Interprofessional Collaboration
In almost any capacity the demands of life can be both hectic and challenging. In light of this, the processes by which life is lived, shared and nurtured must involve organization, effective communication, and collaboration. This simple concept is true of life on almost any level but it is especially true when concerning healthcare. As such, it is important to look at the effectiveness of communication and collaboration within the health care system. This consideration is important because effective communication and collaboration within the health care system has a direct correlation and obvious potential impact on the quality of care provided to the patient. The College of Nurses of Ontario defines interprofessional collaboration as “working
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together with one or more members of the health care team who each make a unique contribution to achieving a common goal. Each individual contributes from within the limits of her/his scope of practice” (College of Nurses of Ontario, 2008, p 3.) Evidently, the dialogue that occurs between medical professionals and all those involved in patient care must be clear, productive and expressive of a vested interest in the patient. In short, patient care is larger than the individual and current healthcare provider as it must encompass the work, experience, observations and knowledge base of the many individuals who form the team of caregivers that work collectively to heal, sustain life and bring comfort. That being said, the collaborative relationship between physicians and nurses remains vital to the health care system as they link together to form a key partners in the care of the patient (McCallin, 2005). It is apparent that people who seek medical care do so with the belief that they will receive the best treatment available to them and that is comes from the best teams available. Considering that lives are on the line in these situations personality conflicts, communication barriers and unprofessional conduct are not acceptable; treatment must be fluid and reflective of genuine commitment to the patient. In fact, collaboration among health care professionals is an integral element of care and of the utmost importance in providing for patients in need (Taylor-Seehafer, 1998). To better understand the role of communication and collaboration one should look at an example of ineffective communication and interprofessional collaboration. Exploring the impact of miscommunication, blocked communication and lack of collaborative effort between physicians and nurses reveals the potential consequences a breakdown of collaboration and communication can have on patients, the nursing professional and health care system as a whole.
To begin, the interprofessional event that was experienced was between a physician, nurse and nursing student that worked together in an outpatient cancer clinic. This interprofessional event illustrated ineffective communication and collaboration within the team setting. Specifically, after the team disagreed on a treatment plan for a cancer patient there was a breakdown in communication and collaboration between the health care providers that had an obvious impact on the patient. As caner is a specialized area the oncologist is partnered with a primary nurse that has an extensive background in oncology nursing. The dynamic between these two individuals is imperative as they provide advanced care to outpatients in the cancer clinics. This situation began with a 67 year old female who underwent surgery for a stage three colon cancer diagnosis and was referred to the oncologist’s team for assessment for adjuvant chemotherapy. As in standard practice the patient was interviewed by the nurse and nursing student. During this interview it was evident that the patient was presenting with a form of mild cognitive impairment. When asked questions pertaining to health, daily lifestyle and support systems that patient showed signs of memory impairment and impaired functional abilities. When the patient was asked about having a form of cognitive impairment, the patient denied any impairment. As the patient attended the appointment alone, and no family members were available for consultation, the nursing staff felt that this matter required the attention of the oncologist. The nurse and nursing student felt that further investigation was important because the patient was not capable of consenting to treatment for chemotherapy or understanding the effects of treatment. After this information was presented to the oncologist, the doctor decided that this issue was a result of an elevated calcium level and that the patient was suitable for treatment. The nurses expressed their concerns for the patient’s safety and the professional basis that surrounded their decision. The oncologist, however, declined to listen. This hindered effective communication relative to the patient. It was clear that the team was not able to discuss the case or their difference in opinion and this created a communication barrier within the team.
In light of this event, it is necessary to look at the impact of both effective and ineffective communication on the health care team and on patients.
