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Legislative: Partnership or Collaboration: Words Matter

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Greer Glazer, PhD, RN, CNP, FAAN
Charles Alexandre, RN, MS
Patricia Reid Ponte, RN, DNSc, FAAN, CNAA

Citation: Glazer, G., Alexandre, C., Reid Ponte, P. (March 31, 2008).  Legislative: "Partnership or Collaboration: Words Matter." OJIN: The Online Journal of Issues in Nursing. Vol.13 No.2.

DOI: 10.3912/OJIN.Vol13No02LegCol01

Oft cited components of nursing practice are collaboration and partnership. State nurse practice acts and standards of nursing practice require nurses to collaborate with each other and with other members of the healthcare team. A brief search finds the nursing literature replete with articles extolling the value of both collaboration and partnership with the words collaboration and partnership often used interchangeably. It is our contention that collaboration and partnership are two distinct concepts with collaboration being one component of a true partnership.

There is support in the literature for the idea that collaborative partnerships are essential to addressing emerging issues and trends in nursing and healthcare (Boswell & Cannon, 2005). However, without a precise definition of terms we cannot be sure what each party is expecting of the other, making it difficult to identify specific roles, establish goals, and develop outcomes. Having had varying degrees of cooperation in our previous experiences of collaborative partnerships with organizations outside the university, we found it necessary to take a step back and define these two words to clearly identify what we expect from our partners and ourselves before engaging in future partnerships. 

The Merriam-Webster Dictionary (n.d.) defined collaboration as working “jointly with others especially in an intellectual endeavor.” This definition implies an informal relationship that does not ensure equality among the parties. Gardner (2005) spoke to this discrepancy noting that within the healthcare system many collaborative relationships exist within a hierarchical structure. Lindeke and Sieckert (2005) acknowledged this inequality when they defined collaboration as a sharing of knowledge between stakeholders with joint responsibility for the outcome. Using the example of a nurse-physician relationship, these authors stressed that it is as important to define what is not implied by collaboration as it is to define what is implied. Their example clarified that the nurse-physician relationship is not a supervisory relationship, but one of mutual respect with the shared goal of quality patient care. 

The concept of partnership is defined as a “legal relationship existing between two or more persons contractually associated as joint principles in a business” (Merriam-Webster, n.d.). Unlike collaboration, this definition implies a formal, structured relationship between equals with mutually defined objectives and goals.  According to Feenstra, Gordon, Hansen, and Zandee (2006) through persistence and flexibility, members of a partnership enjoy close mutual cooperation; share common interests, common responsibilities, and common privileges; have equal power; are allowed equal input into all decisions; and have their needs attended to equally. Unlike informal collaboration, a true partnership must be nurtured and provided all of the time and energy required to maintain a successful relationship.

Having been in the situation where we entered a collaborative relationship with another organization without full partnership, we came to understand the importance of clearly defining the language that would establish any future relationships. At the University of Massachusetts Boston College of Nursing and Health Sciences our vision is to “improve the health-related quality of life of diverse urban populations through the integration of teaching, targeted research, service, practice, and health policy in partnership with others” (College of Nursing and Health Sciences, 2007). An example of a true partnership is the relationship between the University of Massachusetts Boston and the Dana Farber Harvard Cancer Center (DFHCC). This partnership has received a National Cancer Institute (NCI) U-56 Grant that focuses on a broad array of projects aimed at increasing minority scientists in the field of cancer research and reducing cancer disparities.

One project is directed at improving the shortage of culturally and ethnically diverse nurses.  Monies from this grant are funding a joint venture in training, mentorship, and community outreach. The University’s College of Nursing and Health Sciences and nurse leaders within DFHCC identified a need for a culturally diverse nursing faculty and workforce to effectively meet the healthcare needs of the population. The failure of sufficient numbers of nurses to graduate from doctoral programs and subsequently serve as nursing faculty has a direct effect on the long-term viability of nursing education programs. To increase the number of culturally diverse nurses and potential faculty, the University and DFHCC are piloting an accelerated BS to PhD program that will focus on oncology practice, health policy, and health disparities.  This program promotes collaboration between expert oncology nurses and nurse scientists throughout the five Harvard Academic Medical Centers within DFHCC Nursing Departments (Dana-Farber Cancer Institute, Brigham and Women’s Hospital, Beth Israel Deaconess Hospital, Children’s Hospital, and Massachusetts General Hospital) to develop new knowledge through research, provide oncology nursing care, and establish community outreach and prevention programs. The Chief Nurse at the Dana Farber Cancer Institute and the Dean of the University of Massachusetts Boston College of Nursing and Health Sciences serve as co-Principle Investigators of this project focused on decreasing the nurse faculty shortage by preparing younger faculty to replace those nearing retirement (College of Nursing and Health Sciences, 2007).

The University and the DFHCC, sharing the common goal of providing quality patient care, entered this relationship as equal partners. Full support from the nursing leadership of the respective organizations provided a solid foundation from which we worked together to develop the grant proposal. Equal power provided each party with a veto. This partnership enabled us to develop a program that would meet our need to educate a diverse group of nurses to more closely mirror the racial and ethnic make up of our community and to prepare graduate nurses to become educators. 

