Patient care is complex. Plans of care typically require contributions from multidisciplinary healthcare professionals including nurses. To achieve optimal patient outcomes, it is essential for all healthcare providers to work together. However, healthcare becomes fragmented when providers from different professions keep an isolated focus on the care delivered by their own disciplines rather than coming together in a partnership with other healthcare providers. People within different disciplines may become adversarial to one another, perceiving that one or the other is not supporting, or even hindering the delivery of patient care.
Do any of the following phrases sound familiar?
- “Respiratory is taking forever. My patient needs his breathing treatment.”
- “Pharmacy can’t ever seem to get our meds stocked. My patient’s antibiotic is going to be late, and I’m going to be the one who gets blamed for it.”
- “That nurse just leaves the patient in Room 302 in the bed all day and can’t be bothered to get him up to the chair. No wonder he is so weak when we try to ambulate him.”
Phrases like the ones listed above create division between different healthcare disciplines and an environment where words of blame and assumption are more likely spoken than words seeking understanding and solutions. Those receiving care are placed at risk for receiving inferior care. It is essential then for nurses to actively partner with other healthcare professionals to problem-solve together on behalf of those they serve otherwise those they serve will pay the price.
Professional Organizations Recognize the Value of Interprofessional Collaboration
Multiple professional organizations recognize the value of interprofessional collaboration, including the Interprofessional Education Collaborative (IPEC), American Association of College of Nursing (AACN), and the American Nurses Credentialing Center (ANCC).
The Interprofessional Education Collaborative (IPEC) was founded in 2009 as a partnership between multiple education associations with the purpose of supporting learning opportunities that would help prepare students training in those professions to participate in team-based, collaborative care. Interprofessional collaboration, as visioned by IPEC, is a “key” to providing care where focus remains on the needs of patients, clients, and communities by supporting each individual to achieve desired health care outcomes (IPEC, 2023). Competency domains include value and ethics, roles and responsibilities, communication, teams and teamwork. Members of the healthcare team must recognize each profession brings a specific, unique skill set to creatively develop solutions to healthcare problems. Strong teams ask “How can we leverage our individual expertise to meet our patients’/clients’ needs?” These domains and competencies are the foundation of building collaboration in healthcare.
The American Association of Colleges of Nursing (AACN) also sets forth competencies within their accreditation standards academic institutions must meet. The descriptor for Domain Six, Interprofessional Partnerships, reads: “Intentional collaboration across professions and with care team members, patients, families, communities, and other stakeholders to optimize care, enhance the healthcare experience, and strengthen outcomes” (American Association of Colleges of Nursing, 2021). These competencies are congruent with those set forth by IPEC as they similarly emphasize the value of different healthcare professionals bringing their knowledge and expertise to a respectful, collaborative partnership focused on common goals.
The American Nurses Credentialing Center (ANCC) also values interprofessional collaboration. Current Magnet document requirements include the submission of examples of improved outcomes achieved through interprofessional collaboration and/or education. For organizations seeking Magnet designation or re-designation, building an interprofessional collaborative culture is quite valuable. Writing to 10 different sources of evidence within the Magnet domains of Structural Empowerment and Exemplary Professional Practice demonstrates evidence an organization engages in interprofessional collaborative practice (American Nurses Credentialing Center, 2023).
Facilitating Interprofessional Collaborative Practice
A study by Schot, et.al (2020) highlights the value of interprofessional collaboration when professionals actively build relationships with one another and seek to learn the perspectives of work performed by other healthcare providers.
Finding from this systematic review included:
- Different professions can share their knowledge with one another, creating an environment where the value of each profession is recognized. Building those relationships requires time and space to do so. Workgroups and task forces can support building professional relationships.
- Different professions can support one another’s care tasks. For example, a physical therapist can wait until a patient is finished in the bathroom and then assist the patient back to bed. A nurse could draw a patient’s labs because the phlebotomy team is short-staffed, and the lab results are required prior to a patient’s planned procedure that day.
- Different professions can engage in negotiations to support patient care. Negotiations may involve making “compromises, bargains and/or trades” to facilitate patient care. For example, to facilitate patient throughput, the emergency department team focuses on patient preparation for transfer and nursing units support the organization’s transporters by going to the emergency department, picking up patients, and transferring them to their units. Each profession collaboratively negotiates how it can contribute to facilitating throughput in the crowded emergency department.