Research has shown that ineffective communication between physicians and nurses can result in missed or delayed diagnosis, unnecessary or repeated testing and over prescribing of medications (Espetin, 2010). It has also been shown that poor communication between team members can have a negative effect on patients in ways of psychosocial experiences. This occurs when patients are confronted with information depending on the nature and quality of information that is transmitted to them and can also affects the enactment and outcome of the decision making process regarding treatment opinions (Thorne, Bultz & Baile, 2005). As a result, patients are often dissatisfied with the amount of knowledge they receive from medical professionals and they, in turn, express that this is an area requiring improvement (Conn, Lingard, Reeves, Miller, Russell & Zwarenstein, 2010). As noted above, poor communication between team members often results in negative outcomes not only for the team itself but also for the patients. Because communication plays a vital role in effective collaboration, healthcare providers must address potential breakdowns so as to ensure productive dialogue and to create troubleshooting strategies. The College of Nurses of Ontario website states that communication is how nurses establish and maintain their therapeutic relationships by building trust, empathy and receptivity (CNO, 2006). This information is also applied to interprofessional collaboration. Effective communication strategies which strengthen nurse-patient relationships can also strengthen nurse – physician relationships. Since communication occurs both verbally and non-verbally, it is important to be aware of the many ways through which one communicates and to understand the fundamental role communication plays in patient care (CNO,
2006).
Furthermore, effective communication is necessary within the healthcare profession because it is essential for conflict resolution, problem solving, ethical dilemmas and improving the work environment while meeting the standards of practice (CNO, 2006). In addition, it has been found that effective teamwork between health care professionals is essential in providing high quality medical care to patients and that the absence of effective communication contributes to nursing burnout and high turnover (McCallin, 2005). All health care professionals, including nurses, want to know that their opinion is valued and will be reflected in planning for patient care (Epstein, 2010). It is certainly understandable that healthcare is yet another service that requires strong interpersonal skills in order to ensure optimal collaborative results (Conn, Lingard, Reeves, Miller, Russell & Zwarenstein, 2010). Optimal communication is characterized by accurately sharing of information with the team, indicating what the patient has been told and also looking at possible areas of concern (Epstein, 2010). While differences in opinions can lead to conflict, conflicts between nurses and doctors are difficult to navigate as physicians are often viewed as the authority for initiating treatment options for the patient (Skjørshammer, 2001). When conflict does arise between teams it is important that each member listen to what the other person has to say and seek out a resolution that involves clarification or finding a middle ground (Conn et al., 2010). The College of Nurses of Ontario set out standards that need to be followed within the nursing practice, as such, nursing focuses on every aspect of communication through verbal and non-verbal means. Therefore, nurses are held accountable in the community and must use communication to assist them in self-regulation to meet the standards of professional practice (CNO, 2006).
As effective communication is essential in interprofessional collaboration, it is also significance to address the importance’s of collaboration and other strategies that builds a successful health care system. With this said, collaboration involves the attempt to find a solution when both parties concerns are recognized and are seen as important (McCallin, 2005). This interactions between the team members helps to reach their full potential in decision making, clarifying of problems and also planning of care. Over the past three decades the collaboration between nurse-physician has matured (Taylor-Seehafer, 1998). What was once seen as a fight for turf and territory and collaboration with physicians been seen as a threat to the developing nursing role is now seen as essential and beneficial to the health care system (Taylor-Seehafer, 1998). Furthermore, the actions of a collaboration team, in this case a physician and a nurse can result in having a significant impact by producing a unhealthy work environment for the team members, but also has a neglect effect on the care of patients and can even potential cause harm to the patient (Larson, 1999). To have a successful collaborative team it is necessary to look at communication patterns within the team, while looking at conflict resolution, clinical interaction, the use of humor, negotiation and also the contributions of both parties (Taylor-Seehafer, 1998). Taylor-Seehafer maintains that if a team is unsuccessful at collaboration the blame can not be put on just one person. With this, it was stated that “nurses cannot point to the physician as the reason for the failure of collaboration without also pointing to themselves” (Taylor-Seehafer, 1998, p 389 para 1). This is an important understanding as all healthcare workers must fully consider their role in the disruption or breakdown of communication and not simply blame those around them. With this in mind, nurses must be able to develop the collaborative skills they need to examine their own, beliefs, values and the behaviours they bring to the relationship (Larson, 1999).
