Given the complex intersection of social determinants of health, the rapid pace of technological advancement, and ongoing changes in reimbursement, the Institute of Medicine1 has called nurses to be full partners with physicians and other healthcare professionals in redesigning healthcare in the United States. Nurse administrators therefore must learn to practice as interprofessional partners.
Historically, healthcare professions were rigidly ranked with more influence attributed to physicians than nurses. Not only did this domination narrative limit collaboration and thwart innovation; it also ignored the important contributions of patients and families. In addition to rigid ranking, the old paradigm taught that communication flows top-down and power remains at the top. According to the principles of domination, good leaders effectively use power over others to maximize efficiency. In addition, domination organizations can be recognized by cultures of shame, blame, and fear.2
Employees in domination-based healthcare systems:
* fear being shamed so they may skip steps or cut corners in procedures to be able to finish work on time;
* worry about being blamed so they may not tell management if a policy, procedure, or product is flawed;
* may not call to report changes in a patient's status until the changes become urgent because of fear of being bullied;
* do not participate in innovation or creative problem solving;
* treat one another with disrespect, lateral violence, and incivility;
* feel disengaged and may have more ill calls; and
* may treat their patients with decreased caring and attention.
Partnership
Partnership promotes interprofessional practice and has a positive impact on the experience of patients and employees. Organizations based on partnership value and respect the unique knowledge and skills of every member of the organization. Communication is encouraged and flows both ways. Ideas and suggestions for quality improvement are sought from all employees, and emphasis is placed on nurturing a just culture rather than blaming and shaming. Nurse administrators in partnership-based healthcare use "power with" instead of "power over," which promotes confidence and fosters innovation.3
In partnership-based healthcare systems, employees:
* know that quality is valued and feel supported to give their best;
* feel safe communicating opinions and observations to the management;
* know that their observations are respected and early detection of status changes is valued;
* have energy to innovate solutions and create process improvements for quality and safety;
* are eager to come to work and be part of a team;
* treat their patients with respect, inviting them to be full partners in their own care;
* treat each other with respect and value one another's unique contributions to healthcare; and
* resolve conflict in a healthy way that encourages dialog and ongoing relationships.
Principles of partnership also promote a highly effective "c-suite." In organizations that orient toward partnership, roles and responsibilities are respectfully negotiated among leaders of different professions and opinions and observations are shared without judgment. If a disagreement arises, the various parties commit to civil conversation and respectful behavior to resolve the issue. If a collaborative meeting requires leadership, selection of the leader is based on a decision by the team rather than an assumed professional hierarchy. Overall, there is a sense of trust, respect, and a deep commitment to being allies for quality and cost-effective patient care.
Educating Nursing Leaders to be Partners
Nurse administrators should be educated to participate in full partnership with other nurses, with other professions, with patients and families, and with the community they serve. They should also be taught how to lead interprofessional councils and patient advisory panels.
Partnership Curriculum
An attitude of partnership begins with each individual nurse. Topics such as emotional intelligence and self-care equip nursing leaders to practice as partners. Nursing administration students also need to have well-formulated professional identity and a high level of role clarity before they can effectively partner with others.
The culture of the healthcare system in the United States tends to orient toward domination. For instance, look at the vocabulary: medical orders, noncompliant, and war on cancer. We do not recognize domination because it is the only system we have ever known. This is particularly true if an individual's family of origin or his/her professional education oriented toward domination. Nursing administration curriculum therefore needs to clearly describe domination attitudes and behaviors. If leaders cannot recognize domination attitudes and behaviors in their employees, they will never be able to change the culture of their organization. Similarly, if they cannot describe partnership, they will not be able to role model behaviors essential for interprofessional practice. "Where does your organization fall on the partnership/domination continuum?" Content in the Document, Supplemental Digital Content 1, http://links.lww.com/JONA/A591, can be used to assess the culture of a unit or an organization.4
Two additional resources to guide curriculum development and prepare leaders for interprofessional partnerships are TeamSTEPPS5 and Core Competencies for Interprofessional Collaborative Practice.6
Partnership Practice
Ideally, all nurse administrator education will include clinical practice in organizations that value interprofessional partnerships and afford students opportunities to observe interprofessional practice councils or interprofessional rounding. Nursing faculty can partner with faculty from other professional schools to co-create assignments that require interprofessional student collaboration. For example, case competitions give students an opportunity to work on interprofessional teams to solve complex problems, and simulation can provide a safe way for students to practice interprofessional collaboration during emergent situations.
The current complexities of healthcare require nurses to practice competently in interprofessional partnerships. Nurse administrators and executives play a key role in leading culture change so the benefits of full partnership are possible.
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