The concept of collaboration comes naturally to human beings. The need to survive requires people to work together to work for their common interests. Over the course of our collective history, we have been compelled to set aside our differences and come together in order to achieve a greater good.
Nowhere is the concept of collaboration more important than in the health care system, where lives are on the line. The concept of collaboration in nursing involves two aspects: the collaboration between doctors and nurses, and the collaboration among nurses. In this regard, Sullivan defines collaboration as the interaction that allows for the synergestic merging of knowledge and skills that allows for the maximum benefit of the patient. He further elaborates that collaboration requires the mutual agreement regarding medical philosophies and models of practice, putting the welfare of the patient first, above anything else. (1998, 3)
The tension between doctors and nurses can be explained by history. During the early years of the nursing profession, nurses were generally perceived as doctor’s right hand, fulfilling the role of assistants in the health care system. But that is a widely held misconception. In reality, nurses and doctors have stood side-by-side as equals, dispensing different but complementary duties of patient care. This means that the nature of health care presupposes collaboration if sick people have any chance of surviving their illness and eventually getting well. The truth is that there is no hierarchy; doctors and nurses have their own important roles to play. And doctors and nurses are aware of that. They have an implicit understanding of how their duties to the patient straddle and overlap each other’s turf (Nevada RNformation, 2004). The problem is that while this understanding among doctors and nurses is implicit, there is no formal documentation to make the concept of collaboration the standard practice among health care institutions.
The delineation of roles between doctors and nurses is mostly an accident. It just so happened that physicians existed way before nurses (Hadley, 1989). To define their roles, doctors encompassed a broad area of responsibility, leaving very little room for nurses to define their own profession. Left with no choice, nurses had to device their own scope of practice that is unique from those of physicians. This resulted in an arrangement that created the perception that nurses were subordinate to doctors. It is a product of history; and it was nobody’s fault. The good thing is that this model did not become an absolute rule. Nurses constantly redefined their practice to suit the needs of society. Refusing to limit themselves, nurses continued to push the boundaries of health care, notwithstanding the inferior perception of the public.
Technological advances have made health care even more effective at curing people’s illness and prolonging patient’s lives. And as more people avail of health care, the need for collaboration among health care workers is imperative.
The problem is that in an industry of professionals, rivalry and competition is often unavoidable. Stories of tension between doctors and nurses are common place, with nurses often complaining that they are not getting the respect that they deserve from doctors. In a similar fashion, tension exists among nurses, in what the industry calls as lateral violence. While this paper will discuss collaboration, it cannot be discussed without touching on these issues of lateral violence in the nursing vocation.
In varying degrees, every newcomer in every field deals with latent hostility from their senior colleagues. This is the culture and there is no getting away from it. In the nursing profession the occurrence of lateral violence is alarming, especially given the sensitive nature of a nurse’s vocation. Furthermore, nurses are what Dr. Martha Griffin rightly calls an “oppressed population” (2006, p. 258). The nurses put in hours and hours of work into caring for their patients, thus they feel they deserve some acknowledgement. This acknowledgement, however, never comes. What comes instead is resentment; deep, intense resentment towards the power structure from which the nurses are categorically, if not intentionally excluded. However, being dependant on it none of them can attack the power structure itself. So instead, the senior nurses take the easy way out and attack the defenseless newcomers who are left to their guidance.
Indeed before any collaboration can take place in the nursing profession, nurses must learn to acknowledge and address the problems that exist among themselves. In light of the acute shortage in nurses, the need for collaboration has never been more important. The work of nurse in itself is difficult because everyday you are responsible for human lives. Add to this pressure the tension in the workplace, and then it makes the work even harder than it already is. Lateral violence is a manifestation of deeper, more complex issues that involve the individual and the entire system as well. As such, lateral violence may be impossible to pin to just one factor alone. It is perhaps a combination of all these factors that pushes nurses into committing hostilities against their own. Of course, the nature of people must also be considered. Some individuals are just naturally rude or mean. In such a case he/she will inflict agony on others naturally and unreasonably, without care or concern for the above-mentioned factors. Hopefully such occurrences will be extremely rare if not completely impossible. (Heinrich, 2005)
Knowing the dynamics of lateral violence among nurses allows policy makers to design a collaborative program that takes these issues into consideration. Only then can collaboration have any hopes of becoming successful. Nurses need to band together if any form of collaboration with doctors is to have any chance at benefitting the system and the welfare of patients.
Collaboration takes root in the idea that every person has something valuable to contribute, and that the system will not exist without the contribution of everyone involved (Melies, 2006). And this concept is universal, regardless of the profession or industry. In this regard, doctors and nurses must work together, with each profession respecting and supporting each other. In terms of health care, collaborative programs are also called patient-centered, which means that both should act in the best interest of the patient, setting aside any personal feelings and beliefs. And collaboration is not limited to doctors alone; nurses must work in synergy with other para-medical professionals (DeLaune, 2002). Because the health care needs of patients are often complex, collaboration should take place at all times and at all instances within a health care institution (Kimpton, et al, 2007). If conflict is unavoidable, which it will be most times, the best way to diffuse the tension is to put aside individual pride and act in the best interest of the patient. And that is what nurses should always keep in heart.
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DeLaune, S. C., Ladner, P. K. (2002). Fundamentals of Nursing: Standards and Practices. Thomson Delmar Learning.
Griffin, M. (2005).Teaching cognitive rehearsal as a shield for lateral violence: an intervention for newly licensed nurses. Journal of Continuing Education in Nursing, 35 (6): 257-63
Hadley, E.A. Nurses and prescriptive authority: a legal and economic analysis. American Journal of Law and Medicine 15:245-299, 1989.
Heinrich, K & Oermann, M. (2005) Annual Review of Nursing Education. Springer Publishing Company. P. 367
Kimpton S., Oandasan I,.Soklaridis S. (2007). Family health teams: can health professionals learn to work together? Canadian Family Physician. Vol. 53, No. 7.
Meleis, A. I. (2006). Theoretical Nursing: Development and Progress. Lippincott Williams & Wilkins.
Sullivan, T. J. (1998). Collaboration: A Health Care Imperative. McGraw-Hill Professional.