While there are teams that work effectively in a co-operative and collaborative setting by sharing information and having transparent decision making, the focus now needs to be on the health care system and the effect that successful collaboration plays (McCallin, 2005). As such, interprofessional practice has been show to benefit the patients and their families directly when a team focuses on clear and open communication. It also allows for the building of trust and respect, the sharing of knowledge/skills and also the development of an integrated plan of care which puts the safety of the patient first (McGill Interprofessional Initiative, 2009). To reinforce the importance of this practice and its corresponding potential for improved patient care, one must keep in mind that the health care system has standards of practice for every discipline. According to reports focused on the United States, the health care system challenges hospitals to achieve what they refer to as “magnet status” which is also known as the seal of approval for quality nursing care (Houser, 2005). Since the magnet program has a set of 65 standards to uphold, this status is difficult to achieve and arguably harder to hold on to (Houser, 2005). This program reinforces the idea that healthcare today is fast paced, complex, accountable and riddled with obstacles. In order to ensure the best quality of care possible, collaboration and team building are crucial; in fact, when effectively executed collaboration and team building translate into better health care management. In addition to this, team building has proven to be effective in increasing workplace efficiency and productivity (Upenieks, 2002). Under closer examination, the three main focus areas of magnet status are administration, professional practice and professional development which when working together will assist in providing optimal patient care (Upenieks, 2002). Research findings also illustrate that collaborative environments within heath care lead to higher reports of both patient and staff satisfaction. This is certainly supported by the fact that nurses are pleased when there is a positive patient flow through the health care system and physicians are better able to perform their roles when supported by attentive, co-operative nursing partners (Upenieks, 2002). The magnet status and its association with interprofessional collaboration is one of the most important efforts to-date as it recognizes the centrality of providing a positive work environment within the health care system (Upenieks, 2002). Building on this, collaboration plays an important role in the health care system. Health Canada focuses on a project called Collaborative Patient-Centered Practice in 2003, which focuses on promoting active collaboration among health care professionals (Health Canada, 2004). This project was put in place to enhance the experiences of the patient and the family while optimizing staff participation in decision making process. Not only has this project shown an improvement in patient safety and communication among health care staff but is has improved patient and staff satisfaction (Health Canada, 2004).
While it is important to consider American initiatives, it is also critical to look closer to home and at the system in place in Canada. As such, the Canadian Nurses Association of Ontario asserts that health care professionals need to work together to be able to focus on the individual patient. The Association further recognizes that a collaborative health care team is better equipped to optimize patient health and well-being by actively engaging the individual within the promotion, prevention and management of their health issues. This is also evident with the College of Nurses of Ontario as it stresses the importance of collaboration between team members in order for the system to work (CNO, 2006) The College of Nurses of Ontario also maintains that nurses and all professionals need to practice within their scope of experiences/abilities and also contribute to the group by allowing others to draw from the strengths of the colleagues around them (CNO, 2006). In fact, it is apparent that not all health care providers have the same training, the same capacity for learning and analyzing situations, or the same instincts and reflexes. In short, all members of a medical team bring with them integral skills for patient care and only when working together can the full scope of patient needs be met. After looking at the five categories of entry-level registered nurse competencies and noting that communication and collaboration can be associated with all five areas, it is important to focus on the competency of service to the public. The service to the public competency states that the nurse is to provide protection to the public through collaboration with clients and other health care members. According to this competency the act of service to the public will in turn improve the overall health care service, which is in the best interest of the public (CNO, 2008). To maintain competency, nurses need to promote collaborative practice, build partnerships and recognize the value of interaction within a team. They also need to promote open communication by recognizing and analyzing changes that have been made to their practice as well as evaluating the effectiveness of these changes within their nursing practice (CNO, 2008). In order to address these objectives to service to the public competency, it is necessary to consider the three ways a nurse will be able to address this competency and apply it to their practice. Firstly, the competency objectives state that nurses demonstrate leadership within the health care system by maintaining professionalism, staying accountable for their own actions, coordinating with the team and also monitoring workload and performance within the health care team (CNO, 2008). Clearly, this leadership role reinforces the importance of interprofessional collaboration and its impact on each patient within the health care system. This is achieved by nurses establishing clear processes and structures that promotes the collaboration and teamwork by establishing conflict resolution strategies, effective evaluation of team performance and being accountable for and respectful to others (Registered Nurses Association of Ontario, 2006).
