Healthcare is multi-faceted. We all know that. Different stakeholders or team members have different roles and responsibilities. Doctors or providers, for the most part, lead a multi-disciplinary team in addressing a patient’s or a client’s health concern. However, they cannot treat a patient all on their own. They do need the cooperation and the participation of other healthcare colleagues: nurses, therapists, social workers, and even housekeepers, to name a few, in order to adequately address the holistic needs of a patient. This is where collaboration comes in.

Before we define collaboration, here are the links to the podcast:

Anchor: https://anchor.fm/mary-grace-reyes9

Spotify: https://open.spotify.com/episode/6OaRSG75K95XMBP8cCf2F6?si=94a6496c2952490b

O’Daniel and Rosenstein cited collaboration in healthcare as

health care professionals assuming complementary roles.  They work together cooperatively, sharing responsibility for problem-solving and making decisions to formulate and carry out plans for patient care.

They continued that

collaboration increases the team members’ awareness of each others’ knowledge and skills. That awareness leads to a more cohesive decision making and the continuous monitoring if improvement or adjustment in care is warranted.

Since we have already established the importance of collaboration, let us now assess how it is being practiced in different healthcare settings.

Having Mutual Respect

For foreign-educated nurses like me, it was strange to know that we don’t address our leaders (e.g. unit managers, shift supervisors, etc.) reverently. By that I meant, I was in shock initially upon finding out that we don’t call them Ma’am or Sir. Rather, we just call each other by first names, as if there are no subordinates and superiors. Personally speaking, it took a while for me to get used to that because it seemed like it is overfamiliarity.

With that being said, imagine my surprise when I found out that we also call our residents by their first names as well. In my old life, this was unheard of. I could have gotten a stare-down from an intern in the Philippines if I forget to call him or her with the ever-important Doctor! They earn that, I get it. That is why Filipino and Filipina nurses are very cautious when addressing superiors because of experiences such as this.

Nevertheless, acclimating means adapting to the culture of our adoptive country. And for the record, I do like it, very much, in fact! Not the part where we call each other by first names. Rather, I feel that nurses here are more respected that back home. How? Three of the ways are listed below.

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It Takes Two

Purposeful rounding is an essential part of front-line patient care. We round while receiving reports from the outgoing staff. We also do hourly rounding to make sure that we address our respective patients’ needs, particularly the five Ps (pain, potty, position, possessions, and pumps). Purposeful hourly rounding allows us to cluster our care and anticipate or adequately address our patient’s needs. This also lessens their need to push the call light seeking assistance from the healthcare team. This kind of rounding is usually done by nurses and nursing assistants or patient care techs.

Another equally important kind of rounding is called It Takes Two. This may be uniquely called that in our organization, but this is being practiced across healthcare systems. In a nutshell, this is an interprofessional rounding, particularly partnering a nurse with a provider: intern, resident, attending, or advanced practice nurses.

It is a little bit similar to multidisciplinary care conferences, to some extent. However, It Takes Two is basically having those two perspectives coming together in assessing a particular patient’s progress while rounding at least once a shift. Once out of the room, they compare notes and those discussions pave the way for a more comprehensive plan of care. This initiative resulted in faster recovery and consequently a shorter length of stay. Moreover, a quality improvement project conducted at the Mayo Clinic concluded that this also improved physician-nurse teamwork.

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Walking a Day in a Nurse’s Shoes

A new program that our organization is piloting is requiring new providers, especially first-year residents, to shadow a nurse. This is designed to promote understanding of what the nurses’ responsibilities include as well as how they are able to prioritize their tasks in the midst of their busyness. This awareness promotes consideration and understanding on the part of the providers whenever a nurse is not able to immediately address their orders if it gets to that.

This also presents an opportunity for the incoming new providers to learn from nurses, most of whom may have been working in the units for a good number of years. Nurses, especially the seasoned ones, teach providers some practical clinical wisdom, particularly with the setting’s culture. In turn, this initiative affirms the nurses’ value as professionals fulfilling both their independent and dependent nursing functions.

Mutually understanding each other’s interdependent responsibilities fosters stronger and more resilient collaboration among providers and nurses.

Shared Governance

Shared Governance (SG) is an emerging concept in healthcare. It is primarily designed to enhance the work environments of nurses. This in turn is expected to increase satisfaction and retention.

While SG is primarily a nurse-led initiative, it has evolved into becoming multi-disciplinary in the hope that collaboration and teamwork among stakeholders will further improve patient outcomes. In a nutshell, SG differs from the conventional decision-making that has historically been made from the top down. SG enjoins committee members to be active participants who take ownership of their own practice. For example, committees identify opportunities for improvement that can help promote patient safety and improve healthcare outcomes.

Having representation from different healthcare disciplines helps each of them understand how the workflow of one team affects that of the others, and so on. Collectively looking at the whole picture, it is easier to advocate for change from the front-liners perspectives. It basically means that collaboration in this way benefits both the patients and the healthcare workers themselves.

The End Goal

It is clear to see that the goal of collaboration amongst healthcare team members is to promote patient safety and improve outcomes. Changes are carried out using models such as the plan-do-study-act tool. As learners for life, it is important for us to continue to advance the practice of nursing specifically, and of healthcare, generally. We cannot do it alone as a profession. Rather, we need cohesive collaboration from our peers and colleagues.