Nurses’ and Physicians’ Attitudes Toward Nurse-Physician Collaboration in the Pediatric Department of a Tertiary Referral Hospital in Ethiopia: A Mixed-Methods Study

In hospitals, the care a child receives often depends on how well the doctors and nurses work together. When these two groups of professionals share decisions and respect each other's roles, patients tend to recover faster, stay in the hospital for shorter times, and face fewer medical mistakes. This teamwork is especially critical in pediatric wards, where children are often too sick to speak for themselves and require complex, coordinated care. However, in many parts of the world, including Ethiopia, the reality of daily hospital life can be far more complicated than the ideal. Traditional hierarchies, where doctors give orders and nurses simply follow them, heavy workloads, and unclear responsibilities can create friction. Understanding whether the people on the front lines actually believe in working together, and what stops them from doing so, is essential for improving the safety and quality of care for sick children.

A recent study conducted at Tikur Anbessa Specialized Hospital in Addis Ababa, Ethiopia's largest referral and teaching hospital, sought to uncover the true state of this relationship within its pediatric department. The researchers, a team of nurses and physicians from the hospital, wanted to know if the doctors and nurses there felt positive about collaborating and to identify the specific barriers that might be getting in the way. They focused on a group of 199 healthcare workers, including nurses, medical interns, and residents, who were actively caring for children in various units ranging from general wards to intensive care. To get a full picture, they used a two-part approach: they asked everyone to fill out a detailed survey about their attitudes, and they held small, private group discussions with a subset of staff to hear their personal stories and frustrations in their own words.

The survey results offered a surprisingly optimistic first look. Nearly 80 percent of the participants, regardless of whether they were doctors or nurses, said they held favorable attitudes toward working together as a team. There was no significant difference between the two groups; both sides expressed a general willingness to collaborate. In fact, when looking at specific aspects of their relationship, nurses scored slightly higher in the area of "caring versus curing," showing a strong focus on the holistic well-being of the child, while physicians showed a slight tendency to reject the idea that they should dominate decision-making. The data suggested that, in principle, the staff at this busy hospital wanted to work as partners.

However, the story changed when the researchers listened to the staff speak openly in the group discussions. While the survey numbers showed a desire for teamwork, the conversations revealed a daily reality filled with tension. Participants described a workplace where conflicts happened almost every day, often triggered by high-stress situations in emergency rooms or by the sheer exhaustion of long shifts. Nurses spoke of feeling unheard or dismissed when they offered suggestions, while junior doctors described feeling powerless or ignored by the nursing staff. One recurring theme was the feeling of being trapped in a rigid hierarchy where respect seemed to depend more on seniority than on the quality of care. A junior doctor noted that as they gained experience and became more familiar with the team, the friction decreased, suggesting that personal relationships often mattered more than formal roles.

The discussions also highlighted how the specific environment of the hospital shaped these interactions. Staff in different units faced different challenges; those in high-acuity areas like the emergency room and intensive care units reported more frequent clashes than those in general wards. The researchers found that the workload and the number of patients a team was responsible for directly influenced how well they could communicate. When staff were overwhelmed and burnt out, the ability to work together broke down, leading to delays in care and a sense that no one was accountable for the whole picture. The staff described a cycle where unclear roles meant that mistakes were often blamed on individuals rather than being seen as a team failure, which further eroded trust.

The study concludes that while the doctors and nurses at this Ethiopian hospital genuinely believe in the value of collaboration, their positive feelings are not enough to overcome the structural problems they face every day. The gap between what people say they value and what they actually experience is wide. The researchers suggest that simply hoping for better teamwork will not work; instead, specific changes are needed to address the root causes of the friction. They recommend making it mandatory for all team members to participate in patient rounds together, creating clear systems for accountability that do not rely on blaming individuals, and providing joint training to help staff understand each other's roles better. Ultimately, the findings show that improving care for children requires more than just good intentions; it requires fixing the environment so that the people who want to work together are actually able to do so.