Strategies to Overcome Barriers to Effective Nurse Practitioner and Physician Collaboration

Introduction
Nurse practitioners (NPs) and physicians have worked together to manage patients since the inception of the NP role in the 1960s.[1] Because the underserved and rural areas lacked primary and specialty care physicians, the NP role eventually evolved to one of a collaborating midlevel provider.[2] The integrated use of NPs and physicians together has positively affected the health care system, yet barriers to effective collaboration continue to exist, and this may lead to a reduced level of quality health care for patients. The barriers to effective collaboration between NPs and physicians are important to consider because the main goals of any NP–physician collaborative team are positive patient care outcomes.
Numerous articles have been written on collaboration between NPs and physicians; each giving different perspectives on the barriers to collaboration. Current research examines the experiences of NPs and physicians in collaborative practice and lists the critical components of effective collaborative relationships. Formal orientation to collaborating between health care providers in different disciplines is essential to managing patients efficiently.[3] The use of theoretical frameworks was deemed helpful in developing an effective collaborative practice.[4] The aim of this literature review is to review common barriers to effective NP and physician collaboration to identify the strategies to overcome these obstacles. The hope is that once common barriers are clearly identified and the strategies to overcome these barriers are used, successful collaboration will occur, leading to improved patient outcomes.
Essentially, the role of the NP is similar or equal to that of a physician; therefore, the duties inadvertently overlap. A physician will do the same type of work as a NP but brings more in-depth knowledge and expertise to patient care. In addition, physicians have the ability to perform special procedures or make more advanced clinical decisions and therefore can serve as an excellent resource in practice. Regardless, an NP has had sufficient knowledge and training to accurately assess and treat patients who have common disorders. Sharing similar goals and mirroring each others' practice provides consistent and comparable patient medical management. Together their duties overlap, but ultimately physicians and NPs share the goal of improved or better patient outcomes.[5,6]
The effect of barriers to effective NP and physician collaboration on patient outcomes is depicted in Figure 1. Two circles at the top depict the interprofessional relationship and how many duties overlap. The obstacles of the path to better patient outcomes are the barriers. The common barriers found in the literature are presented as the peach-colored square. The strategies to eliminating the barriers are shown in gray. Because better patient outcomes are the ultimate goal, this concept is illustrated as a barrel to show the open door to improved quality of care provided by the NP and physician collaborative team.