Secondly, the need to participate and contribute through team building, interactions and promoting collaborative practice was identified (CNO, 2008). As such, interprofessional collaboration is now one of the key factors in the transformation of the health care system and nurses are the largest group within the health care system (McCallin, 2005). To be able to effectively collaborate with other health care teams nurses need to move out of their comfort zones. This can be achieved via reflection on practice and professional inputs, challenging their assumptions and using critical thinking skills (McCallin, 2005). Afterwards, the nurse will be better able to recognize their full potential and appreciate the significant role they play. With the positive effects of this strategy apparent, nurses can develop the knowledge, values and behaviour needed to support teamwork and direct teamwork towards patient safety and patient outcomes (Registered Nurses Association of Ontario, 2006).
Thirdly, the service to the public competency states that nurses are to practice in the best interests of the public and to protect the public from harm’s way (CNO, 2008). In this case, it is the nurse’s responsibility to effectively communicate with the health care team, patient and visitors in order to provide patient centered care and to successfully establish interprofessional collaboration (CNO, 2008). For this nurses need to apply all five national competencies to their practice, develop a healthy work environment with mutual understanding and respect for others is evident and to advocate for patients when needed (Health Canada, 2004).
As the graduates of the nursing program prepare to enter the world of work and become true members of collaborative health care teams, it is imperative that they do so with a vested interest in working within the system and promoting positive change. New nurses must appreciate the established groundwork and recognize the strengths of those who served this vocation before them. In doing so, they will be introduced to teams who seek to develop the potential in the new nurse while appreciating the fresh eyes and modern skill set that they bring with them. As such, a new graduate will need to establish an understanding of their role, scope of practice and responsibilities in the work environment while developing effective conflict resolution and problem solving skills. As interprofessional collaboration is becoming a cornerstone of practice, new graduates and experienced nurses alike would benefit from reading the article entitled “Interprofessional practice: learning how to collaborate,” by Antoinette McCallin, 2006. This article facilitates a close examination and clear understanding of the development of interprofessional practice. It also looks at the impact collaboration has on the health care system, talks about the importance of dialogue and applies practice strategies that translate to individual nursing practice. Overall this article provides a wide range of educational information and is both insightful and inspiring.
In conclusion, communication and collaboration can have a truly positive impact on both the working environment and the health care system. Although health care professionals still struggle to understand the exact role of collaboration, collaboration is an essential part of client care. When used effectively, collaboration can optimize patient outcomes and improve the quality of care made possible within the health care system (McCallin, 2005). Thus, nurses must make involvement with other disciplines a priority. The dynamic between the nurse and doctor is an incredibly important one in patient care and when this relationship is optimized it is undoubtedly professional, positive and potentially life changing.
together with one or more members of the health care team who each make a unique contribution to achieving a common goal. Each individual contributes from within the limits of her/his scope of practice” (College of Nurses of Ontario, 2008, p 3.) Evidently, the dialogue that occurs between medical professionals and all those involved in patient care must be clear, productive and expressive of a vested interest in the patient. In short, patient care is larger than the individual and current healthcare provider as it must encompass the work, experience, observations and knowledge base of the many individuals who form the team of caregivers that work collectively to heal, sustain life and bring comfort. That being said, the collaborative relationship between physicians and nurses remains vital to the health care system as they link together to form a key partners in the care of the patient (McCallin, 2005). It is apparent that people who seek medical care do so with the belief that they will receive the best treatment available to them and that is comes from the best teams available. Considering that lives are on the line in these situations personality conflicts, communication barriers and unprofessional conduct are not acceptable; treatment must be fluid and reflective of genuine commitment to the patient. In fact, collaboration among health care professionals is an integral element of care and of the utmost importance in providing for patients in need (Taylor-Seehafer, 1998). To better understand the role of communication and collaboration one should look at an example of ineffective communication and interprofessional collaboration. Exploring the impact of miscommunication, blocked communication and lack of collaborative effort between physicians and nurses reveals the potential consequences a breakdown of collaboration and communication can have on patients, the nursing professional and health care system as a whole.
