Relationship between nurses and physicians in terms of organizational culture: who is responsible for subordination of nurses?

AIM To investigate how nurses and physicians perceive organizational culture, their integration into the organizational processes, and relations within a health care team. METHODS We performed a cross-sectional study that included 106 physicians and 558 nurses from 14 Slovenian hospitals in December 2005. The hospitals were randomly selected. We distributed the questionnaires on the same day to physicians and nurses during a morning shift. The total number of distributed questionnaires represented a 20% of each personnel category at each hospital. The following variables were studied: organizational culture, integration of nurses and physicians in hospital processes, and subordination of nurses to physicians. RESULTS Physicians and nurses favored a culture of internal focus, stability, and control. Both groups estimated that they had a low level of personal involvement in their organizations and indicated insufficient involvement in work teams, while nurses also felt that they were subordinated (mean+/-standard deviation, 3.6+/-0.9 on a scale from 1 to 5) to physicians (2.7+/-1.0; P<0.001). Control orientation correlated positively with the subordination of nurses (PP<0.005) and negatively with personal integration in an organization (PP<0.005). CONCLUSION We found out that subordination of nurses can be explained by market culture, level of personal involvement, and the level of education. Our research showed that the professional growth of nurses was mainly threatened by organizational factors such as hierarchy, control orientation, a lack of cooperation and team building between physicians and nurses, as well as insufficient inclusion of both physicians and nurses into change implementation activities.