All ETDs from UAB

Advisory Committee Chair

S Robert Hernandez

Advisory Committee Members

Kristine R Hearld

Allyson G Hall

Karen Hill

Document Type


Date of Award


Degree Name by School

Executive Doctor of Science (DSc) School of Health Professions


Background: Hospitalized patients outcomes are impacted by many professionals, with registered nurses and physicians being the most predominant. Nurses and physicians represent different autonomous professions, but their interdependent relationship effective collaboration for patients to receive high-quality and safe care. Nurse-physician collaboration is a key behavior that must be fostered by hospital leadership to meet or exceed value based outcomes (safety and quality). The purpose of this study was to examine the Chief Nursing Officer’s (CNO) perception of nurse-physician collaboration and its influence (mediating affect) on their direct reports (Nurse Directors). Furthermore, this study examining the relationship of this influence and perceptions of nurse-physician collaboration as it relates to clinical and operational outcomes. Methods: A cross-sectional survey design was used to query Chief Nursing Officers (CNO) and Nurse Directors (direct reports) on their perceptions of nurse-physician collaboration in acute care U.S. hospitals from June 2017 to May 2018. The sample included 40 hospitals, 40 CNO’s, and 57 Nurse Directors. Descriptive statistics and multivariate regressions were used to analyze the relationship of perception of nurse-physician collaboration on clinical (central line associated blood stream infections and catheter associated urinary tract infections) and operational (nurse turnover) outcomes as well as the mediating effects of the CNO’s perception of nurse-physician collaboration to the same outcomes. Results: The results of this study showed there was a significant statistical relationship for the CNOs perception of nurse-physician collaboration effecting the Nurse Director’s perception of nurse-physician collaboration (p < 0.05). However, no other analysis demonstrated a finding of statistical significance as it relates to a mediating effect or perceptions of collaboration impacting clinical or operational outcomes. Conclusions: Though this study’s results were limited the finding for H1 did demonstrated a quantitative effect of nurse executive leadership (CNO) with their direct reports (Nurse Director) which was noted as a gap in the current literature. Further research is necessary to examine the influencing relationship of the CNO as it relates to clinical and operational outcomes



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