“What is Found There”1: Qualitative Analysis of Physician–Nurse
Kathleen A. McGrail, MD1,2, Diane S. Morse, MD3,4,
Theresa Glessner, RN, MSN, NP, BC, CCRN2, and Kathryn Gardner, RN, EdD2
1Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA;2Rochester General Hospital,
Rochester, NY, USA;3Fulbright Program, Washington, DC, USA;4Department of Medicine and Psychiatry, University of Rochester Medical
Center, Rochester, NY, USA.
BACKGROUND: Effective physician–nurse collaboration
is an important, but incompletely understood determi-
nant of patient and nurse satisfaction, and patient safety.
Its impact on physicians has not been described. This
study was undertaken to develop a fuller understanding
of the collaboration experience and its outcomes.
METHODS: Twenty-five medical residents, 32 staff
nurses, 5 physician and 5 nurse faculty wrote narratives
about successful collaboration; the narratives were then
qualitatively analyzed. Narrative analysis was the initial
A phenomenological approach was subsequently used to
develop a framework for collaborative competence.
RESULTS: Collaboration triggers, facilitative behaviors,
outcomes and collaborative competence were the
themes identified. Affect was identified in the triggers
leading to collaboration and in its outcomes. Prac-
tioners typically entered a care episode feeling worrried,
uncertain or inadequate and finished the interaction
feeling satisfied, understood and grateful to their col-
leagues. The frequency of affective experience was not
altered by gender, profession, or ethnicity. These
experiences were particularly powerful for novice prac-
tioners of both disciplines and appear to have both
formative and transformative potential. Collaborative
competence was characterized by a series of graduated
skills in clinical and relational domains. Many stories
took place in the ICU and afterhours settings.
CONCLUSIONS: Despite the prevailing wisdom that
nursing and medicine are qualitatively different, the
stories from this study illuminate surprising common-
alities in the collaboration experience, regardless of
gender, age, experience, or profession. Collaborative
competence can be defined and its component skills
identified. Contexts of care can be identified that offer
particularly rich opportunities to foster interprofession-
KEY WORDS: collaboration; competency; relationship-centered
J Gen Intern Med 24(2):198–204
© Society of General Internal Medicine 2008
Physician–nurse interactions in the acute care setting are a
powerful force, capable of shaping clinical, educational and
professional outcomes for patients,2–4nurses5and physicians.
In the context of a critical and growing nurse shortage, it is
important to note that when the collaborative dyad is func-
tioning well, nurse satisfaction and retention are improved,5,6
as are patient and family satisfaction.7Little comparable data
exist regarding the impact of successful collaboration on
physician satisfaction, but there is evidence that negative
interactions significantly affect both nurses and physi-
cians.5,8,9Patient safety experts also advocate optimizing the
function of the nurse–physician unit to reduce error and
Recognizing the centrality of effective physician–nurse rela-
tionships, the Accreditation Council for Graduate Medical
Education designated team functioning as a competency area
to be addressed by residency programs.13However, research
addressing this relationship has appeared primarily in nursing
journals, with occasional physician co-authors. Little on this
subject has appeared in journals routinely accessed by
physicians or medical educators.
Work fundamental to understanding physician–nurse collab-
oration was initially undertaken in the 1990s.6Subsequently,
behaviors and attitudes that facilitate physician–nurse collabo-
ration were studied using ethnographic observations in the
ICU,14resulting in a validated collaboration assessment sur-
vey.15This early work focused on observable behaviors: “sharing
responsibility,” joint problem solving and “making plans” togeth-
er for patient care. More recent studies suggest that differences
between physicians and nurses outweigh shared experience.16–
18It is not surprising, then, that much of the existing literature
supports the notion that physicians and nurses have irreconcil-
able differences in attitudes towards collaboration and thatthese
attitudinal and behavioral differences are reinforced across
gender and nationality.16–19
Various models of the nurse–physician relationship have
appeared in the literature. For example, one writer referred to
There was no financial/funding support for this study or paper. The
section of this paper on affective dimensions of collaboration was
presented as an abstract at the annual meeting of the Society of General
Internal Medicine, Toronto, Ontario, Canada, April 26, 2007.
