In today’s ever-evolving health care system, interprofessional collaboration has become a catchphrase that highlights the need to move beyond silos and work across professions to maximize the quality of health care. I have been a registered nurse for six years and an adult-health nursing instructor for four, so I thought I was pretty well-versed in how to be an effective member of an interprofessional team.
I teach students the importance of collaborating across professions, and I challenge them to insert themselves into teams as members rather than stand watching on the periphery. So when I had an opportunity this past year as part of my doctoral program to take a course on working in interprofessional teams, I decided to sign on. I was not expecting to learn much, but thought I would share with other members of the class what I have learned from experiences as a nurse. I soon realized I had much to learn.
The course began with defining interprofessional collaboration and reading Core Competencies for Interprofessional Collaborative Practice, a report by the Interprofessional Education Collaborative Expert Panel (2011). Although I was being introduced to formal expectations and new literature on the topic, I didn’t feel I was learning anything new. All of this changed a week or two later, however, when we were asked to explore professional stereotypes. In a class composed of medical students and graduate-level nursing, social work, pharmacy, and psychology students, stereotypes of each profession represented were pervasive.
Who are we, really?
Many positive nursing stereotypes were identified—compassionate, wanting to help, caring, etc.—but negative stereotypes were also listed: pill poppers, overworked and underpaid, and can’t talk-must chart. Even candy striper
made an appearance. Other professions fared no better. Physicians are egotistical. Social workers are the same as case managers and psychologists. Psychologists are aloof and strange. Pharmacists are overly studious without much personality. The list goes on. I was shocked that nursing, well-known and ubiquitous as it is, was understood so poorly by those with whom we work so closely to provide patient care.
As nurses, we know we play a critical role in patient care. More than anyone else, we are the ones at the bedside, the ones who know the patients and their families, the ones who spend time exploring their concerns. We use this knowledge to advocate for our patients. Our expertise allows us to call into question the actions of others and, it is hoped, speak up before it is too late.
We know that social workers help manage psychological needs of patients, pharmacists are the ones we call for help with medications, and physicians write orders and direct patient care. We still aren’t sure what clinical psychologists do, because we don’t usually see them in the hospital. Patients see these therapists after they are more physically stable.
Knowing all of the above, I felt I needed to stand up for nursing and correct the inaccurate stereotypes. But, more importantly, I recognized I needed to learn what my colleagues actually do. I can only imagine they were as bothered by stereotypes about their professions as I was about mine.
True, false, or in between?
Next, to create a true identity of our professions, we were asked to work with fellow students from the same profession to categorize stereotypes as true, somewhat true, or false. It was through sharing the results of this assignment with other professionals in the class that my former notion that I was a well-versed interprofessional collaborator was dashed. I had defined other professions by their stereotypes rather than by what they truly are. I had much to learn.
As the class progressed, topics moved on to family-based care, teamwork, TeamSTEPPS
training, integrated behavioral health, and so forth. With each, I remained open-minded and continued to learn about new ways to maximize collaboration among the health care professions and what my colleagues and I can do to help.
Not all problems in interprofessional collaboration have been addressed; some have just recently come to light. Still, this course brought issues forward for discussion and exploration. At times, we were asked to share stories of good and bad experiences of interprofessional collaboration. I found I tended to have more examples of when teamwork was suboptimal, when things were missed or overlooked because too many hands were stirring the pot with too many spoons.
Needed: ‘I’ exams for professional myopia
I would argue that my experience is not unique. In talking with colleagues, I have come to realize that few of us, especially those who have had their nursing licenses for more than a few years, ever received formal education on interprofessional collaboration. Other discussions have helped me realize that we often operate within the world of professional stereotypes. We don’t take the time or expend the energy to ask colleagues what they contribute to patient care. We accept bad experiences of interprofessional collaboration as the norm, thinking, “I worked with others; who cares if it didn’t go well for them?”
Instead, we need to ask others: “How can I fully utilize the expertise of other health care professionals? How might they help me enhance my efficiency in providing patient care? What should I do differently to make interprofessional collaboration a good experience rather than merely continuing the status quo?" These are questions that are often missing in our current practices, and they are the kind of questions we need to begin asking.
As wonderful as it would be, I know it is not feasible for everyone to take a formal, three-credit graduate course on interprofessional collaboration, so I suggest the following: Ask another health care professional what they contribute to patient care. Ask about their professional abilities, their boundaries, and what they wish others knew about their profession.
Next, ask them to share their understanding of what nurses can and cannot do. Take time to correct misconceptions. Use staff training opportunities to explore abilities and boundaries of other professions. Utilizing the same classroom exercise I described above, explore and address professional stereotypes. Cases of bad interprofessional collaboration can be discussed and good cases praised.
Through efforts such as these, we nurses will begin to truly understand who else is working on our interprofessional teams. We can work together civilly and advocate for our patients as much as we want, but until we take a step back and correctly identify roles and responsibilities of other team members, we will never be able to achieve true interprofessional collaboration.
Megan Pfitzinger Lippe, MSN, RN, president of Epsilon Theta Chapter and assistant instructor at The University of Texas at Austin School of Nursing, is a doctoral candidate and a Jonas IV Nurse Leader Scholar (2014-16 cohort).
Interprofessional Education Collaborative Expert Panel. (2011). Core competencies for interprofessional collaborative practice: Report of an expert panel. Washington, D.C.: Interprofessional Education Collaborative.