The nurse mangers role in creating a collaborative work environment
The nurse manager is vital in creating an environment where nurse-physician collaboration can occur and is the expected norm. It is she, who clarifies the vision of collaboration, sets an example of and practices as a role model for collaboration. The nurse manager also supports and makes necessary changes in the environment to bring together all the elements that are necessary to facilitating effective nurse-physician collaboration. Many authors (Alpert, Goldman, Kilroy, & Pike, 1992; Baggs & Schmitt, 1997; Betts, 1994; Evans, 1994; Evans & Carlson, 1993; Keeman, Cooke, & Hillis, 1998; Jones, 1994) have indicated that nurse-physician collaboration is not widespread and a number of barriers exist. The following will discuss the necessary ingredients for creating a nursing unit that is conducive to nurse-physician collaboration and supported through transformational leadership.
The first important barrier according to (Keenan et al., (1998) is concerned with how nurses and physicians have not been socialized to collaborate with each other and do not believe they are expected to do so. Nurse and physicians have traditionally operated under the paradigm of physician dominance and the physician’s viewpoint prevails on patient care issues. Collaboration, on the other hand, involves mutual respect for each other’s opinions as well as possible contributions by the other party in optimizing patient care. Collaboration (Gray, 1989) requires that parties, who see different aspects of a problem, communicate together and constructively explore their differences in search of solutions that go beyond their own limited vision of what is possible. Many researchers have argued (Betts 1994; Evans & Carlson, 1993; Hansen et al., 1999; Watts et al., 1995)
that nurses and physicians should collaborate to address patient care issues, because consideration of both the professions concerns is important to the development of high quality patient care. Additionally, effective nurse-physician collaboration has been linked to many positive outcomes over the years, all of which are necessary in today’s rapidly changing health care environment. One study by (Baggs ; Schmitt, 1997) found several major positive outcomes form nurses and physicians working together, they were described as improving patient care, feeling better in the job, and controlling costs. In another study (Alpert et al., 1992) also found that collaboration among physicians and nurses led to increased functional status for patients and a decreased time from admission to discharge. Along with improved patient outcomes, nurse-physician collaboration has several other reasons why it has become significant in today’s health care environment. Several examples of which are, as identified by (Jones, 1994) the cost containment effort, changing roles for nurses and physicians, the Joint Commission on Accreditation of Health Care Organizations focus on total quality management, and emphasis by professional organizations and investigators have focused attention on this area.
The challenge of creating an environment for patient care in which collaboration is the norm can be difficult and belongs to the domain of the nurse manager. In order to create a collaborative work environment several conditions must be achieved and several natural barriers to nurse-physician collaboration must be overcome. In creating this environment for collaborative practice, (Evans, 1994) identified several more barriers to overcome. She expresses that the most difficult to overcome is the time-honored tradition of the nurse-physician hierarchy of relationships, which encourages a tendency
toward superior-subordinate mentality. Keenan et al. (1998) found that nurses expect the physicians to manage conflict with a dominant/superior attitude. They also found that nurses are oriented towards being passive in conflict situations with physicians. A second barrier to collaboration is a lack of understanding of the scope of each other’s practice, roles, and responsibilities. Evans (1994) feels that one cannot appreciate the contribution of another individual if one has only limited understanding of the dimensions of that individual’s practice. It is equally true that appreciation of one’s own contribution is blurred if the understanding of one’s own role is limited. A third constraint to collaborative practice might be related to this perceived constraint on effective communication. Although there might be individual differences causing restraint in communication, the organizational and bureaucratic hierarchies of most hospitals hinders lines of communication. Several final factors cited by (Evans, 1994) as barriers to collaborative practice