Received November 24, 2007
Revised August 6, 2008
Accepted November 11, 2008
Published online December 17, 2008
the nurse–physician relationship as a “game,”20wherein the
nurse must take care to understand and “work around” the
doctor in order to get the orders that she or he feels necessary
for patient care, the dominance-deference model of “collabora-
tion.” More recently, the relationship has been characterized as
a “trading of commodities,” i.e., “if I get/do this for you, what
will you give me in return,” or an updated, quid pro quo,
version of the “game.”21Others have referred to empathy as
“emotional labor,” conceptualizing it as a commodity and not a
quality of character and self.22Game theory and emotional
labor focus on a zero sum world view in which one party wins,
one loses, one succeeds and one fails. What may be lost in
these conceptualizations is shared experience and meaning.
The current study, part of a larger effort to improve
physician-nurse interactions in a community-based teaching
hospital, was undertaken to develop a fuller understanding of
successful physician-nurse collaboration from written narra-
tives about collaboration. The goal of this study was to analyze
and describe the experience of nurses and physicians using
qualitative analysis of collaboration narratives. Since this is
also one of the few studies to examine the collaborative
experience of medical residents and nurses, an additional goal
is to provide program directors and educators with insights
useful in designing programmatic interventions.
A workshop focusing on successful physician-nurse collabora-
tion was developed for, and attended by, medical residents and
hospital-based nurses at a community teaching hospital.
The workshop, a “participatory inquiry” exercise,23utilized
an appreciative inquiry (AI) format24–26AI is an organizational
change technique that uses narrative to focus on what is
working, effective and good in an organization. Knowledge
generated from AI is then used to build on identified strengths
and to promote change.
Central to the exercise was the opportunity to write a
narrative as follows:
“Think of a time when you experienced nurse-
physician collaboration at its best, resulting in
either better care, greater satisfaction on your
part or an unexpected good result. It could be an
experience you had personally or one you ob-
served. It could have occurred in the clinical,
administrative, research or teaching arenas.”
All participants submitted their narratives and consented to
their use for research purposes. The study was approved by
the hospital’s institutional review board. Narratives were
analyzed and coded by four researchers, all female: two
physician clinician-educators, a clinical nurse specialist and
a nurse administrator, all with previous and ongoing program-
matic, educational and/or research interests in appreciative
inquiry, collaboration and/or doctor-patient communication.
Narrative analysis27was the primary approach for the inter-
pretation of the written stories. Phenomenology28–31was used
as a complementary method to view each narrative, and the
entire body of narratives as a whole, employing an inductive,
discovery-oriented approach to examine the collaborative
interaction in its entirety. Phenomenology concerns itself with
the lived experience of the people involved in the question or
issue being studied and involves introspection and an em-
pathic mind to move into the mind of the other.30,31
Applying an inductive approach, members of the research
team used consensus to develop the initial coding scheme from
five nurse-physician collaboration narratives, subsequently
revising the scheme in an iterative manner.32Codes were
developed in the following categories: location, triggers, beha-
viors facilitative of collaboration and outcomes. Coding devel-
opment continued until saturation was reached. With each
revision, all previously coded narratives were recoded and
checked by a minimum of two researchers on the team.
Differences in coding were brought to the larger group and
resolved by consensus.32Utilizing a phenomenological ap-
proach, the narratives were re-examined for key words and
phrases that influenced the form and quality of the collabora-
tion. Levels of collaboration (Table 1) and domains facilitative of
collaboration (Table 2) were identified, and the narratives were
re-coded for both.
Final versions of the coding were aggregated, generating
frequency tables for analysis. These tables summarized the
total number of responses (9 codes, 75 sub-codes) for each
coded behavior by all nurses and physicians.
Trustworthiness of the analysis was ascertained by trian-
gulation.33First, following completion of the coding, themes
identified by the researchers were compared with those
identified by participants at the time of the workshop. Second,
ten representative narratives were selected, presented and
discussed with internal medicine residents at a noon confer-
ence. Last, the same materials were presented at a hospital
leadership nurse council meeting. Coding and saturation were
confirmed, and there were no additions or deletions.
