Collaborative practice in nursing:
Traditionally, nurses provided bedside care for patients whereas physicians assessed diagnosed and prescribed treatment. However, with time, due to increasing demand for nurses, there has been overlapping of responsibilities and duties. The nursing profession has evolved during the last century to cope with new demands and new issues. Nurses today are required to provide a wide range of services independently and several other services in collaboration with other healthcare providers (CUSN, 2006). This shift towards collaborative work environment has changed the education of nurses, the nature of nursing tasks in the clinical environment and the perception of the roles of nurses (ANA, 2006). In the past, there was no regulation in healthcare and there was no definition for the nurse/physician collaborative relationship. This has changed in recent times as state legislatures have widened the authority of nurses to receive direct payment and to write prescriptions (CUSN, 2002). These laws permit nurses to practice independently like primary care physicians and allow them to establish collaborative practices whereby they can share clinical responsibilities with physicians. In an era when America is failing to meet the health needs of its citizens, collaborative practice is seen as a significant key to ushering in more and better primary care to the public.
In collaborative practice, a nurse practitioner and a physician along with other healthcare professionals provide healthcare services to patients. Authority for providing care is equally shared among the professionals in this collaborative environment – within the scope of their practice (CUSN, 2002). Though the nurse practitioner in collaborative practice can independently provide care without the physician’s consent, when there are differences, it is accepted that authority is transferred to the higher qualified professional. In the case of a patient’s direct medical care, final authority rests with the physician. Thus in a collaborative environment we find that physicians hold responsibility for complex medical problems involving critically ill patients whereas nurse practitioners hold responsibility for prevention, access to community-based resources, health education, and counseling. It has been shown through research that nurse practitioners are equally competent as the physicians in the context of primary care decisions. The physician focuses on illness of the patient whereas the nurse focuses on the wellness. These two approaches are complementary and provide the best possible healthcare solution in a collaborative practice. Another valuable benefit of collaborative practice is that it proves to be very cost-effective (CUSN, 2002).
In this collaborative environment, nurse practitioners are required to communicate well with the patient and know his personal background and preferences. This needs a high level of communication skills. They must also be good at counseling the patients about prevention of diseases, nutrition, and stress reduction. They must support relevant research and facilitate the implementation of recent research findings in their clinical practice. Nurses in the collaborative practice need to take on leadership roles by developing fresh approaches to solving problems, acquiring decision making and strategy formulating skills, acting as a change agent, mentoring other nurses, being professional, and acquiring team-building and team-managing skills (CNA, 2002). Thus we find that nurses need additional skills apart from their traditionally acquired ones. This fact emphasizes the importance of updating and redesigning medical training for nurses.
According to The Nursing Organizations Alliance, the following elements promote a collaborative nursing environment: collaborative practice culture where there is trust, respect and team orientation; excellent open communication; accountability; adequate number of qualified nurses; good leadership; shared decision-making, and encouragement of growth of professionalism in practice through continued education, and recognition of the contribution of nurses (NACNS, 2006).
Collaborative practice is best seen in rural hospitals and primary healthcare settings where there is acute nursing shortage. It is a model solution that works towards providing timely access to essential health services that are also of high quality, client-centered and safe. Ultimately, collaborative practice is expected to create a sustainable and affordable health care system for all.
CNA (2002). Advanced Nursing Practice: A National Framework. April 2002. http://www.cna-nurses.ca/CNA/documents/pdf/publications/ANP_National_Framework_e.pdf
CUSN (Columbia University School of Nursing) (2006). The Evolving World of Healthcare. http://www.nursing.hs.columbia.edu/about-school/healthcare.html
NACNS (2006). Principles and Elements of a Healthful Practice/ Work Environment. http://www.nacns.org/NOAhealthyworkenvironment.pdf
ANA (2006). Collaboration and Independent Practice: Ongoing Issues for Nursing. http://www.nursingworld.org/readroom/nti/9805nti.htm