Each day as a Clinical Nurse is a dynamic and rewarding experience – with that being said, that does not mean each day is devoid of anxiety and hysteria. My current mission as a nurse and future leader includes advocacy, autonomy, collaboration, use of evidence-based practice, and professional development to build a great unit. While all go hand and hand, I’ve decided to discuss the importance of collaboration as effective communication is integral to working relationships. Whether being unsure of who I will be working with or collaborating with, how many patients I will have, or if I will have to undertake being in charge of the unit, I always take it into my own hands to succeed in providing the best of care, while communicating efficiently and effectively with collaborators (Huber, p. 268, 2014.)
My personal ethics are dynamic yet connected with a good set of roots in beneficence and non-maleficence, as well as justice. I believe that being virtuous, truthful, diligent, honest, respectful, and modest define my moral character. In other words, I have integrity. I believe in myself, and in others, but know that humans all have different views on what makes something ethical. According to Carey, in the Rational Frame, “an individual who is embedded in the rational frame will understand every problem from this perspective, and therefore the solution is always to find the appropriate structure or improve the efficiency of the present one.” (Carey, p. 52, 1999) There is constantly a change to improve the efficiency of the working environment of nurses.
I devote myself gladly to said collaborations, and with an open heart constantly. I do pay the price in deriving a good amount of my happiness on that achievement. I know I must advocate for my patient in ways I would will others to do for me, but I also know that I must do this within the scope of my own practice, hospital, system, or even that of my state board. “Strategic channel choice means choosing your channel consciously, thoughtfully, and carefully (in view of your objective, audience, and message)—instead of unthinkingly selecting channels you feel comfortable using.” (Munter & Hamilton, p. 26, 2014.) Managing situations that break the barriers of my own personal ethics is what I always enjoy reveling in.
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That’s what makes nursing challenging, and forever engaging. As I comprehend it, ethics is the art and science of achieving the ideal human character. I know that’s kind of impossible, but I enjoy making myself exhausted trying. “A human frame manager understands that organizational problems reflect and incongruence between the needs of healthy people and the goals of the organization and can be resolved by empowerment (Carey, p. 60, 1999.) How might all of these aspects of myself impact my ability to lead a unit into a more well-rounded and collaborative place, with more engagement and efficiency? How do you create a well-rounded unit?
We must ethically provide for and determine the impact our collaboration has on our patients and their outcomes from the moment they are admitted up to the time of discharge, which includes post-discharge from the hospital. “The importance of creating an environment with a culture and climate that empowers nurses to practice in ways that support a positive practice environment can maximize nurse and patient outcomes” (Huber, p. 57, 2014.) We must not forget how important this collaboration is, as nurses.
We aim to effectively learn to respect and honor our patient’s wishes, communicate their needs to others, all while following provider’s orders, and providing social, moral, and spiritual support, especially as it pertains to working with social workers, case management, and pastoral care. This does not occur without promoting positive inter-professional relationships, which is no easy task, and takes time to master. This mirros Dr. Carey’s perspective on the systems frame, in which “the integration process is extrinsically imposed by management and intrinsically located in each worker…” and “…the whole, therefore, is contained in each of the parts” (Carey, p. 67, 1999.) A unit is more than just a workplace. It takes having deep connections to maintain a unity that makes the union of quality nurses effective.
Nurse collaboration begins with our patients and extends to every aspect of our work on a unit. Whether it be communicating with other nurses, providers, nursing management, case management, social work, environmental and engineering, materials, other units, or the emergency department, we are in a constant state of flux, not really knowing where our day will begin and end, giving everything, we have to patients we most likely have never met before. This is courageous and exciting and draws from the senses – the heart and mind – what the soul screams.
“Dealing with the complexities and constant change in nurse’s environments, coupled with working long hours, can be exhausting mentally and physically, which leads to decreased mental clarity, depression, irritability, and anxiety” (Huber, p. 89, 2014.) Nevertheless, we are reminded that we are human, that we are fallible, but that we can always strive to do better, and to enhance humanity in the process. What do we take from that and how do we better achieve those goals on a busy and constantly changing unit?
