Preventable resident hospitalizations in nursing homes (NH) represent a pressing public health issue in the USA. NH hospitalization rates range from 9 to 59 % (Grabowski et al., 2008; Spector et al., 2013; Xu et al., 2019), and 48.2 % of them are preventable (Grabowski et al., 2008; Kayser-Jones et al., 1989). Resident populations have been rising over time, and as a result, NH nurses are facing higher workloads and struggling more in their interprofessional relationships (Fleischmann et al., 2016). Unlike many healthcare settings, NH nurses and providers (e.g., physicians, nurse practitioners) are not necessarily co-located when determining resident care. On-site nurses become off-site providers' “eyes and ears” as they discuss hospitalization decisions over the phone (Wagner et al., 2013). Providers rely on nurses' descriptions to determine whether to hospitalize residents. Such communication processes can be complex and may lead to poor NH resident outcomes, including preventable or unnecessary hospitalizations (Colón-Emeric et al., 2006; Madden et al., 2017). Although research has identified several factors associated with preventable hospitalizations (e.g. the availability of equipment and staffing on-site (Intrator et al., 2004; Lima et al., 2012; Thomas et al., 2013)), more work is needed to understand the role of interpersonal communication between nurses and providers.

Studies show that improved relationships among clinicians reduce sentinel events and potentially negative impacts on clinical outcomes (Martin et al., 2010; Tjia et al., 2009). For instance, Gittell et al. highlight the concept of relational coordination (RC) in patient care (Gittell et al., 2013), which refers to the network of communication and relationships among different workgroups involved in a common work process. Communication patterns are assessed by the frequency, timeliness, accuracy, and problem-solving nature of communication, whereas relationships are measured by the degree of shared goals, shared knowledge and mutual respect (Gittell, 2006). Similarly, a set of quality improvement programs called Interventions to Reduce Acute Care Transfers (INTERACT) were developed to improve the delivery of information between staff (Ouslander et al., 2014). These tactics include checklists to improve nurses' reporting of context and vitals. However, mixed outcomes have been reported on reducing hospitalization (Ingber et al., 2017; Kane et al., 2017; Ouslander et al., 2011). Moreover, other studies utilize qualitative descriptive research design to explore nurse-physician communication and collaboration (Boev et al., 2022). However, research on communication processes among different nursing home staff remains limited (Madden et al., 2017).

A nursing home in Illinois conducted lunch and learn sessions around communication to reduce unnecessary rehospitalizations. During the feedback session, we learned that although many of the nurses felt qualified to report on their patients, the results of their communication depended on other factors, including their relationship with the provider. As higher levels of RC are known to lead to better quality and efficiency performance (Gittell et al., 2013), this study aims to assess different features of interprofessional NH relationships and communication between nurses and providers to understand how they could impact unnecessary rehospitalization decisions. Through focus group sessions with nurses and interviews with providers, we explore their perspectives on hospitalization processes and the interprofessional factors that influence these decisions. Finally, we compare findings from both groups and offer insights about how to improve outcomes.