Every sector in every workplace benefits from the essentials of collaborative efforts. There is no more important an area than healthcare where the need for collaboration of those involved in the day-to-day care of patients is evident. Collaborative efforts are necessary to achieve the best patient outcomes-Without collaboration, chaos occurs. Caring for patients, finding solutions to the problems of disease, and achieving outcomes that surpass the past cannot happen in isolation.
The concept of collaboration in healthcare is not a new concept. Luther Christman (personal communication, 1975) spoke about the need for physician-nurse collaboration in the early 1970s. In those days, the idea stemmed from the concept that nurses of the future would have the knowledge and abilities to meaningfully participate as true partners in the management of patient care issues, decisions, and direction. In addition, nurses would be recognized for what they contribute to patient care. Today is that future that Dr. Christman spoke about, and nurses today do have these abilities.
Physician-nurse collaboration began quietly at Rush Presbyterian-St. Lukes Medical Center in 1975. The concept of a physician and nurse working collaboratively to care for a specific population of patients emerged (Elpern, Rodts, DeWald, & West, 1983). Collaborative teams developed with the basic premises that each member of the team possessed different skills but had the same philosophical goals on patient care. Combining skills and defining roles allowed for a comprehensive approach to care of a specific group of patients. The initial development of these teams occurred in orthopedic surgery, pulmonary medicine, and oncology. The success of collaborative teams was validated and was supported by hospital administration.
Three decades later, physician-nurse collaboration is not seen as unusual but rather the norm. Collaborative teams work in every locale, practice setting. and specialty. The way the team functions is defined by the participants on the basis of the needs of the population that are being cared for. Lack of communication and collaboration has been cited as a reason for poor patient outcomes. Programs have been put in place to enhance physician-nurse collaboration to ensure better outcomes for patients (McCaffrey et al., 2010).
Collaboration does not end with the physician- nurse relationship. Even more important is the nurse-nurse collaborative relationship that must flourish to ensure comprehensive, quality patient care. Alspach (2008) reported that 53% of critical care nurses reported withholding support for peers. It is necessary to take the initiative to develop an atmosphere where collegial and collaborative activities are allowed to and must exist. Removing barriers to developing a collaborative atmosphere is essential. Barriers include
* lack of clear role definition or acceptance of role definition;
* concern about losing perceived power based on knowledge sharing;
* lack of commitment by nurse participants to develop a collaborative relationship;
* inadequate interpersonal skills by team members; and
* limited administrative support for the development of collaborative teams.
Identifying barriers that are present and methods to overcome them is essential to the development of a collaborative team and environment. If barriers cannot be overcome or modified, reorganization of the team or changes to the environment should be considered.
Nurse-nurse collaboration has recently begun to be studied in an effort to determine the role of lack of collaboration in patient outcomes (Dougherty & Larson, 2010). This will be important information to validate the need to develop the environment that supports collaborative nurse relationships and the identification of nurses who would benefit from education on the skills necessary to be successful in this environment.
The art of collaboration is essential in ensuring that every nurse has the information, environment, and support to successfully manage day-to-day patient issues. Building this type of practice relationship and setting will only help us achieve our goals of providing the excellent patient care we strive to give.
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