Table 1. Elements and Levels of Collaboration
Level of collaborationElements encountered
I. Low level collaboration
Doesn’t know what collaboration is
Doesn’t know that he/she doesn’t know
Jobs done in complementary ways on
Little or no interaction
Use of protocol or pathway
Little affective component
Give and take interactions
Use of other’s abilities to jointly
Active listening regarding patient
Satisfaction with job well-done
Some appreciation of “the other”
Fluid, repetitive interactions
Flexible use of one another’s’ abilities
On-the-spot collaborative problem solving
Intuitive appreciation of others’ needs
and use of that knowledge
Potential for high level affective outcomes
II. Mid level
III. High level (high order)
McGrail et al.: Physician–Nurse Collaboration
Characteristics of the 67 participants are detailed in Table 3;
most residents were international medical graduates, while
most nurses were US born and educated.
Despite the fact that no specific directions were given regarding
the setting for the narratives, 15 of 30 resident stories occurred
in the ICU. Most of the nurse stories occurred on medical or
surgical floors outside the ICU, with a few occurring in
operating rooms, the emergency department or outpatient
setting. For both groups, a significant number of stories
occurred during evening, night and weekend shifts.
Two types of triggers initiated collaborative cascades: patient
care crises and affective crises. A patient care crisis was
defined as an acute change in a patient’s status for which
next steps in care were not clear, or a change perceived by the
nurse or physician as life-threatening or with high potential for
a bad outcome. An affective crisis was defined as the experi-
ence of an emotion on the part of the professional with the
common underlying theme being one of worry and/or vulner-
ability. Affective triggers for nurses and physicians were
different. Nurses experienced worry, anxiety or concern about
a patient’s progress. The following fragment of a nurse
“When I first started last year on the Hematology/
Oncology floor, I was nervous. One of my first days
I had a patient with leukemia. They had their
initial fever spike and I had to call the MD on
call...” (RN 1).
By contrast, physicians most often experienced a sense of
inadequacy, uncertainty or feelings of being overwhelmed, all
of which were self-directed. The text fragment below illus-
“It was the beginning of my second year in the ICU
and I was supposed to take care of my patient. My
first ICU rotation and my first code in ICU goes off.
Patient goes into recurrent V tach and we were
coding him. I was well prepared for leading a code,
but in real life I just stood there not knowing what
to do...” (MD 1).
Affective trigger themes are summarized in Table 4. Despite
differences in emphasis, nurses and physicians both experi-
enced affective triggers often (80% of the stories). There was no
difference in frequency of affective triggers by gender, regard-
less of profession.
In these stories, a physician who was perceived as collabora-
tive displayed the following qualities or behaviors: trusts and
respects his/her nurse colleague; responds quickly, is physi-
Table 3. Participant Demographics
MD faculty (5)
Nurse faculty (5)
*Of non-US graduates, 52% from India or Pakistan, the majority of the
remainder from Eastern Europe and the Middle East
Table 4. Affective Triggers
Affective triggers (AT)MD RN
N=30 (%)N=37 (%)
Inadequate to task,
ineffective, unable to meet
Anxious, concerned, worried,
Sense of responsibility/
Total with AT
(one or more themes)
4 (16)3 (8)
MD 25 (87%) RN 27 (73%)
*AT present in 64% of male MD stories
Table 2. Domains Contributing to Collaboration
Clinical expertise Technical or biomedical knowledge
Interpersonal and relationship building
behaviors and skills with respect to
Knowledge of the system and how to
make it work in the care of the patient
Relationship building behaviors and
skills between professionals
Existing structures or work processes
that increased the likelihood of
Components of an interaction that
occurred as a function of the
individuals involved, but that, if
intentionally replicated by an
institution, could increase the
likelihood of collaboration
Trans-disciplinary* teaching, modeling
or fostering of knowledge or behaviors in
the clinical or relational domains
*Trans-disciplinary applies to the ability of professionals to bridge
disciplines and to teach and operate, in the clinical and/or relational
domains of the other
McGrail et al.: Physician–Nurse Collaboration
cally present and intellectually available; takes time; teaches;
and is perceptive, flexible, supportive and kind. For instance:
his patient’s care and asked for suggestions....[The
patient] had an unusually large abdomen wound....
We examined the patient together, the MD described
what we were seeing in the wound...and I identified
potential strategies for wound healing.... The MD/PA
team acknowledged my expertise and came to me for
assistance to assist the patient” (RN 2).
