Letter to the Editor by Donlin on Nurse-Physician Workplace Collaboration

Partnerships and Collaboration: What Skills are Needed?

Response by Michael Donlin to "Nurse-Physician Workplace Collaboration' by Linda L. Lindeke and Ann M. Sieckert. (January 31, 2005)

May 27, 2008

Dear Editor,

I write to further the discussion of Lindeke and Sieckert  regarding 'Nurse-Physician Workplace Collaboration' in OJIN's Partnerships and Collaboration topic. I share below an experience that has enabled me to collaborate more effectively with the physicians in my work area.

When I was considering my first position as a staff nurse, I looked for several 'must-haves' - a competitive salary and benefits package, good commute time, favorable staffing, the right patient population. After a year of practice, I realize that while those aspects of my job were important, none were as powerful as the support I received my colleagues. Flowing top-down from the 'leadership triad' - nurse manager, clinical nurse specialist, and operations coordinator - the environment on the floor was one of clinical excellence, continuing education, and professional empowerment. I always felt that I had the resources available to me to discover my own practice with confidence, knowing that I had expert clinicians and a willing staff behind me. So why today, in retrospect, do I consider my first year as a nurse to have been the most challenging and stressful time of my life so far?

Although my 8-week orientation provided me with the needed clinical support to feel comfortable with my practice, the emotional weight of enculturation into the nursing profession, the transition from student to clinician, and the increased responsibility of the independent role as staff nurse was a burden I was not adequately prepared to carry. While there was a 10-page long list of clinical competencies I had to squeeze into the first two months, the orientation left no structured time for reflection on the experience, sharing my thoughts and concerns with other new graduates, or mentorship from veteran nurses. I think I would have benefited from a simple validation of what I was feeling, knowing that I was not alone in my experience. Informally, we shared some of this in brief encounters in the med room or the staff lounge, but these exchanges were often rushed and rarely was there any continued dialogue or follow-up.

So what does this all have to do with nurse-physician workplace collaboration?  I'd like to share an encounter I had with one of the medical interns on my floor. I was one month out of orientation and she was just finishing a 24-hour overnight shift. One after another, three new nurses approached her with challenging questions regarding difficult decisions about complex patients. She looked upset, crossed her arms, and even became short with one of the nurses - they both stormed off angry. Laying a hand on the physician's shoulder, I remarked, 'It seems like you're having a tough day.'  She immediately began to cry and laugh simultaneously then asked, 'How did you know?'  I could so easily recognize her struggles because they were the same that I experienced in my daily practice. We talked for a few minutes, each offering the other a chance to vent, to support, and to laugh. In the next few weeks as we worked side-by-side, I found that we shared a bit more about what was happening with our patients - the difference was subtle, but it affected the delivery of care. The immediate change was increased communication, but the ultimate change, I suspect, would be improved patient outcomes.

As new clinicians, graduate nurses and interns share many common experiences. Through an open, honest, and safe sharing of these experiences, I believe that we can come to a greater understanding and eventually a greater appreciation and respect for each other's unique contribution to the interdisciplinary team. If we are to develop a culture of collaboration based on patient-centric care rather than a hierarchical structure, we must initiate this dialogue as early as possible. I propose that we work to set up a system where this communication is not only accepted, but built into the way in which we practice. This can only happen when both nursing and medical leaders come together and recognize the impact and importance of interdisciplinary initiatives. I am excited for what the future offers my practice - and my patients.

Michael Donlin, BS, RN
Staff Nurse - General Medicine
Massachusetts General Hospital
Boston, MA