Intraprofessional collaboration is the new teamwork

The term collaboration is used everywhere. Across Canada, governments are transforming health care organizations, and these changes are requiring us to work collaboratively with new teams and organizations. Within organizations, increasing patient complexity, resource constraints, and human resource shortages are driving discussions about new ways of working that leverage the contributions of all nurses in achieving safe, high-quality care.

We’ve reached a point where interprofessional collaboration is no longer an option but essential to the future of nursing in Canada.

Extensive research shows the positive impacts of collaboration and teamwork on patient, staff and organizational outcomes. A 2018 study by Grubaugh and Flynn¹ states that willingness to assist team members, known as team backup, has been identified as a core indicator of effective teamwork and is associated with reductions of adverse events. The study also notes that threats to teamwork occur when the conflict in the workplace is ineffectively managed. These findings support the importance of the nurse leader’s ability to manage conflicts and highlight the importance of conflict management as a leadership competency. In a 2015 study, Ma et al.2 found that nurses reported lower intent to leave, higher job satisfaction, and better quality of care in units with better collaboration and stronger nursing leadership. They concluded that creating a caring environment with strong collaboration among care providers and nursing leadership can help hospitals maintain a competitive nursing workforce supporting a high quality of care.

The Institute for Health Care Improvement (IHI) identifies camaraderie and teamwork as a component of achieving Joy in Work.³ For staff to be engaged, they must feel that they are a part of a team, working together towards something meaningful. They must have people at workthey can turn to for advice who care about them. They must work in teams where appreciation for each other’s work is regularly expressed.

While there are many examples of exemplary collaboration or teamwork in nursing, it is inconsistent, and communication issues continue to be the root cause of many patient safety incidents. Public expectations, new technologies, new staff types, rapid patient turnover and human resource shortages all create stress, which paradoxically limits our ability to collaborate when we need it most.

Dougherty and Larson⁴ describe the collaboration between nurses as “an interpersonal relationship between and among colleagues defined by the commonality of a goal recognized by each party, shared authority, power, and decision making, based on knowledge and expertise.” D’Amour and Oandasan5 identify that knowledge, skill and attitude are essential competencies in interprofessional collaboration. These competencies are equally relevant to interprofessional (nurse to nurse) collaboration.

Knowledge

 In order to collaborate, we must understand our own and other’s roles — we cannot work effectively with others without role clarity. This is especially relevant to Ontario nurses with our overlapping scopes of practice. Although the legislation governing the scope of practice has been in place for many years, a WeRPN report⁶ identified that many misconceptions exist with respect to RPN scope of practice, contributing to role confusion, conflict and inappropriate utilization. These misconceptions continue to be evident in many practice settings today.

Skill

To work collaboratively, we must be able to communicate, negotiate and manage different perspectives. We need to be able to establish and maintain trusting relationships with a diverse group of colleagues. We must be able to interpret the scope of practice and provide feedback when it impacts staffing decisions. Yet giving feedback is not easy. Authors Douglas Stone and Sheila Heen⁷ say that when they ask people to name their most challenging conversations, feedback always comes up. They state that “When we give feedback, we notice that the receiver isn’t good at receiving it. And when we receive feedback, we notice that the giver isn’t good at giving it.”

Attitudes

Neither knowledge nor skill is sufficient. Real intra-professional collaboration requires us to move beyond turf wars, generational differences, and ‘us versus them’ attitudes to the belief that there is more than enough work for all of us and that each role and individual brings value to the practice setting. Appreciation and respect are not finite goods, to be doled out only occasionally for fear of having less for ourselves. We are truly stronger together!

Knowledge, skill, and attitude are critical precursors to collaboration but must be combined with action. Here are some practical strategies to foster interprofessional collaboration within nursing:

For Individuals

• Be a role model and demonstrate through your actions that you value collaboration. Offer to help your colleagues when you can — even those who do not routinely assist you. Do your part to demonstrate interprofessional collaboration to nursing students so that they, in turn, recognize its value in the practice setting.
• As human beings, we tend to support those we know and like — so take time to develop relationships with your colleagues. Attend huddles and staff meetings. Volunteer for working groups and committees where you can work with others you may not interact with regularly. Attend work-related social gatherings.
• Practice giving and receiving feedback with a trusted colleague. Your goal should always be to try and ensure your message is heard and gets across positively and constructively.

For Leaders

• Support all nurses to work to their full scope of practice. Review job descriptions and policies to ensure that they are current and reflect regulatory standards and expectations. Ask for input from staff.
• Incorporate scope of practice discussions and role clarity into recruitment practices, role expectations, orientation, assignment decisions, and performance discussions.
• Make space at huddles and staff meetings for meaningful discussions and stories that involve teamwork. Did the charge nurse do a great job in realigning assignments yesterday? Did a nurse go out of his way to support a colleague? Acknowledge them!
• Incorporate programs and approaches that provide teams with opportunities to collaborate and communicate. Examples include leadership development, patient safety, and performance improvement programs. The TeamSTEPPS (Team Strategies and Tools to Enhance Performance and Patient Safety) program has been identified as a standard for team training in healthcare.⁸

We’ve reached a point where interprofessional collaboration is no longer an option but essential to the future of nursing in Canada. It is a key requirement for safe, high-quality care and healthy work environments. Let’s commit to making 2020 ‘The Year of the Nurse,’ our year to do better. Our patients, our colleagues, and our organizations require it.