I believe that collaboration requires critical-thinking on all ends, and we must ensure that the team that stems from such collaboration can effectively work in order to have these small successes daily. “To achieve Magnet status [hospitals] must meet the 14 forces of Magnetism,” focusing more so on eight characteristics of an excellent work environment, which includes clinically competent nurses, as well as collaborative nurse-MD relationships (Huber, p. 58, 2014.) Through understanding our roles in the team, we are able to appropriately and safely provide care to each patient, especially because we know how to utilize one-another and our resources. I am proud of our abilities as a team to respect one-another, and understand each other’s strengths and weaknesses in order to provide that patient-centered care integral to my core values, which are an extension of my hospital’s mission. With small wins each day, we can see just how important effective collaboration is. What do we do to make keep this going?
It is our priority as nurses and nurse leaders to work in collaboration with one another, and with our environment. This invokes the best we have to give; respect, courtesy, and love, which come from our hearts, our minds, and our souls. In order to succeed at this, we must promote consistent communication and partnership to promote quality outcomes in the nursing arena, medical arena, and most importantly to the lives of our patients and our patient’s family members. This can only happen if we are able to confront difficult situations that exist inherently, and amongst one-another.
The interdisciplinary team collaborates in many ways, some ways that work and some that do not. Through the use of documentation, informal discussions, and meetings, providers, care coordination, nurses, patients, and family members can have important conversations that help to describe interventions that meet goals, but all the pieces must fit in order to ensure this happens. “System stress introduced by demand for nurses to care for more or sicker patients has been shown to be a leading cause of adverse patient outcomes” (Huber, p. 378, 2014.) Nurses must be engaged and interested in protecting and promoting their profession, as well as their patient’s health, but they must be able to succeed, rather than be set up to fail. How does leadership play a role in success and failure of nursing departments?
Nurses must feel that they are able to access leadership. Nurse leadership therefore must make themselves available in numerous ways. Nurses must know their nurse leaders, and their leaders must know them. Leaders and management must at least understand the needs of nurses, and how those needs can be met in correlation with the collaborative effort an organization may be working to attain. “Daily staff allocation requires managing a variable staffing plan, measuring and predicting demand, and then providing balanced workload assignments to ensure that the correct caregivers are best matched to patient needs.” (Huber, p. 375, 2014.) In other words, nurses must feel that leadership validates the love and energy that they put into their work. In order for a mission to work, that mission and vision must be something that can be understood.
Collaboration as it pertains to nursing staff and its support staff requires open conversation and communication with leadership. “In the political frame, however, conflict is not a problem, and so focus is not on the resolution of conflict, but rather on strategies and tactics in conflict.” (Carey, p. 76, 1999) The concept of shared governance is tightly interwoven with the political frame, as nurses must feel that their voices are important, and that they can be heard; without that input, the vital partnership taken in being a participant to those values of an organization go out the door. “Shared governance remains out of reach to some, and an endless process to others because it requires slow, gradual development, role modeling, and mentoring by nurse leaders, and continual coaching nurturing, and education for nursing staff and management.” (Huber, p. 251, 2014.) Shared governance plays a huge role in the emergence of new nursing care delivery, but employee engagement must come with appreciation, and good understanding of what makes them an asset to organizational success, as well as great patient outcomes.
Clinical staff must utilize a breadth of communication outlets to deal with disagreements or uncertainty as it pertains to difficult patient management decisions and cases. “Nurse Managers have the responsibility to prepare themselves and those reporting to them to deal effectively with ongoing conflicts between clinical and organizational ethics” (Huber, p. 105, 2014.) Nursing leadership must back a nurse’s judgment, as well as protect the voices of the nurses that aim to instill organizational values.
A chain of communication that promotes safe and consistent patient care helps to resolve professional dissonance. By empowering all those in collaboration to ensure that that collaboration is effective and has a positive impact, nurses can feel that their voices will be heard without a reprisal. We must resolve issues that occur regularly within our collaboration by communicating with one another, rather than just complaining to those who will never listen or will never show interest in our needs.
Having access only with a direct manager and clinical manager makes most nurses feel that those who are making the biggest decisions that impact the way in which care is delivered care little about who they are or how they may want to go about delivering on the mission of the hospital, and most importantly the unit. Those in senior management must take the time to get to know the nurses and acknowledge their needs in order to do so. Having nursing directors, assistant directors, etc. who have little to nothing to do with nurses distances nurses from the mission and makes them passive.