“The MD called back promptly....He stated that he
would be up to see the patient... He was not in a
rush and took the time to come and sit with me to
explain everything and its importance because it
was all so new. He also took the time to talk with
the patient about everything that would be hap-
pening. He explained why there was going to be a
lot of commotion and to try not to worry. At the
end of the night, I had learned a lot and the
patient was relaxed” (RN 1).
Facilitative nursing qualities partially overlapped with physi-
cians’, but included more complex behaviors requiring multiple,
simultaneous interfaces and tasks. These included: coordinating
care; and advocating for, and supporting, patients, families and
knowledgeable, experienced, responsive and gentle; and also as
taking initiative, teaching and respecting their physician col-
league; and taking time. An example of the latter follows:
“[She] asked me gently if we have to give him
magnesium....It struck me that he could have
electrolyte abnormalities.... I liked the way she
approached me gently and the way she put the
words. It made me comfortable rather than ridicul-
ing me that I didn’t know what to do” (MD 1).
Impact on the Involved Professional
Affective outcomes for the nurses and physicians are categorized
in Table 5. There were some differences in affective outcomes by
nurse colleague. Nurses were more likely to experience satisfac-
tion with a job well-done. Both groups reflected feeling respected,
valued and understood. Three examples of gratitude follow.
“...This was all in a very stressful and challenging
situation, and proper care would not have been
possible without the help and understanding of the
nurse. I thank her whole heartedly for helping out
and coordinating care effectively” (MD 2).
“I was very appreciative that the resident came in
and explained to me what was going on and then
figure out the best outcome for the patient” (RN 3).
“...The DKA resolved well within a few hours, we
didn’t miss a single order, and the patient was out
of the unit by the time of morning rounds. And all
of us lived happily ever after” (MD 3).
Twenty-five of the 67 narratives were categorized as high-level
collaboration. When the demographic characteristics of their
authors were assessed (Table 6), the likelihood of a story being
rated as high order, or high level, collaboration was unrelated
to age, years in practice, gender or profession.
Four stories were excluded from the analysis of collabora-
tion level as they involved single discipline interaction only.
Two stories were rated as 0. Despite the presence of both
doctors and nurses in the narrative, these stories contained no
interaction that could be assigned a collaboration value.
In some high level collaboration stories, clinical expertise
was the primary determinant; in some, the inter-professional
relationship dominated; and in yet others, both components
were present. High level collaborative behaviors could be
identified in both nurse and physician or in only one individual
of the dyad. Equality of experience, expertise or knowledge was
not a precondition for successful, high order collaboration.
Structural and/or systemic components (Table 2) also con-
tributed to high order collaboration. These included: physical
proximity of nurse and physician (both members of the
collaborating pair were physically in the same place, i.e., “the
physician came”); geographic clustering of nurses and physi-
cians in one unit, i.e., the ICU; continuity and stability of nurses
and physicians, such as in the operating, recovery, emergency
rooms and the outpatient department; seeing and assessing a
patient together. Most of these elements were not a result of
deliberate institutional planning, but occurred fortuitously.
Mentoring (Table 2) occurred when a nurse or physician
helped an individual of the other discipline acquire knowledge
or skill in relational or clinical domains. This type of collabo-
rative interaction could occur between an experienced nurse
and a resident physician or vice versa. In some of the mentor
narratives, both professionals were novice practioners. For
Table 5. Affective Outcomes
Affective outcomes (AO)MDRN
N=30 (%) N=37 (%)
Gratitude for/appreciation of MD
Thanks, respect, appreciation,
admiration for RN
Job well-done, pride, capable,
sense of accomplishment
Felt understood, respected,
valued, like a partner
Total with AO (one or more themes) 58
8 (27) 16 (43)
6 (20)7 (19)
*AO present in 78% of male MD stories
McGrail et al.: Physician–Nurse Collaboration
several nurse writers, mentoring stories had occurred many
years before in their early professional lives.
MD 1, a story quoted earlier as an example of Facilitative
Behavior, involves a nurse mentoring a physician in the
relational domain, while the following is an example of
bidirectional mentoring. In this case, the nurse may have been
modeling relational skills (intellectual curiosity and respect for
the colleague’s knowledge) at the same time the resident was
teaching the nurse in the clinical arena:
“A 45-year-old female with ORSA bacteremia.