Collaboration in Action: Two Exemplars
In our organization, nurses in multiple roles, i.e., clinical, advanced practice, nursing professional development, and leadership, actively engage in interprofessional collaborative practice. Nursing leadership advocates for nurses’ ability to practice at top-of-license, clinical and advanced practice nurses manage direct patient care, and nursing professional development practitioners design and implement education activities to support evidence-based nursing practice.
In our organization, the Cardiovascular Operating Room (CVOR) workgroup is comprised of individuals representing multiple healthcare professions providing care to patients undergoing cardiac surgery including surgeons, cardiologists, anesthesiologists, nurses, advanced practice clinicians, perfusionists, respiratory therapists, and rehab professionals. Members of these professions provide care across a continuum from the CVOR to the cardiovascular ICU (CVICU) to outpatient cardiac rehabilitation after discharge. Part of the scope of this interdisciplinary group is to review current practice following organizational and professional guidelines. In reviewing the rate of post-operative complications, the workgroup identified post-operative hyperglycemia to be a common denominator in many of the cases. Through shared goals, communication, and collaboration, the CVOR workgroup developed a specific patient handoff tool to communicate key elements from the pre-operative CVICU nurse to the CVOR nurse then to the post-operative CVICU nurse. Patient blood glucose levels were specifically documented and given in reports between nurses as the patient prepared to transfer between care settings. Use of the patient handoff tool led to tighter control of blood glucose for cardiac surgery patients. Within the first month of implementation of the new patient handoff tool, the percentage of patients experiencing a post-operative complication decreased by 65%.
Another interprofessional workgroup within the organization is the Joint Replacement Steering Committee (JRC). The JRC includes surgeons, anesthesiologists, advanced practice clinicians, nurses, social workers, and rehab professionals working together to facilitate a comprehensive hip and knee joint replacement program. Each profession identified contributions it would make to support success of patient throughput. Starting with a shared decision-making conversation in the orthopedic surgery clinic, surgeons and clinic nurses identified patients appropriate for joint replacement surgery. Clinic nurses then partnered with patients to identify discharge needs after surgery, scheduled pre-surgery education classes, preoperative screenings and imaging, and post-operative physical therapy evaluations. Anesthesiologists modified their practice to increase use of regional anesthesia. For patients planning same-day discharge, a physical therapist was scheduled each day in the post-anesthesia care unit (PACU) to evaluate patient ability to ambulate with a walker and safely navigate a brief staircase. The average length of stay for total knee replacement surgery decreased by 35% and the average length of stay for total hip replacement surgery decreased by 28%. Bringing together these various stakeholders and their willingness to collaborate drove positive outcomes for these patients.
The Nurse’s Role in Collaboration
As demonstrated in the examples above, nurses in multiple roles are in a key position to not only identify gaps in care but initiate and engage in collaborative work. Direct care nurses may participate in interdisciplinary rounds or service line workgroups to help coordinate care between multiple healthcare professionals. Nursing professional development practitioners support interdisciplinary collaboration through the provision of learning activities involving nurses and other disciplines to improve patient outcomes. Nurses can be the catalyst to driving a change that leads to care improvement. It will require nurses to become more proactive in seeking partnership with other healthcare professionals, but the rewards will well be worth the effort.
References
- American Association of Colleges of Nursing. (2021). The Essentials: Core Competencies for Professional Nursing Education. https://www.aacnnursing.org/Portals/0/PDFs/Publications/Essentials-2021.pdf
- American Nurses Credentialing Center. (2023) 2023 Magnet Application Manual. Silver Spring, MD. American Nurses Association Enterprise.
- Interprofessional Education Collaborative. (2023). IPEC Core Competencies for Interprofessional Collaborative Practice; Version 3. Washington, DC: Interprofessional Education Collaborative.
- Schot, E., Tummers, L. & Noordegraaf, M. (2020). Working on working together. A systematic review on how healthcare professionals contribute to interprofessional collaboration. Journal of Interprofessional Care, 34:3. 332-342, DOI:10.1080/13561820.2019.1636007
Ginnie Covey, BSN, RN, CV-BC, CHFN
Magnet Program Director, CHRISTUS® Trinity Mother Frances Health System
Ginnie Covey entered in healthcare in 1989 as an exercise physiologist working with cardiac rehabilitation patients and wellness clients. In 2007, she completed her BSN at the University of Texas at Tyler and engaged in clinical practice in the cardiology service line of her organization. In the fall of 2023, she returned to UT Tyler and completed a post-bachelor’s certificate in nursing professional development in April 2024. She has been a member of her organization’s nursing professional development team since 2018. She joined the professional development department as an RN clinical educator and in 2019 transitioned into her current role serving as magnet program director.