AACN News—January 2004—Opinions

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Vol. 21, No. 1, JANUARY 2004


Rising Above: New Questions, New Opportunities
Why Can’t We Get Our Arms Around True Collaboration?

By Dorrie Fontaine, RN, DNSc, FAAN
President, AACN

Collaboration. We get excited when we hear nurses, physicians and administrators talk about it. Visions of patient-focused care and great teamwork dominate our conversation. We all crave collaboration, and seek it like a kind of Holy Grail. So, why is it so elusive? Why do we hear more tales about how people “play bad” than about how they “play nice”?
Just before the holidays, I noticed an impressive lineup of examples that confirm our desperate quest for genuine collaboration. Here are just six of them, which even suggest that some things are on course. But, are we all seeking the same destination?

It’s Not a New Quest
First example: The AACN Board of Directors unanimously elected Dr. Joyce Clifford to receive the 2004 Marguerite Rodgers Kinney Award for a Distinguished Career. Her name should be familiar. For nearly 30 years she was nurse-in-chief at Beth Israel Hospital in Boston. And, with her physician-in-chief colleague Dr. Mitch Rabkin, she created one of the most vivid examples of a healthy and collaborative work environment this country has ever seen.
The lesson: The quest for genuine, patient-focused collaboration isn’t new. Nor is it elusive. The question: Why can’t we seem to find it?

ACCP Physicians Pledge Patient-Focused Care
Second example: Dr. Richard Irwin, new president of the American College of Chest Physicians, instituted a patient-focused care pledge. A physician, Richard is professor of medicine and nursing at the University of Massachusetts. In October, the college’s members pledged in public for the first time to “strive to provide patient-focused care wherever and whenever I have the privilege of caring for patients.” As an ex officio member of the ACCP Board of Regents, I was proud to sign the pledge on behalf of AACN.
The lesson: Nurses aren’t the only ones seeking to make collaboration reality. The question: Why does it seem like we’re traveling down parallel tracks instead of down the same road?

Landmark IOM Report Released
Third example: The Institute of Medicine released its landmark report titled “Keeping Patients Safe: Transforming the Work Environment of Nurses.” Electronic copies are available online at www.nap.edu. In written testimony to the expert panel that developed the report, AACN once again took the lead in highlighting the power of a healthy work environment where mutual respect and effective communication between nurses and physicians prevent errors. A special appendix on interdisciplinary teams and patient outcomes is well worth the read.
The lesson: Because of its direct impact on patient safety, collaboration is brightly lit on the radar screen at the nation’s highest policymaking levels. The question: What new opportunities must we seize to transform the IOM’s recommendations into action?

The Public Still Trusts Nurses
Fourth example: A recent Gallup poll reaffirmed that the public continues to rate the honesty and ethical standards of nurses as the highest of 23 professions. Eighty-three percent of respondents rated nurses “very high” or “high,” compared with 68% for physicians and 67% for pharmacists.
The lesson: Nurses have succeeded in staying close to patients and families, despite a steadily worsening nursing shortage and the continued brokenness of the American health system. The question: If genuine collaboration reigned, shouldn’t we expect to see comparable trust ratings among all health professionals?

Like a Ton of Bricks
Fifth example: I peeked at a preview copy of a provocative book due out early this year. The chapter on teamwork, aptly titled “Hubris and Teamwork,” in Internal Bleeding: The Truth Behind America’s Terrible Epidemic of Medical Mistakes speaks to our shared sensibilities. Noting the impact of the nursing shortage, Wachter and Shojania, the physician authors, recognize that “…a hospital spending hundreds of thousands of dollars trying to recruit nurses is going to come down like a ton of bricks on a doctor who harasses the nurses or makes their lives miserable by being an arrogant cad.” The book ends with the sobering reminder that we’re “all in this together.” Look for it at www.ruggedland.com.
The lesson: When collaboration falls short, the best designed procedures will still fail to ensure patient safety. The question: How can AACN’s healthy work environment initiatives become embraced as the ultimate catalyst in achieving true collaboration?

500,000 Nurses Will Focus on Healthy Work Environments
Sixth example: Remember the days when the ICU picked on the CCU, which picked on telemetry? And, they all picked on the ED? Nationally we may be getting beyond that. The Nursing Organizations Alliance representing more than 500,000 nurses met for the second time in November. Bringing together the presidents, presidents-elect and chief staff officers of more than 60 nursing organizations is an accomplishment in itself. But this was eclipsed when they agreed to one issue where each association would make a contribution during the coming year. As a result, the elements of a healthy work environment will be disseminated so that each association can adopt and implement them as part of their strategic direction.
The lesson: Persistence pays off. The question: How do we stay focused, remembering that this accomplishment is the first step—not the end goal.

Ask the Important Questions
These are encouraging examples, aren’t they? They confirm the value of persistently seeding change, as AACN continues to do on so many fronts. They affirm the importance of staying in the dialogue and continuing to seek new opportunities from which to create new collaboration.

These examples also prompt vital questions that we must consider by rising above: Do we honestly know what patient-focused care looks like? Do we understand what genuine collaboration means and requires? Do we need new language or concepts to guide us down this road? What does collaboration look like to you? When and where have you seen it? What did it take to make it happen?

These are the questions that challenge me when I rise above to take a new look at true collaboration. Experience tells me that each member and reader of AACN News has thought-provoking answers. Will you send me yours at dorrie.fontaine@aacn.org?

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