced by Mechanic and Aikan (1982), who stated that a nurse must begin her work with the idea that she is only the instrument to which the doctor gets his instructions carried out. He/she occupies no independent position in the treatment of the sick person.

Kafaru, (1994) argued that no matter how gifted a nurse may be, he/she will never be a reliable nurse until he/she can obey without questioning the instruction of the doctor. To her, a nurse is simply an intelligent machine for carrying out doctors orders. Rosenfield (1992), posits that, in many countries, doctors determine the scope of nursing practice and education, and can directly define the limits of nursing knowledge. Also, doctors head public health care institutions thus affording them additional opportunities to influence the training of nurses. However, so many others argue that these working relationships are changing and should be examined against prevailing development in the profession, society, and work (Ferger and Shitt, 1979).

Johnson (1983), argued that collaborated work among nurses and doctors has been found to be very rewarding. This is because some hospital managements have identified the unique roles each of them plays in the care of patients. Attempts have been made to change their designation in such a way that one complements the other. This study examines the form of relationship that exists between doctors and nurses, and how nurses are coping with the situation, bearing in mind the differences in status relationship. There may also be gender bias against the nurses which in turn have negative effect on their job performance and level of satisfaction which further affects their care for patients. Elaborating further, Rosenfield (1992) asserted that collaborative nurse-physician relationships are associated with improved patient, nurse and physician outcomes. Kohn (1996) asserted that modern nurse has come of age; hence should be given a rightful place in the health profession. The nurse’s role is significantly symbolized in “care” for the sick. Care according to Limm (1994), is the essence and the central unifying and dominant domain that characterized nursing. It is an essential human need for full development, health maintenance, and survival of human beings in all world culture; yet care has not received the same degree of attention by other professionals as has been given by nurses. As a matter of emphasis, there cannot be “cure” without “care” and curing is traditionally the doctor’s function while caring is regarded as primary function of the nurses. Kennedy and Garvin (2004), stated that the quality of product in the industrial sector and efficiency of production are dependent on successful teamwork. Therefore, one assumes that the efficiency and quality of patient care is dependent on the degree at which interdisciplinary relationships are collaborative and this shows the importance of teamwork.

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