Designing Nurse–Physician Collaboration to Improve Psychological Safety, Satisfaction and Commitment of Critical Care Nurses—A Multi‐Informant Survey Study

Background

Psychological safety is a key component of effective healthcare teams and may impact job satisfaction, commitment and change readiness among critical care nurses. The design of nurse–physician collaboration may influence psychological safety but has not been systematically studied in intensive care settings.

Aims

To investigate how nurse autonomy, participation in ward rounds, quality of nurse–physician relations and team size relate to psychological safety in critical care nurses, and how psychological safety mediates statistical effects on job satisfaction, affective commitment and commitment to change.

Study Design

We performed a multicentre, cross‐sectional, multi‐informant survey study conducted between December 2013 and March 2015 using a convenience sample of 22 intensive care units (ICUs) in 19 German hospitals, including university, public and private hospitals. Organisational data were provided by ICU leaders. Validated scales were used to assess psychological safety, job satisfaction, affective commitment to unit and commitment to change (nurse survey), and nurse–physician collaboration (physician survey). An organisational questionnaire was developed to assess nurses' autonomy and structural factors. Linear regression and mediation analyses tested hypothesised associations at the unit level.

Results

Of 1216 invited nurses and 379 invited physicians, 600 and 217 participated, respectively. Higher nurse autonomy (0.51 [95% CI: 0.1, 0.91], p  = 0.016), consistent participation in ward rounds (0.51 [0.11, 0.91], p  = 0.014), better nurse–physician collaboration (0.59 [0.21, 0.97], p  = 0.004) and lower number of nurses working in a unit (−0.55 [−0.94, −0.16], p  = 0.008) were statistically significantly associated with higher psychological safety in linear regression analysis. Psychological safety mediated effects of all predictors on job satisfaction, affective commitment and commitment to change.

Conclusions

Psychological safety among critical care nurses can be enhanced through interprofessional collaboration, nurse autonomy and smaller team structures. These findings inform organisational strategies to improve nurse wellbeing and retention, as well as organisational readiness to change.

Relevance to Clinical Practice

Fostering interprofessional collaboration and enhancing nurses' autonomy in critical care are key to enhancing psychological safety and thereby enhancing job satisfaction and retention. Increasing team size can have unintended negative consequences that need to be weighted against potential gains.

Trial Registration: German Clinical Trial Register: DRKS00005357