Intra-professional Collaborative Practice among Nurses

Recommendation 1.1: Nurses develop an understanding of the roles, values and behaviours that support intra-professional collaborative practice by: 

• learning about the attributes of supportive teams; and 
• demonstrating willingness to work effectively with others.

Recommendation 1.2: Nurses acquire and demonstrate the attributes of team work through: 

• learning about the impact of interpersonal factors on the team; 
• team building activities; 
• demonstrating their commitment to the team; and 
• communicating effectively and openly, based on a clear understanding of their own roles scope of practice, and those of other team members.

Recommendation 1.3: Nurses initiate collaborative processes to improve patient/client outcomes, in particular when the acuity of the patient/client is increasing: 

• in circumstances when a diagnosis has not been established, the patient should be assigned to an RN to ensure the continuity of care.

Recommendation 1.4: Nurse managers model effective team behaviour and demonstrate power-sharing.

Recommendation 1.5: Nurses enhance the quality of work environments and improve outcomes for patients/clients by establishing processes and structures to promote intra-professional collaboration. Nurses should do this by: 

• collaboratively establishing processes for shared-decision making in a variety of circumstances; and 
• introducing non-hierarchical, democratic working practices.

Recommendation 1.6: Nurses promote open, honest and transparent communication by 

• promoting a culture of effective communication; and 
• establishing processes for verbal, written and electronic communication.

Recommendation 1.7: Nurses promote intra-professional collaborative practice by creating supportive learning environments and participating as mentors to students.

Recommendation 2.1: Organizations develop strategies to encourage and enable effective teamwork.

Recommendation 2.2: Organizations build a transformational or relational leadership culture that provides clear policies and supports effective teamwork.

Recommendation 2.3: Organizations develop systems and processes that promote collaboration and continuity of patient/client care. They can do that by: 

• implementing shared governance models that empower staff at all levels;
• supporting all nursing staff working to their full scope of practice; and 
• encouraging staff to engage in communities of practice for support and mentorship.

Recommendation 2.4: Organizations develop systems and processes to support nurses engaging in intra-professional practice. They can do this by: 

• developing and providing intra-professional learning opportunities and evaluating effectiveness; 
• developing competencies for intra-professional practice that are linked to performance appraisals; and
• providing opportunities for feedback on intra-professional practice.

Recommendation 2.5: Organizations develop outcome measures for evaluating the effectiveness of intra-professional collaborative practice. Those indicators could include 

• patient/client and family experience and satisfaction; 
• nursing turnover rates, overtime, absenteeism, engagement and satisfaction; 
• infection rates, fall ratios, re-admission rates;
• delayed or missed nursing interventions, gaps in continuity of care and caregiver, appropriate staff mix and skill levels; and 
• eliminating obstacles (e.g. broken or malfunctioning equipment, complacency) to evaluation processes.

Recommendation 2.6: Organizations encourage and develop preceptors in order to make the intra-professional collaborative environment more welcoming for students and new staff. They can do this by: 

• Assigning preceptors from the same class of nursing (e.g. RN student to RN preceptor);
• selecting, assigning and supporting willing preceptors to work with students or new staff placed on the team; 
• informing preceptors of students’ learning objectives and ensuring good communication between academic and clinical settings; and 
• reducing preceptors’ caseloads to give them sufficient time to meet student nurses’ learning objectives.

Recommendation 2.7: Organizations develop conflict management policies, practices and interventions by teaching and supporting managers and colleagues to address intra-professional relational challenges.

Recommendation 3.1: Governments promote sustainable intra-professional collaborative nursing by allocating funding for 

• Intra-professional collaborative team development and evaluation initiatives; 
• nursing leadership development initiatives; 
• design, implementation and evaluation of approaches for safe and equitable workload; 
• technology to support team interaction; 
• staffing levels to provide person-centred models of care; and 
• recruitment and retention.

Recommendation 4.1: Research is needed on how changing work structures affect intra-professional collaborative nursing in all health-care sectors.

Recommendation 5.1: Health services accreditation bodies include evidence-based standards and criteria for collaborative intra-professional practice as part of their standards.

Recommendation 6.1: Educators and educational institutions promote professionalism and intra-professional collaborative nursing and be role models of both. They can do this by 
•    introducing case studies that depict realistic team issues and scenarios (building the complexity along the continuum of the program); 

• focusing elective courses on teams and team functioning; 
• offering courses on respectful interaction and conflict resolution; 
• setting learning objectives focused on social and relational issues; 
• demonstrating collaborative teamwork during clinical placements; and 
• providing students with accurate information on role clarity and responsibilities of all members of the health-care team.

Recommendation 7.1: Nurse professional and regulatory bodies (provincial and national) work together to help their members become more informed about their own and their colleagues’ roles in the health system. They can do this by 

• discussing roles and responsibilities associated with their education, skills and knowledge; and 
• promoting respectful, egalitarian relationships.