Interdisciplinary Team Communication and Conflicts Among Nurses and Sexual Assault Victim Advocates

Purpose: To address the complex legal, medical, and mental health acute needs of rape survivors, Sexual Assault Nurse Examiner (SANE) programs have emerged throughout the United States (Littel, 2001). In many SANE programs, a forensic nurse works alongside a victim advocate who provides emotional support to the survivor (Taylor, 2002). Emerging research has shown that conflict exists between nurses and advocates while working together, which can impact the quality of survivor care (Campbell, Bybee, Ford, & Patterson, 2008). To provide a more in-depth understanding of this issue, the current study interviewed nurses and advocates from a Midwest SANE program about their team functioning, including the nature of their conflicts and communication patterns when addressing these conflicts.

Method: Utilizing a case study approach, in-depth semi-structured interviews were conducted with 29 nurses and advocates from a Midwest SANE program. Data analysis proceeded in two phases. First, two analysts developed open codes (Strauss & Corbin, 1990) that captured key thematic content in the survivors' narratives. In the second phase, we used Erickson's (1986) analytic induction method for data analysis, which is an iterative procedure for developing and testing empirical assertions in qualitative research.

Results: The nurses and advocates reported that conflicts typically occur when the nurses and advocates disagree about the appropriate response to survivors. However, the nurses and advocates differed in their approach to resolving conflicts. While the nurses communicated their concerns directly to advocates, the advocates rarely addressed their concerns to the nurses directly. Instead, the advocates reported the concerns to their supervisor, which led to multiple discussions with other supervisors over the span of months before the nurse was informed of the concern. The advocates explained that they did not verbalize their concerns with the nurses directly because they feared this would create tension. Additionally, the advocates believed that the nurses did not trust their expertise or view the advocacy role as equally important in the care of sexual assault survivors. Thus, the advocates avoided sharing their concerns with the nurses because they believed that their feedback would not be taken seriously. Most participants believed joint meetings might improve communication because increasing familiarity with each other might improve receptiveness to each other’s feedback.    

Implications: The findings highlight the complexity of interdisciplinary communication and suggest that communicating concerns differs among disciplines. While the nurses communicated their concerns directly to advocates, the advocates rarely addressed their concerns to the nurses directly for multiple reasons. Unfortunately, this lack of direct communication can result in missed learning opportunities for other disciplines. For example, the advocates occasionally witnessed nurses responding to survivors in a potentially hurtful manner. When these concerns were not communicated, the nurses did not learn how their approach may have been hurtful or how they could have improved their response. Training future social workers on how to communicate concerns to professionals from other disciplines may increase team functioning as well as improve the response to clients. The author will elaborate on these implications for social work education and practice.