Interprofessional relationships and their impact on resident hospitalizations in nursing homes: A qualitative study

The aim of this study is to explore experiences and perspectives of nurses and providers (e.g., physicians, medical directors, fellows, and nurse practitioners) on reducing preventable hospitalizations of nursing home (NH) residents in relation to interprofessional relationship and hospitalization decision-making process. Preventable NH resident hospitalization continues to be a pressing public health issue. Studies show that improved interprofessional relationship may help reduce hospitalization, yet research on communication processes and interactions among different NH staff remains limited. This is a qualitative descriptive study. Two focus groups were held with fourteen nurses and thirteen in-depth, qualitative interviews were conducted with providers from two Chicagoland NHs. Focus group sessions and interviews were transcribed, coded, and analyzed for common themes based on qualitative description method. All study participants agreed that providers have the ultimate responsibility for hospitalization decisions. However, nurses believed they could influence those decisions, depending on provider characteristics, trust, and resident conditions. Nurses and providers differed in the way they experienced and conveyed emotions, and differed in key elements affecting hospitalization decisions such as structural or environmental factors (e.g., lacking staff and equipment at the facility, poor communication between the NH and hospitals) and interpersonal factors (e.g., characteristics of effective nurses or providers and the effective interactions between them). Interpersonal factors, including perceived competence, respect, and trust, may influence NH hospitalization decisions and be targeted for reducing preventable hospitalizations of residents. •In nursing home settings, where nurses are often onsite and providers are often remote, complex decision making around whether to hospitalize residents requires interprofessional relationships•Three inter-group factors that can impact Interprofessional relationships between providers and nurses are roles, relationship quality and trust, and emotional experience and expression. Factors outside of the group can include the nursing home culture, structure and environment, residents and their families, and external groups.•Practitioners could enhance interprofessional relationships by providing time and space for nurses and providers to build shared understanding, mutual trust, and shared knowledge.