Nurse enthusiastically worked on patient man-
agement. Was very curious and kept on asking
provoking questions and kept the team updated
about the progress. That made the entire process
very satisfying for us, as well as the patient,
discussing the treatment plan and prognosis with
nursing staff really helps. Later I made it a
The literature on physician–nurse collaboration often laments
the poor relationship between the professions, emphasizing
anger, conflict,20,35,36and differences in attitudes towards
collaboration.16–19,37–40By contrast, this study focused on
successful physician–nurse interactions, illuminating the syner-
gistic, positive, affective dimensions of successful collaboration.
The power of affect seen in these narratives suggests two
concepts. First, successful collaboration may have transfor-
mative potential, especially for early collaborators. An episode
that begins with the professional entering a patient care
situation feeling worried, insecure or inadequate is trans-
formed, ending with the professional feeling gratitude, often
combined with relief and pleasure, for a job well-done.
Second, some narratives recalled events from training and
early practice that continued to affect current practice,
suggesting that early collaboration experiences may be forma-
tive, producing life-long collaboration expectations, attitudes
The nurses who participated in this study were predomi-
nantly US born and educated, and had years of experience,
while the physicians were primarily international medical
graduates in residency training. The differences in worldview
that one might have expected from these discrepancies in age,
experience, gender, ethnicity and profession16–19make this
study’s discovery of overlapping affective themes surprising, as
many qualities of the affective experience were actually shared
across the professions. What might account for this finding?
First, the results of any study are shaped by the methods
chosen for exploration. Many studies of collaboration have
used pre-determined surveys, while others have used ethno-
graphic approaches. By virtue of their design, they may be
more likely to amplify differences or uncover areas of conflict.
Conversely, this study using Appreciative Inquiry solicited only
success stories, making negative or discrepant experiences
less likely to surface.
Second, although there were some differences in the
narratives, many writers reported strong affective experiences,
with uncertainty and vulnerability as central themes. Given an
open-ended opportunity to share these experiences, it is not so
surprising that physicians and nurses, entering into an
interaction with similar feelings, would, on reflection, produce
narrative coherence in terms of created and shared meaning.
Most importantly, based on gender and professional stereo-
types and preconceptions, one might anticipate that affective
experiences would be more common among the nurses than
the physicians, but this was not the case. Despite the fact that
the residents were 50% male and nearly 100% IMGs, the
affective component was apparent more often in their narra-
tives than in those of nurses, 98% of whom were female. The
affective trigger for the residents was most often a sense of
vulnerability and inadequacy. This theme of vulnerability and
fear of making mistakes with dire personal consequences also
appeared in a previous qualitative study involving IMGs, and it
may be an implicit theme common in their early professional
lives in the US.41
One might also expect that affective dimensions of collabo-
ration would differ between seasoned professionals and
novices of either profession, with affect diminishing as experi-
ence grows. In this study group, nurses could be categorized
more often than residents as “seasoned.” However, the most
important components influencing the affective dimensions of
collaboration were not found in the age, gender, profession or
ethnicity of the participants. Instead, they resided in the
individual’s personal sense of competence and confidence or,
conversely, uncertainty and vulnerability, and the extent to
which a professional identity had been formed. Taken together,
these two factors may account for the convergence in the
Another aspect of the affective dimension of collaboration
may have stemmed from the narrative setting most common in
the residents’ stories, the ICU. The literature on physician–
nurse collaboration in the ICU is one of inter-professional
conflicts.37–40Yet 60% of resident stories about successful
collaboration took place in the ICU setting, paradoxically
suggesting that the tensions particular to the ICU may
represent fertile ground for teaching and modeling effective,
successful collaboration. Evening and night duty for nurses,
and night float experiences for residents may be of similar
The formative nature of early collaboration coupled with the
settings most often cited in the narratives (ICU and off-hour
shifts) have educational and practice implications. Since high
Table 6. Demographics of High Level Collaboration Narratives
Years in practice
30 or more
Seventy-five percent of MD stories were from residents
McGrail et al.: Physician–Nurse Collaboration
stress, high stakes environments appear to offer unique
opportunities for cross-disciplinary support, education and
cooperation, interventions could be profitably focused in those
arenas. Combined ICU nurse–physician patient care rounds
could create opportunities to teach and model collaboration,
and to do both formative and summative evaluations of these
skills for physicians and nurses. Creating the systemic
expectation that nurses be included in ICU family meetings
could facilitate development of collaboration skills. Routinely
integrating physicians and MD-RN collaboration assessment
into near-miss conferences, root cause analyses and case
conferences could create opportunities to operationalize the
principles of collaboration and to review and improve team
functioning. Integrated MD-RN evening and night sign-out
rounds could represent another high-yield opportunity.
