The multidisciplinary renal team: who makes the decisions?

Members of renal unit teams across Canada and in Michigan were asked to describe the involvement of various occupational groups and of patients in the treatment decision-making process in their actual unit and in an ideal unit. All occupational groups shared a belief in a relatively egalitarian team, in which the nephrologists would have primary responsibility for decision-making and the other groups would be highly involved. Nephrologists perceived reality as largely in accord with this ideology, indicating little difference between their authority in actuality and in an ideal unit, and perceiving other team members as having greater responsibility for decision-making than those groups perceived themselves as having. Ambiguity existed as to the appropriate level of decision-making involvement for the semiprofessional roles, and a substantial minority of nonphysician respondents saw staff nurses in particular (as well as patients) as having too little involvement. The findings suggest that as a technology becomes routinized, the multidisciplinary team approach may become less realistic. The resulting dissonance between ideology and reality may lead to job stress and adverse effects on job functioning.