Standard 13. Collaboration
Pamela Brown PhD, RN
Standard 13. Collaboration. The registered nurse collaborates with the healthcare consumers, family, and others in the conduct of nursing practice.
Definition and Explanation of the Standard
The word collaborate comes from Latin origins, com (together) and laborare (to labor), to exert together, to work one with another, to cooperate, especially in a joint effort toward mutual goals (Merriam-Webster, 2011). In nursing and medicine, Baggs and Schmitt (1998) defined collaboration more narrowly as “nurses and physicians cooperatively working together, sharing responsibility for solving problems, and making decisions to formulate and carry out plans for patient care” (p. 74). Over time, the definition has broadened to include multiple professions and a variety of stakeholders.
Collaboration, as a concept, is not new to nursing or health care and continues to be an essential element in safe and high-quality patient-care outcomes (IOM, 2010). Although collaboration is a common and an essential part of everyday practice, much variation in outcomes continues to exist in health care (Sullivan, 1998; IOM, 2010). The ongoing challenge to achieve positive outcomes through collaboration rests with the “co” part of collaboration, in working together effectively toward a mutual goal. This approach takes “intentional knowledge sharing and joint responsibility” (Lindeke & Sieckert, 2005, p. 1).
Collaboration is multifaceted and complex. It occurs in rapid one-on-one encounters and in long-term projects, as well as electronically with no face-to-face interactions. It occurs within short- and long-term relationships. In nursing, it includes descriptors, such as intraprofessional (nurse to nurse or within the profession) and interprofessional (nurse to other professionals or between the professions). It also includes nurse to healthcare consumers and external agencies.
The Interprofessional Education Collaborative Expert Panel (2011)— representing the American Association of Colleges of Nursing, the American Association of College of Osteopathic Medicine, the American Association of Colleges of Pharmacy, the American Dental Education Association, the Association of Medical Colleges, and the Association of Schools of Public Health—released a report addressing core competencies for interprofessional collaborative practice. The panel proposed four domains of care competencies needed to provide integrated, high-quality patient care, and it identified 38 specific, individual-level, core, interprofessional competencies that are across the domains and are necessary for future health professionals. They recommend that health professionals do the following:
Assert values and ethics of interprofessional practice by placing the interests, dignity, and respect of patients at the center of healthcare delivery and by embracing the cultural diversity and differences of healthcare teams.
Leverage the unique roles and responsibilities of interprofessional partners to appropriately assess and address the healthcare needs of patients and populations served.
Communicate with patients, families, communities, and other health professionals in support of a team approach to preventing disease and disability, maintaining health, and treating disease.
Perform effectively in various team roles to deliver patient- and population-centered care that is safe, timely, efficient, effective, and equitable.
Registered nurses (RNs) are expected to have competencies (ANA, 2010) that encompass using interpersonal communication and teambuilding skills to partner with others to effect change and manage conflict. Nurses must participate in documenting an integrated plan of care that focuses on outcomes and decisions related to care and delivery of services and that indicates
mutual communication with healthcare consumers. An RN also engages in collaborative reasoning and decision-making. Collaborative reasoning refers to the “nurturing of a consensual approach toward the interpretation of examination finding, the setting of goals and priorities, and the implementation and progression of treatment” (Edwards, Jones, Higgs, Trede, & Jensen, 2004, p. 72).
mutual communication with healthcare consumers. An RN also engages in collaborative reasoning and decision-making. Collaborative reasoning refers to the “nurturing of a consensual approach toward the interpretation of examination finding, the setting of goals and priorities, and the implementation and progression of treatment” (Edwards, Jones, Higgs, Trede, & Jensen, 2004, p. 72).
Collaborative reasoning requires RNs to have ample depth of knowledge in their own discipline and clear understanding of the patient, family, community, and population, along with adequate knowledge about other disciplines’ scope of practice. Collaborative decision-making ethically supports (1) the right of persons and communities to participate in making decisions affecting their health and (2) the importance of ensuring informed consent. Collaborative decision-making emphasizes the partnership among nurses; other professionals; and patients, families, communities, and populations with the mutual goal of improving patient safety and outcomes.
In summary, an RN is expected to be proficient in collaborating with healthcare professionals and to be an effective part of an interprofessional healthcare team that provides high-quality and safe patient care to individuals and populations.
Competencies expected of the graduate-level prepared specialty nurse and the advanced practice registered nurse (APRN) encompass establishing, improving, and sustaining collaborative relationships, as well as partnering with other disciplines (ANA, 2010). Graduate nurses are key leaders in collaborative discussions that improve healthcare consumer outcomes. An APRN is expected to be proficient in collaboration among healthcare professionals and to effectively implement high-quality and safe patient care at the systems level and at the level of the individual, family, community, or population. All nurses must become proficient in working in collaborative and interdependent relationships and in fostering an interprofessional team approach to patient care.
Common interprofessional collaborations for both levels of nursing practice include population-based disease management, such as diabetes, congestive heart failure, and pneumonia. Multiple professionals are involved in managing the care of such patient populations, including physicians, nurses in home care and acute-care settings, nurse case managers, social workers, pharmacists, respiratory therapists, and physical therapists. All of those professionals, plus the patient and family, are crucial contributors to safe and quality care outcomes.
The nurse’s knowledge, skills, and attitude determine how effective he or she is at collaboration. Nurses need knowledge to assess their collaboration
expertise and to understand the scope and roles of other professionals, and they need strong communication skills to promote collaboration that is within interprofessional teams and that improves safety and quality of consumer healthcare (QSEN, 2011). The skills necessary include commitment to lifelong learning and self-development.
expertise and to understand the scope and roles of other professionals, and they need strong communication skills to promote collaboration that is within interprofessional teams and that improves safety and quality of consumer healthcare (QSEN, 2011). The skills necessary include commitment to lifelong learning and self-development.
Competency in one’s own practice, whether as a team member or leader, is essential in integrating professional contributions to consumer health goals. To lead or participate in designing systems that support collaborative practice, nurses must act with integrity and respect toward other’s differing viewpoints. They must communicate in styles that minimize risks associated with handoffs among providers and across transitions in care. And nurses must diminish risks associated with authority gradients among health professionals.
Finally, nurses need to be able to welcome differences that may lead to disagreements and conflicts and, at the same time, appreciate that safe quality patient care is the imperative among all providers and caregivers. Nurses must respect that the healthcare consumer is central to the collaborative process, because nurses value the influence of system solutions to achieve effective collaborative practices (QSEN, 2010). Baggs (2005) identifies networking as the most crucial behavior associated with collaboration. Leaders need to inspire stakeholders, and they need a vision to reach shared purpose and mutual goals.
Application of the Standard in Practice
Education
To align with the IOM recommendations, nursing education must include interprofessional team learning experiences. Interprofessional team learning offers students practice in teamwork and collaborative reasoning and decisionmaking. Benner, Sutphen, Leonard, and Day (2010) found “almost no interdisciplinary learning or practice opportunities for students,” and believe “practice in an interdisciplinary setting can help students work more effectively on a healthcare team as well as better integrate knowledge, skilled know-how, and ethical comportment in practice” (p. 229). Interprofessional classroom, clinical, laboratory, and simulation experiences are all effective ways to foster collaboration and appreciation for contributions of all professionals to the team. In 2011, national experts convened to develop strategies that healthcare educators
could use to implement the IPEC (Interprofessional Education Collaborative) core competencies and move the healthcare educational system toward collaborative health professionals. Those strategies include the following:
could use to implement the IPEC (Interprofessional Education Collaborative) core competencies and move the healthcare educational system toward collaborative health professionals. Those strategies include the following:
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