Nursing News

Collaboration Needed Among All Levels of Nursing

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By Debra Wood, RN, contributor 

May 17, 2012 - When one thinks about improving teamwork in the health care setting, the focus often is on nurse-physician relationships. But professionals cannot stop there. Effective work environments also require clinical nurse-nurse manager collaboration and communication.

Nursing Collaboration
Cole Edmonson, DNP, RN, FACHE, NEA-BC, said the relationship of the direct care nurse and his or her immediate manager is a true determinate of nurse engagement and longevity in an organization.

“The relationship [of the direct care nurses and their immediate managers] represents a coming together of the two domains of clinical and leadership, with the greatest opportunity to impact the care of patients on the units, the development of the nurse’s career and the success of the overall organization,” said Cole Edmonson, DNP, RN, FACHE, NEA-BC, vice president of patient care services and chief nursing officer at Texas Health Presbyterian Hospital Dallas. “Poor relationships between these two roles can endanger patients, cause poor performance of a unit, and can destabilize the patient-care system by increasing turnover and vacancy rates.”

Clinical nurses and nurse managers share a goal of delivering high-quality patient care. A highly effective practice environment with professionals working together helps make that a reality.

“It is very important for nurse managers to have a good working relationship with staff members as it promotes better patient experiences and outcomes due to a synergistic working environment,” added Lisa Roberts, BSN, RN, CCRN, NE-BC, nurse manager of the surgical intensive care unit at Texas Health Dallas.

Nursing Collaboration
Lisa Roberts, BSN, RN, CCRN, NE-BC, said the manager that has good working relationships with clinical nurses also retains high performing nurses that positively affect patient care and outcomes.

Roberts explained that the “role and responsibilities of both clinical nurse and nurse manager are constantly changing in today’s health care environment, and both roles have hands-on and administrative qualities, in large part due to the introduction of the EHR (electronic health record), increased standards of care for CMS (Centers for Medicare and Medicaid Services), and the growth of the profession of nursing.”

A synergistic work environment also allows the clinical nurse and manager to work effectively together on process improvement projects that affect patients and their care, Roberts added.

Bonita L. Longo, MS, RN, a consultant with Pearson’s Readypoint Nursing in Upper Saddle River, N.J., added that nurse managers serve as the liaison between staff and administration--passing along policy changes, institutional goals/benchmarks/concerns, etc., and the nurse manager communicates the concerns/issues of nursing staff back to administration.

“The nurse manager improves client care through the above activities,” Longo said. “The nurse manager also promotes cooperation among staff and supports a positive working environment.”

But that does not always happen.

The American Nurses Association and American Organization of Nurse Executives recognized the need to boost collaboration and convened a group of nurses and nurse managers to draft “ANA/AONE Principles for Collaborative Relationships between Clinical Nurses and Nurse Managers.” They divided the principles into three main themes: effective communication, authentic relationships, and learning environment and culture.

Julia Weinberg, RN, of Bow, Wash., president of the Washington State Nurses Association, a clinical staff nurse and a member of the workgroup that developed the principles, said “much misunderstanding and mistrust by clinical nurses toward nurse managers happens because communication either does not happen at all, or these same clinical nurses only get the information as it relates to ‘what clinical nurses need to know for the job’ or not.”

The principles shed serious light on the importance of communication and of sharing information with all staff, not just those at leadership level, Weinberg added.

Key concepts include “foster an open, safe environment,” “empower others to have ideas,” and “inspire innovation and creative thinking.” The principles serve as a guide to enhancing good collaboration where it occurs and improving situations where it is suboptimal.

Weinberg encourages nurses to use the principles document as a tool to start conversations with their managers and to assess how well they are listening to each other and if they could be doing more to ensure patients feel cared for and safe.

“Patients can sense when teamwork is happening or not happening,” Weinberg said. “These same patients can also sense if the care of the team is happening or not happening.”



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