Medical directors as partners in creating healthy work environments.

Relationships between nurses and physicians in the intensive care unit can range from collegial and supportive to dysfunctional and abusive. When there is trust, open communication, respect, and a sense of camaraderie, the work is still challenging but gets done: priorities are met and people feel good about what they are doing. When these key elements are missing, satisfaction on the part of staff and patients decreases and turnover and costs increase. More importantly, research findings suggest that improving collaboration and teamwork are more than "feel-good" exercises: patient outcomes of care can be jeopardized when nurses, physicians, and other members of the critical care team are not communicating or collaborating. The nurse manager and medical director of the unit, as leaders of this team, are responsible for ensuring not only that quality care is delivered to patients, but also that the environment is supportive to caregivers. Purposefully establishing a collaborative partnership and then modeling these behaviors to the rest of the team, and holding them accountable, are key steps in creating an environment that is healing to patients, families, and caregivers.