To begin, the interprofessional event that was experienced was between a physician, nurse and nursing student that worked together in an outpatient cancer clinic. This interprofessional event illustrated ineffective communication and collaboration within the team setting. Specifically, after the team disagreed on a treatment plan for a cancer patient there was a breakdown in communication and collaboration between the health care providers that had an obvious impact on the patient. As caner is a specialized area the oncologist is partnered with a primary nurse that has an extensive background in oncology nursing. The dynamic between these two individuals is imperative as they provide advanced care to outpatients in the cancer clinics. This situation began with a 67 year old female who underwent surgery for a stage three colon cancer diagnosis and was referred to the oncologist’s team for assessment for adjuvant chemotherapy. As in standard practice the patient was interviewed by the nurse and nursing student. During this interview it was evident that the patient was presenting with a form of mild cognitive impairment. When asked questions pertaining to health, daily lifestyle and support systems that patient showed signs of memory impairment and impaired functional abilities. When the patient was asked about having a form of cognitive impairment, the patient denied any impairment. As the patient attended the appointment alone, and no family members were available for consultation, the nursing staff felt that this matter required the attention of the oncologist. The nurse and nursing student felt that further investigation was important because the patient was not capable of consenting to treatment for chemotherapy or understanding the effects of treatment. After this information was presented to the oncologist, the doctor decided that this issue was a result of an elevated calcium level and that the patient was suitable for treatment. The nurses expressed their concerns for the patient’s safety and the professional basis that surrounded their decision. The oncologist, however, declined to listen. This hindered effective communication relative to the patient. It was clear that the team was not able to discuss the case or their difference in opinion and this created a communication barrier within the team.
In light of this event, it is necessary to look at the impact of both effective and ineffective communication on the health care team and on patients.
Research has shown that ineffective communication between physicians and nurses can result in missed or delayed diagnosis, unnecessary or repeated testing and over prescribing of medications (Espetin, 2010). It has also been shown that poor communication between team members can have a negative effect on patients in ways of psychosocial experiences. This occurs when patients are confronted with information depending on the nature and quality of information that is transmitted to them and can also affects the enactment and outcome of the decision making process regarding treatment opinions (Thorne, Bultz & Baile, 2005). As a result, patients are often dissatisfied with the amount of knowledge they receive from medical professionals and they, in turn, express that this is an area requiring improvement (Conn, Lingard, Reeves, Miller, Russell & Zwarenstein, 2010). As noted above, poor communication between team members often results in negative outcomes not only for the team itself but also for the patients. Because communication plays a vital role in effective collaboration, healthcare providers must address potential breakdowns so as to ensure productive dialogue and to create troubleshooting strategies. The College of Nurses of Ontario website states that communication is how nurses establish and maintain their therapeutic relationships by building trust, empathy and receptivity (CNO, 2006). This information is also applied to interprofessional collaboration. Effective communication strategies which strengthen nurse-patient relationships can also strengthen nurse – physician relationships. Since communication occurs both verbally and non-verbally, it is important to be aware of the many ways through which one communicates and to understand the fundamental role communication plays in patient care (CNO,
2006).
Furthermore, effective communication is necessary within the healthcare profession because it is essential for conflict resolution, problem solving, ethical dilemmas and improving the work environment while meeting the standards of practice (CNO, 2006). In addition, it has been found that effective teamwork between health care professionals is essential in providing high quality medical care to patients and that the absence of effective communication contributes to nursing burnout and high turnover (McCallin, 2005). All health care professionals, including nurses, want to know that their opinion is valued and will be reflected in planning for patient care (Epstein, 2010). It is certainly understandable that healthcare is yet another service that requires strong interpersonal skills in order to ensure optimal collaborative results (Conn, Lingard, Reeves, Miller, Russell & Zwarenstein, 2010). Optimal communication is characterized by accurately sharing of information with the team, indicating what the patient has been told and also looking at possible areas of concern (Epstein, 2010). While differences in opinions can lead to conflict, conflicts between nurses and doctors are difficult to navigate as physicians are often viewed as the authority for initiating treatment options for the patient (Skjørshammer, 2001). When conflict does arise between teams it is important that each member listen to what the other person has to say and seek out a resolution that involves clarification or finding a middle ground (Conn et al., 2010). The College of Nurses of Ontario set out standards that need to be followed within the nursing practice, as such, nursing focuses on every aspect of communication through verbal and non-verbal means. Therefore, nurses are held accountable in the community and must use communication to assist them in self-regulation to meet the standards of professional practice (CNO, 2006).
