Failure to collaborate?

Professional Practice Failure to Collaborate? "WHAT WE HAVEHE~ is a failure to communicate:' This famous line from the movie Cool Hand Luke has special significance for our profession when the phenomenon of nurse-to-nurse communication is examined. Two separate incidents raise the issue of whether or not nurses share information with colleagues. The first incident invoh'ed a home health nurse who, in caring for several postoperative bypass patients at home, was convinced that she had discovered a new problem in this patient group--depression. A literature search on home care and depression turned up nothing. She asked me if I was aware of the degree of depression in these patients. I told her that depression in post-bypass patients was well documented in the cardiac rehabilitation literature,~ provided reference information, and discussed possible nursing strategies. She left me with the comment that if such syndromes were so well known to cardiovascular nurses, the information should be shared to prevent other nurses from reinventing the wheel. Two or three days later, another nurse was discussing a patient's symptoms that had not manifested before her 3-day leave. An examination of progress notes in the hospital record showed the symptoms and the consensus that they were not life threatening. The patient had a long-standing history of these symptoms. I asked the nurse if she had read the chart or talked with her colleagues. No, was her reply, but she thought that she should have been told during report. These two incidents have four points in common. First, problem-solving information was available. Second, other nurses had this information. Third, a nurse acted on an assumption that this was new information. Fourth, only as a last step did a nurse seek assistance from a colleague. Why is it that in some cases nurses cannot seem to communicate with each other? The first nurse's inquiry about her patient may not indicate a lack of information exchange, but rather a reluctance to seek needed help in planning care for her patient. The second nurse exemplifies a specific concern. She did not look in the appropriate place to find the answer, use the readily available resources, or recognize the value of written communication from colleagues. This lack of communication between nurses is troublesome. I decided to seek consultation for two reasons: to validate my impression that the lack exists and to investigate how intradisciplinary communication could be enhanced. Validating my impression was not difficult. Staff nurses, administrators, and faculty agreed that the phenomenon exists. Agreement from such a broad range of nurses, albeit withodt careful investigation, lent credence to the problem. Why practitioners Fail to collaborate with one another is a subject that merits scientific investigation. However, several possi276

ble reasons come to mind. Perhaps the education process that fosters and rewards independent thinking and action is a contributing factor. The assignment patterns used in most health care settings that are designed to fix accountability for nursing care on an individual practitioner may hinder communication. The profession may be at a developmental stage that encourages competition rather than collaboration. 2 Until research is done on this issue, several strategies can be employed to improve communication and collaboration be~,een nurses. Daily nursing rounds, face-to-face reports bet~'een shifts, patient care conferences that include muhispecialty consultation, discharge planning teams composed of acute care and home health nurses, and staff development offerings that focus on the communication process and the need for professionals to share information about clinical practice are all workable methods of improving communication and collaboration. Another viable technique is role modeling, which enables an expert clinician to demonstrate the importance of communication skills and collegial consultation as an essential aspect of quality patient care. The two incidents that precipitated this examination of communication and collaboration might not have occurred if mutual trust and respect had been present. Collaboration should not be sought in desperation but should be an ongoing process used to achieve organizational and professional goals. Leddy and Pepper state that "collaborative effort is characterized by a high degree of information exchange, clarity of communication, and mutual trust and respect and is inherent in order to accomplish goals of the group or organization'~ If nursing is to achieve its goals of high-quality patient care, consumer responsiveness, and continued professionalization, it is imperative that nurses at all levels collaborate with each other. Collaboration can be an effective method of achieving nursing's" goals and is achieved through effort and mutual trust and respect. References 1. HackettTP, CassemNH: Ps~chologicaspectsof rehabilitationafter myocardial infarctionand coronaryartery b)'passsurgery.In WengerNK. Hellerstein HK (eds):Rehabilitationof the coronarypatient. NewYork,JohnWiley & Sons. 1984 2. ChaskaNL: Winter of discontent and invinciblespring. In ChaskaN (ed): The Nursing Profession:A Time to Speak. New York, McGraw.Hill.1983

3. LeddyS,PepperJM:ConceptualBusisofProfessionalNursing.Philadelphia. Jl~ LippincottCompany, 1985, p. I83 JEAN A. MASSEY, PHD, CCRN ELAINE M. REIMELS, MS, RN

Assistant Professor Assistant Professor Medical.Surgical Nursing PracticeFoundations College of Nursing College of Nursing University of South Carolina Universityof South Carolina Columbia, SC 29208 Columbia, SC 29208

JOURNAL OF PROFESSIONAL NURSING

• .SEPTEMBER-OCTOBER1986