Six Ways to Improve Collaboration on Nursing Teams
Is your unit made up of soloists who’d rather not join the choir? Not only is that lack of collaboration frustrating, it can negatively impact everyone involved — including the patients and families who are counting on you all to work as a team.
Effective collaboration isn’t a luxury. In fact, collaboration is one of the basic nursing responsibilities outlined by California’s Nursing Practice Act. Strong coordinated efforts — including interdisciplinary relationships — are also part of the American Nurses Credentialing Center’s “exemplary practice” requirement for organizations seeking Magnet status.
The bottom line is that collaborating effectively with other nurses, doctors and allied healthcare staff is one of your professional and legal responsibilities as a nurse. Regardless of your feelings towards that difficult doctor, you still have to share notes to ensure the best quality of care for your patients. Studies show that effective nurse-physician communication improves survival rates in the ICU while dysfunctional communication can cause medication errors, patient injuries or even patient deaths.
WHY COLLABORATION IS OFTEN INEFFECTIVE
Too often, effective teamwork exists more in theory than in practice. Why? Unfortunately, there are more barriers to effective collaboration in healthcare than you can shake a stick at.
In their chapter on professional communication and team collaboration in the Agency for Healthcare Research and Quality’s 2008 manual, Patient Safety and Quality: An Evidence-Based Handbook for Nurses, Michelle O’Daniel, MHA, MSG, and Alan H. Rosenstein, M.D., MBA, offer the following list of common obstacles to collaboration between members of the healthcare team:
❉ Personal values and expectations
❉ Personality differences
❉ Disruptive behavior
❉ Culture and ethnicity
❉ Generational differences
❉ Historical interprofessional and intraprofessional rivalries
❉ Differences in language and jargon
❉ Differences in schedules and professional routines
❉ Varying levels of preparation, qualifications and status
❉ Differences in requirements, regulations and norms of professional education
❉ Fears of diluted professional identity
❉ Differences in accountability, payment and rewards
❉ Concerns regarding clinical responsibility
❉ Complexity of care
❉ Emphasis on rapid decision-making.
Reading through this list of common barriers, you’ve probably found yourself nodding in recognition and possibly even wondering how with all these obstacles there can be any quality patient care at all.
There will always be impediments to communication and collaboration. However, that doesn’t mean there aren’t tried and true ways to overcome those barriers. Here are six strategies to help you do it:
1. Look in the mirror.
Effective collaboration with the other members of your team starts with you, which makes self-awareness your first step. After all, if you don’t understand what makes you tick, you can’t expect your colleagues to figure it out. Take another look at the list above and ask yourself honestly which of those points make you tense. Do you bristle when dealing with people who went to a better (or worse) school than you did? Are you self-conscious about the way you speak or your experience and credentials?
If you’re new to this kind of self-analysis, ask a trusted friend to help you. Being aware of your own triggers and hot buttons will help you develop techniques for dealing with them before you reach the point of throwing down your stethoscope and stalking out the door.
2. Create a safe space to share information.
No one likes being yelled at, dismissed or ridiculed for offering an opinion or asking a question. If those reactions are part of your organizational culture, they will shame people into silence, which is an enormous barrier to good teamwork. Mutually beneficial relationships depend on the sharing of information, which makes it vital that team members listen to one another and reinforce the value of each other’s input.
This is an area where rookies often fare better than more seasoned team members. If you’re new, it’s easier to embrace the idea that no question is silly, but for veterans, it can take real courage to admit you don’t know something or risk offering an opinion that others may reject.
Practice listening and responding constructively to the other people on your team even when you disagree or when they ask a question whose answer seems obvious to you. Doing that will help create an environment where team members — including you — don’t have to suffer in silence for not having all the answers.
3. Handle conflict with care.
There’s no healthcare environment on Earth that’s free of conflict, which is why it’s important to manage it well. In fact, some experts point to poor conflict management as the single most critical obstacle to effective collaboration.
Trying to avoid conflict entirely isn’t the answer. Sometimes, being willing to fight is part of your responsibility as a patient advocate. In some circumstances, avoiding an argument can cause real harm. However, handling conflicts professionally will ultimately help everyone, especially the patients under your care.
4. Belong to the right team.
The best care is provided by truly interdisciplinary teams in which professionals from different areas meld their diverse knowledge and experience to achieve a common goal. Sadly, too many supposedly interdisciplinary teams are really multidisciplinary. They are collections of professionals so focused on their own precious areas of practice that the idea of listening to or involving anyone else in a meaningful way just isn’t in the cards.
Remember that a group of people each working in their own little silo is not a team, and it takes a team to create the best possible care plan for each patient.
5. Communicate effectively.
There are several facets to this one. Communications between nurses is comparatively easy because nurses usually understand each other pretty well. The important points there include clarity, honesty, compassion, and respectfully resolving grievances rather than letting them ferment into grudges.
Communicating with professionals in other disciplines, particularly physicians, can present more of a challenge. (We’ve all experienced the good, the bad and the ugly in that area!) One of the keys to communicating with doctors and other types of healthcare professionals is recognizing the distinct ways each discipline approaches patient care.
A paper by Joan Liaschenko and Anastasia Fisher, published in the Spring 1999 issue of Scholarly Inquiry for Nursing Practice, theorizes that healthcare providers operate based on three different types of knowledge: case knowledge, which involves general, objective details like the characteristics of diseases; patient knowledge, which considers the patient within a healthcare context, such as test results and response to treatments; and “person knowledge,” which considers the patient as an individual.
Although nurses usually integrate all three of these areas, physicians tend to rely primarily on case knowledge. That’s an important consideration that may explain why the doctor rejects your insistence that something is wrong until there’s evidence to prove it. The secret is understanding what type of knowledge each discipline most relies on and framing what you say in that context. By speaking their language, you’ll make it easier for them to hear what you’re saying and vice versa.
6. Be a leader.
Real leaders don’t need a leadership title. If you’re a nurse, you’re a leader — period. You’re the hub of all things related to patient care, providing expertise, guidance and support in a hundred different ways each time you snap on your badge. There are more people counting on you than you may realize and your patients are just a few. Be a role model for those around you by asking for help when you need it, circling the wagons to solve an issue and being generous with your praise.
No one will deny that effective collaboration can be hard work. We have to be persistent, clear, flexible and at times humble. Nurses cannot avoid collaboration; it is an essential part of our commitment to providing patients with the best quality of care. Soloists have no place in healthcare, so swallow your pride, reach out your hand to your teammates and help everyone take a seat in the choir.
Sidebar: Checklist for Successful Teamwork
How well does your unit or team collaborate? The Agency for Healthcare Research and Quality’s 2008 manual, Patient Safety and Quality: An Evidence-Based Handbook for Nurses, offers the following key features of effective teams:
◗ Open communication
◗ Nonpunitive environment
◗ Clear direction
◗ Clear and known roles and tasks for team members
◗ Respectful atmosphere
◗ Shared responsibility for team success
◗ Appropriate balance of member participation for the task at hand
◗ Acknowledgement and processing of conflict
◗ Clear specifications regarding authority and accountability
◗ Clear and known decision-making procedures
◗ Regular and routine communication and information sharing
◗ Enabling environment, including access to needed resources
◗ Mechanism to evaluate outcomes and adjust accordingly.
Sue Montgomery, RN, BSN, CHPN, is a critical care and hospice nurse who writes on healthcare issues. She is a member of the Hospice and Palliative Nurses Association and the American Medical Writers Association.
This article is from workingnurse.com.