As effective communication is essential in interprofessional collaboration, it is also significance to address the importance’s of collaboration and other strategies that builds a successful health care system. With this said, collaboration involves the attempt to find a solution when both parties concerns are recognized and are seen as important (McCallin, 2005). This interactions between the team members helps to reach their full potential in decision making, clarifying of problems and also planning of care. Over the past three decades the collaboration between nurse-physician has matured (Taylor-Seehafer, 1998). What was once seen as a fight for turf and territory and collaboration with physicians been seen as a threat to the developing nursing role is now seen as essential and beneficial to the health care system (Taylor-Seehafer, 1998). Furthermore, the actions of a collaboration team, in this case a physician and a nurse can result in having a significant impact by producing a unhealthy work environment for the team members, but also has a neglect effect on the care of patients and can even potential cause harm to the patient (Larson, 1999). To have a successful collaborative team it is necessary to look at communication patterns within the team, while looking at conflict resolution, clinical interaction, the use of humor, negotiation and also the contributions of both parties (Taylor-Seehafer, 1998). Taylor-Seehafer maintains that if a team is unsuccessful at collaboration the blame can not be put on just one person. With this, it was stated that “nurses cannot point to the physician as the reason for the failure of collaboration without also pointing to themselves” (Taylor-Seehafer, 1998, p 389 para 1). This is an important understanding as all healthcare workers must fully consider their role in the disruption or breakdown of communication and not simply blame those around them. With this in mind, nurses must be able to develop the collaborative skills they need to examine their own, beliefs, values and the behaviours they bring to the relationship (Larson, 1999).
While there are teams that work effectively in a co-operative and collaborative setting by sharing information and having transparent decision making, the focus now needs to be on the health care system and the effect that successful collaboration plays (McCallin, 2005). As such, interprofessional practice has been show to benefit the patients and their families directly when a team focuses on clear and open communication. It also allows for the building of trust and respect, the sharing of knowledge/skills and also the development of an integrated plan of care which puts the safety of the patient first (McGill Interprofessional Initiative, 2009). To reinforce the importance of this practice and its corresponding potential for improved patient care, one must keep in mind that the health care system has standards of practice for every discipline. According to reports focused on the United States, the health care system challenges hospitals to achieve what they refer to as “magnet status” which is also known as the seal of approval for quality nursing care (Houser, 2005). Since the magnet program has a set of 65 standards to uphold, this status is difficult to achieve and arguably harder to hold on to (Houser, 2005). This program reinforces the idea that healthcare today is fast paced, complex, accountable and riddled with obstacles. In order to ensure the best quality of care possible, collaboration and team building are crucial; in fact, when effectively executed collaboration and team building translate into better health care management. In addition to this, team building has proven to be effective in increasing workplace efficiency and productivity (Upenieks, 2002). Under closer examination, the three main focus areas of magnet status are administration, professional practice and professional development which when working together will assist in providing optimal patient care (Upenieks, 2002). Research findings also illustrate that collaborative environments within heath care lead to higher reports of both patient and staff satisfaction. This is certainly supported by the fact that nurses are pleased when there is a positive patient flow through the health care system and physicians are better able to perform their roles when supported by attentive, co-operative nursing partners (Upenieks, 2002). The magnet status and its association with interprofessional collaboration is one of the most important efforts to-date as it recognizes the centrality of providing a positive work environment within the health care system (Upenieks, 2002). Building on this, collaboration plays an important role in the health care system. Health Canada focuses on a project called Collaborative Patient-Centered Practice in 2003, which focuses on promoting active collaboration among health care professionals (Health Canada, 2004). This project was put in place to enhance the experiences of the patient and the family while optimizing staff participation in decision making process. Not only has this project shown an improvement in patient safety and communication among health care staff but is has improved patient and staff satisfaction (Health Canada, 2004).
