December 11, 2012
Response by Kern-Manwaring to Partnerships and Collaboration: What Skills are Needed? (January 31, 2005)
It takes a village of disciplines and health care personal to care for our patients today. As nurses we believe we are always open to collaboration and think we do it well. However, recently I have discovered that collaboration is not always valued, and teaching students and younger nurses collaboration is easier said than done.
Over the past two years, I have been involved with junior level baccalaureate nursing students in an interdisciplinary health fair that is a joint project with psychology students. Students filled out a survey after the event and rated their satisfaction with the program. One of the questions I asked in the survey was, “Rate the impact this experience had on your feelings of working with others outside your discipline.” I was astonished to see that not only did the students not see this as a favorable event but rather a more adversarial one. One nursing student group did a fire safety display for children ages kindergarten-3rd grade and when they found that the psychology students did a poster with some of the same information they began to point out errors in the psychology students’ presentation and came to me to claim victory. One of the main objectives of this joint venture was to allow the students to work with another discipline to increase their understanding of collaboration, yet they did not value it. Although assumptions should not be made with a few groups of students, it brought to my attention many issues regarding collaboration.
Health care is so complex, with sicker patients, and it is imperative that we collaborate in our patients’ best interest. We need to start early and have frequent discussions with our students and young nurses regarding collaboration. Collaboration is taught to our baccalaureate students in the first year of the nursing program, yet they may not have opportunities to collaborate in a health care setting until their senior year or beyond.
The Quality and Safety Education for Nurses (2012) commission define teamwork/collaboration as “function effectively within nursing and inter-professional teams, fostering open communication, mutual respect, and shared decision-making to achieve quality patient care.” Furthermore it is the appreciation of intra-and inter-professional collaboration and respect of the unique attributes that members bring to a team, including variations in professional orientations and accountabilities.
Nurses are the case managers and gate keepers to our patients. I recall being a new nurse having practiced around 5 years. I will put myself in the Patricia Benner (1984) category of proficient. I felt I had a good knowledge base and experience level at the time. Working in a NICU in the Northeast I recall being upset when a feeding specialist arrived on my unit to evaluate one of my primary patients. I thought to myself – I know this patient very well and feed premature infants all day long. How is she going to make a plan of care for them? I am sure as readers you can recall the same feeling when another discipline has come to work with or evaluate one of your patients. In nursing, we have given up a multitude of parts of nursing care that we used to deliver. It takes time to feel comfortable as a nurse to collaborate and it may not be until we are at Benner’s competent or even expert level that we truly embrace collaboration.
As complex as patients are today, it takes a village of disciplines working alongside nursing to create the best outcomes we all desire for our patients. We need to teach collaboration to our young nurses early and often. First nurses need to see the value and then learn the art and skills of collaborating with diverse disciplines. In the hospital setting I have become more aware of pointing out collaboration to the students and role modeling the spirit and need for collaboration. We all need to foster collaboration. I have grown as a nurse to value the expertise of my colleagues in other disciplines and look for their input and guidance.
Nancy M. Kern-Manwaring, RN, MSN, CNS
Benner, P. (1984). From novice to expert: Excellence and power in clinical nursing practice. Menlo Park, CA: Addison-Wesley.
QSEN (2012). Teamwork and collaboration. Retrieved from http://qsen.org/competencies/pre-licensure-ksas/