Interprofessional collaboration
While doctors only registered social information sporadically, nurses more often registered the patient´s social history on arrival:
“It is mostly something that the nurses take care of. They know more about the social background. But the communication between the doctors and the nurses is not always optimal [laughs]. So, it is possible that something gets lost” (D5:2).
Discussion of patients’ social circumstances required doctors and nurses to share information, especially since doctors considered this mainly a task for nurses.
Some HPs found that interprofessional collaboration between doctors and nurses was limited due to cuts, leading to a reduction of information exchange about patients’ social circumstances.
Exchange of social information about patients also depended on the nurses’ ability to put patients’ social circumstances on the agenda. Some younger nurses felt they lack the authority to introduce social issues:
“When you sit with the doctor in the outpatient clinic, it is mainly the doctor who speaks with the patient and then you must be quite good as a nurse to address social issues that might be relevant for the patient… [T]here are some nurses who are tougher and dare to enter the conversation (N2:3).
Our observations from outpatient clinics showed that doctors typically set the agenda for patient encounters, nurses playing a supportive role. The tone adopted in interprofessional communication often determined the extent to which nurses interfered or offered information about the patients’ social circumstances.