“Shared governance remains out of reach to some and an endless process to others because it required slow, gradual development, role modeling and mentoring by nurse leaders, and continual coaching, nurturing and education for nursing staff and management” (Huber, p. 251, 2014.) It is important to have a channel by which to know and connect with upper management, and to feel that the need for quality staffing and resources to effectively care for patients is allotted or made available. Senior nurse management is quick to forget the experiences they’d had on units as bedside nurses themselves. “Regardless of job title, all nurses have a role in making evidence-based practice changed” (Huber, p. 287, 2014.)
In order to continue to gain an education in nursing, as it were, I propose senior management ascertain a certain understanding or be reminded of just how hard it is to be an engaged bedside nurse without the proper resources. After all, nurse leadership is nurse-driven. In that case, shared governance alone does not cut it. This time with senior management is valuable to nurses, especially if they feel their voices are heard. “Cultural values develop as the original leader or founder applied his or her priorities to the challenges or problems of the organization. They do not become cultural values until others respond to the problems and challenges using those values and find them effective and useful” (Carey, p. 83, 1999.) A good nurse leader makes themselves available and explores the needs of those who claim to follow their lead. Their audience must be equally available to receive that message (Munter & Hamilton, 2014.)
In conclusion, it is most important that nurse leaders make time, as well as take time to understand and appraise the needs of nurses in order for them to be engaged, and subscribe to a mission, and be devotees on a unit. Shared governance is only so effective. According to Huber:
“Nursing leaders can build a strong program supporting evidence-based care delivery using a building block approach. Building on the origination’s vision, mission, and value for high-quality care provides a foundation for success. Nurse leaders must connect their evidence-based initiatives to the organization’s vision, mission, and infrastructure to garner support and resources for provision of the best care possible” (Huber, p.289, 2014.)
If without a voice, there would be no nurse, and with no nurse, there would be no voice for the many patients out there. Nurses must be heard, in order for a mission, a vision, and a value to be a prospect. According to Freire, “we can legitimately say that in the process of oppression someone oppresses someone else; we cannot say that in the process of revolution someone liberates someone else, nor yet that someone liberates himself, but rather that human beings in communion liberate each other” (Freire, 2000, p.53.). To be a revolutionary leader is to help revolutionize others to access their best. Can this process actually function in the scheme of a hospital?
According to Northouse, “access to technology has empowered followers, given them access to huge amounts of information, and made leaders more transparent. The result is a decline in respect of leaders and leaders’ legitimate power. Power is no longer synonymous with leadership, and in the social contract between leaders and followers, leaders wield less power…” (Northouse, 2016, p. 11.) At my hospital, all employees have access to ways in which they can communicate with all other employees, having access to email addresses and business phone numbers of anyone employed in the system.
Managers, as well as executives all maintain that they are open and available for communication, but their being committed to doing so is questionable. Despite being an extremely large institution, the size of departments helps to lessen the extent to which the vastness of the organization impacts its employees. This becomes a strength and a limitation, as nurses are specifically able to connect with higher-ups regularly, and have a shared-governance model, but don’t feel their voices are heard nonetheless.
According to Palmer, in the community of the truth, “the therapeutic is the model most often implied when we use the word community. This model makes intimacy the highest value in human relationships, because intimacy is regarded as the best therapy for the pain of disconnection.” Shared-governance aims to prevent a “loveless enterprise,” as it is “likely to be pathological.” There is no place for that in healthcare.
Reference
- Carey, M. R. (1999). The Political Frame. In Heraclitean fire: Journeying on the path of leadership. Dubuque, IA: Kendall/Hunt Pub. Co.
- Finley, R (2013, February). The Courage To Teach: Exploring the Inner Landscape of a Teacher’s Life. San Francisco: Jossey-Bass
- Freire, Paulo. (2000). Pedagogy of the Oppressed. Ney York, NY: Bloomsbury Academic.
- Huber, D. L. (2014). Leadership & Nursing Care Management Fifth Edition (Fifth ed.). St. Louis, Mo.: Elsevier Saunders.
- Munter, M., & Hamilton, L. (2014). Guide to managerial communication. Harlow: Pearson.
- Northouse, Peter G. (2016). Leadership: Theory and practice (7th ed.). Los Angeles: Sage.
- Palmer, P. J. (2017). The courage to teach: Exploring the inner landscape of a teachers life. Hoboken, NJ: Jossey-Bass.