The literature tells us the success of any partnership is dependent on each party gaining the respect and trust of the other (Feenstra et al., 2006; Gardner, 2005).  Within this grant program, we expect nursing staff throughout DFHCC will come to recognize and respect the University and trust that nursing students will be educationally prepared and have sufficient faculty support while assigned to their hospital. Alternatively, the University will recognize that the hospitals’ nurse leaders will ensure students placed there will be treated fairly and given appropriate learning opportunities. Within this partnership, collaboration is demonstrated as the DFHCC nursing departments provide research mentors to graduate students of the University while the University provides graduate research assistants to researchers at the hospital.

It is clear from the nursing literature that collaborative partnerships are an effective approach to addressing emerging healthcare issues.  Having clearly defined collaboration and partnerships we were able to establish a partnership to help us meet our goals. In our example, the University of Massachusetts Boston College of Nursing and Health Sciences, and the Dana Farber Harvard Cancer Center’s Nursing Services identified a shortage of minority nurses and a failure of sufficient numbers of minority nurses to graduate from doctoral programs that threatened the viability of nursing education programs. With the shared goal of quality patient care a collaborative partnership was formed, a grant proposal written, and a research program established. The success of this program will be dependent on the ability and commitment of the University and DFHCC to provide “the time, energy, persistence, and flexibility” required for maintaining it (Feenstra et al., 2006, p. 237).

Authors

Greer Glazer, PhD, RN, CNP, FAAN
E-mail: Greer.Glazer@umb.edu

Dr. Greer Glazer is Dean and Professor of Nursing and Health Sciences at University of Massachusetts Boston. She received her BSN from University of Michigan, and MSN and PhD from Frances Payne Bolton School of Nursing, Case Western Reserve University. She became particularly interested in collaboration and partnerships while serving as a Robert Wood Johnson Executive Nurse Fellow in 2001. Since then she has developed an interdisciplinary, PhD-level, leadership course; partnered with agencies in Israel to improve women's health; and engaged in partnerships and collaborations with the following Massachusetts agencies and organizations: Partners Healthcare; Children's Hospital of Boston; The Massachusetts Board of Higher Education; Bunker Hill Community College; Roxbury Community College; and Dana Farber Harvard Cancer Center. She is on the Board of the Massachusetts Center for Nursing.

Charles Alexandre, RN, MS
E-mail: Charles.Alexandre@umb.edu

Charles Alexandre is a doctoral student at the College of Nursing and Health Science at the University of Massachusetts Boston. He received his BSN from Rhode Island College and his MS in Nursing Administration from the University of Rhode Island. He is the Chief, Health Professions Regulation at the Rhode Island Department of Health.

Patricia Reid Ponte, RN, DNSc, FAAN, CNAA
E-mail: Pat_Reid_Ponte@dfci.harvard.edu

Patricia Reid Ponte is the Senior Vice President for Patient Care Services and Chief Nurse at Dana‑Farber Cancer Institute and the Director of Oncology Nursing and Clinical Services at the Brigham and Women's Hospital. She also serves as an American Academy of Nursing American Nurses Credentialing Ceneter (ANCC) Magnet Commissioner; co‑leader of the American Academy of Nursing Expert Panel in Advancing Magnet, and a 2001 Robert Wood Johnson Nurse Executive Fellow. She is the immediate Past President of the Massachusetts Organization of Nurse Executives, a Board member of the Massachusetts Hospital Association and a member of the American Organization of Nurse Executive Patient Safety Committee. Dr. Reid Ponte's research has focused on patient safety, patient and family-centered care, interdisciplinary leadership, and empathy and distress in cancer patients. She has had numerous publications in peer‑reviewed journals and conducted lectures both nationally and abroad. Dr. Reid Ponte received both her DNSc and MS from Boston University. She received her BSN from the University of Massachusetts Amherst.

References

Boswell, C., & Cannon, S. (2005). New horizons for collaborative partnerships. OJIN: The Online Journal of Issues in Nursing, 10(1) Retrieved October 10, 2007 from www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume102005/No1January31/tpc26_216009.aspx

College of Nursing and Health Sciences. (2007). CNHS initiatives target health disparity & promote diversity. Retrieved October 19, 2007, from www.cnhs.umb.edu/CNHSHealthDisparitiesDiversity.html

Feenstra, C., Gordon, B., Hansen, D., & Zandee, G. (2006). Managing community and neighborhood partnerships in a community-based nursing curriculum. Journal of Professional Nursing, 22(4), 236-241.

Gardner, D. B. (2005). Ten lessons in collaboration. OJIN: The Online Journal of Issues in Nursing, 10(1) Retrieved October 10, 2007 from www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume102005/No1January31/tpc26_116008.aspx

Lindeke, L. L., & Sieckert, A. M. Nurse-physician workplace collaboration. OJIN: The Online Journal of Issues in Nursing, 10(1) Retrieved October 10, 2007 from www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume102005/No1January31/tpc26_416011.aspx

Merriam-Webster Online Dictionary. Retrieved 10/08, 2007, from www.m-w.com/dictionary/


© 2008 OJIN: The Online Journal of Issues in Nursing
Article published March 31, 2008

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