Rising Above: New Questions, New
Why Can’t We Get Our Arms Around
By Dorrie Fontaine, RN, DNSc, FAAN
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
The lesson: The quest for genuine, patient-focused
collaboration isn’t new. Nor is it elusive. The question: Why can’t we seem to
ACCP Physicians Pledge
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