While it is important to consider American initiatives, it is also critical to look closer to home and at the system in place in Canada. As such, the Canadian Nurses Association of Ontario asserts that health care professionals need to work together to be able to focus on the individual patient. The Association further recognizes that a collaborative health care team is better equipped to optimize patient health and well-being by actively engaging the individual within the promotion, prevention and management of their health issues. This is also evident with the College of Nurses of Ontario as it stresses the importance of collaboration between team members in order for the system to work (CNO, 2006) The College of Nurses of Ontario also maintains that nurses and all professionals need to practice within their scope of experiences/abilities and also contribute to the group by allowing others to draw from the strengths of the colleagues around them (CNO, 2006). In fact, it is apparent that not all health care providers have the same training, the same capacity for learning and analyzing situations, or the same instincts and reflexes. In short, all members of a medical team bring with them integral skills for patient care and only when working together can the full scope of patient needs be met. After looking at the five categories of entry-level registered nurse competencies and noting that communication and collaboration can be associated with all five areas, it is important to focus on the competency of service to the public. The service to the public competency states that the nurse is to provide protection to the public through collaboration with clients and other health care members. According to this competency the act of service to the public will in turn improve the overall health care service, which is in the best interest of the public (CNO, 2008). To maintain competency, nurses need to promote collaborative practice, build partnerships and recognize the value of interaction within a team. They also need to promote open communication by recognizing and analyzing changes that have been made to their practice as well as evaluating the effectiveness of these changes within their nursing practice (CNO, 2008). In order to address these objectives to service to the public competency, it is necessary to consider the three ways a nurse will be able to address this competency and apply it to their practice. Firstly, the competency objectives state that nurses demonstrate leadership within the health care system by maintaining professionalism, staying accountable for their own actions, coordinating with the team and also monitoring workload and performance within the health care team (CNO, 2008). Clearly, this leadership role reinforces the importance of interprofessional collaboration and its impact on each patient within the health care system. This is achieved by nurses establishing clear processes and structures that promotes the collaboration and teamwork by establishing conflict resolution strategies, effective evaluation of team performance and being accountable for and respectful to others (Registered Nurses Association of Ontario, 2006).
Secondly, the need to participate and contribute through team building, interactions and promoting collaborative practice was identified (CNO, 2008). As such, interprofessional collaboration is now one of the key factors in the transformation of the health care system and nurses are the largest group within the health care system (McCallin, 2005). To be able to effectively collaborate with other health care teams nurses need to move out of their comfort zones. This can be achieved via reflection on practice and professional inputs, challenging their assumptions and using critical thinking skills (McCallin, 2005). Afterwards, the nurse will be better able to recognize their full potential and appreciate the significant role they play. With the positive effects of this strategy apparent, nurses can develop the knowledge, values and behaviour needed to support teamwork and direct teamwork towards patient safety and patient outcomes (Registered Nurses Association of Ontario, 2006).
Thirdly, the service to the public competency states that nurses are to practice in the best interests of the public and to protect the public from harm’s way (CNO, 2008). In this case, it is the nurse’s responsibility to effectively communicate with the health care team, patient and visitors in order to provide patient centered care and to successfully establish interprofessional collaboration (CNO, 2008). For this nurses need to apply all five national competencies to their practice, develop a healthy work environment with mutual understanding and respect for others is evident and to advocate for patients when needed (Health Canada, 2004).
As the graduates of the nursing program prepare to enter the world of work and become true members of collaborative health care teams, it is imperative that they do so with a vested interest in working within the system and promoting positive change. New nurses must appreciate the established groundwork and recognize the strengths of those who served this vocation before them. In doing so, they will be introduced to teams who seek to develop the potential in the new nurse while appreciating the fresh eyes and modern skill set that they bring with them. As such, a new graduate will need to establish an understanding of their role, scope of practice and responsibilities in the work environment while developing effective conflict resolution and problem solving skills. As interprofessional collaboration is becoming a cornerstone of practice, new graduates and experienced nurses alike would benefit from reading the article entitled “Interprofessional practice: learning how to collaborate,” by Antoinette McCallin, 2006. This article facilitates a close examination and clear understanding of the development of interprofessional practice. It also looks at the impact collaboration has on the health care system, talks about the importance of dialogue and applies practice strategies that translate to individual nursing practice. Overall this article provides a wide range of educational information and is both insightful and inspiring.
In conclusion, communication and collaboration can have a truly positive impact on both the working environment and the health care system. Although health care professionals still struggle to understand the exact role of collaboration, collaboration is an essential part of client care. When used effectively, collaboration can optimize patient outcomes and improve the quality of care made possible within the health care system (McCallin, 2005). Thus, nurses must make involvement with other disciplines a priority. The dynamic between the nurse and doctor is an incredibly important one in patient care and when this relationship is optimized it is undoubtedly professional, positive and potentially life changing.