Lastly, gratitude or thanks for the collaborating colleague
gratitude is rarely expressed. Based on the findings of this study
and the intensity of this dimension of the affective experience,
encouragement of its expression would be appropriate.
Collaborative competence was another critical theme iden-
tified in our analysis. Collaboration has been defined as
“nurses and physicians cooperatively working together, shar-
ing responsibilities for solving problems, and making decisions
to formulate and carry out plans for patient care.”15Elsewhere
in the nursing literature, collaboration, coordination, cooper-
ation and mentoring are all considered as separate behaviors.
Our analysis suggests that these might be best recognized as
collaborative behaviors along a developmental continuum.
Viewing collaboration in this way, relational skills between
professionals play a seminal role and can, at times, trump
clinical skills, placing an interaction into the “high order”
collaboration category. Conceptualizing high level collabora-
tion as “high order” characterizes the interaction in the
language of energy and kinetics, in this instance, with fluidity,
flexibility, synchronicity and intuition simultaneously opera-
tive on both clinical and relational levels.
Collaboration can be conceptualized as a series of graduated
skills on a developmental continuum, which also suggests the
notion of collaborative competence. Our data suggest that
collaboration is not the exclusive province of the seasoned
professional who is clinically sophisticated, but also happens
at the novice level. Collaboration is not specifically addressed
by most curricula. Instead nurse–physician collaboration
attitudes and skills are deeply imbedded in the hidden
curriculum of medical education and practice.49
If the concept of collaborative competence were generally
accepted, the educational focus would shift from high level
clinical skills to include equally important relational skills.42,43
This comes at a time when the relationship-centered care
model44,45and Watson’s “caring theory46are gaining increas-
ing recognition in medicine and nursing. Extending the focus
on relationship to the nurse–physician dyad suggests a
parallel process47between successful collegial relationships
and successful patient care.
We propose, as have others,48that collaboration be consid-
ered a competency area, with attendant implications for
nursing, medical education and staff development. We have
observed that collaboration takes place in two principal
domains, clinical and relational, which are known to be
teachable and learnable. Given the fact that ours was a small
study in an unrepresentative sample, additional confirmatory
research will be needed to make this concept viable on a wider
This study was largely confined to the medical services of a
community hospital and the physicians involved were predom-
inantly international medical residents. As a result, our
findings may not be generalizable to university settings or
other services within the hospital, and may not reflect the
collaboration experience of attending physicians. As a qualita-
tive study of a relatively small group, differences in the affective
experiences of residents and nurses may not be discernable.
Additionally, participants knew before they wrote their stories
that they would be sharing them with a colleague and the
content may have been influenced by that knowledge. Lastly,
the analysis was done by four females, and the results may
have been influenced by gender.
This study, the first we are aware of describing successful
resident-nurse collaboration, highlights the role of affect in
initiating the collaborative cascade and the positive affective
outcomes observed. The collaborative dyadic relationship,
important in patient, family and nurse satisfaction, also seems
to be powerful in the lives of medical residents. Collaborative
competence is situated in a complex educational and institu-
tional milieu, and the ability and opportunity to collaborate
can be confounded by variables beyond the control of individ-
ual professionals. Time, proximity, and organizational and
educational values are key in determining whether we are
professionally prepared and enabled to apply “caring” and
“relationship-centered care” principles in our relationships
with one another.
There is a compelling need to move collaboration out of the
hidden curriculum49and to actively define what it is, and how
to teach, model and evaluate this essential skill.
Acknowledgements: The authors thank the nurses and residents
who offered their stories freely and the interdisciplinary faculty who
generously gave their time to this collaboration exercise. We also
thank Madeline Schmitt for conceptual input. There was no external
funding support for this study.
Conflicts of Interest: None.
Corresponding Author: Kathleen A. McGrail, MD.; 275 Parkview
Drive, Rochester, NY 14625, USA (e-mail: Kathleen.McGrail@
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McGrail et al.: Physician–Nurse Collaboration