The Nurse Managers Role

The bear music director is vital in creating an environment where hold in-physician coaction go off occur and is the expected norm. It is she, who clarifies the vision of collaboration, sets an example of and exercises as a economic consumption model for collaboration. The shelter manager excessively supports and makes inevitable changes in the environment to bring in concert all the elements that are necessary to facilitating hard-hitting obtain-physician collaboration.Many authors (Alpert, Goldman, Kilroy, & Pike, 1992 Baggs & Schmitt, 1997 Betts, 1994 Evans, 1994 Evans & Carlson, 1993 Keeman, Cooke, & Hillis, 1998 J one(a)s, 1994) have indicated that nurse-physician collaboration is not widespread and a chassis of passageblocks exist. The following will discuss the necessary ingredients for creating a nursing social unit that is conducive to nurse-physician collaboration and supported through shiftingal leaders.The original master(prenominal) barrier according to (Keenan et al. (1998) is concerned with how nurses and physicians have not been socialized to collaborate with from each one other and do not believe they are expected to do so. Nurse and physicians have traditionally operated under the paradigm of physician simplicityraint and the physicians viewpoint prevails on tolerant care issues. Collaboration, on the other hand, involves mutual respect for each others opinions as well as possible constituents by the other party in optimizing enduring care.Collaboration (Gray, 1989) requires that parties, who see different aspects of a problem, communicate together and constructively explore their differences in search of solutions that go beyond their give birth limited vision of what is possible. Many researchers have argued (Betts 1994 Evans & Carlson, 1993 Hansen et al. , 1999 Watts et al. , 1995) that nurses and physicians should collaborate to address patient care issues, because consideration of some(prenominal) the professio ns concerns is important to the development of high timber patient care.Additionally, impressive nurse-physician collaboration has been linked to many positive outcomes everywhere the years, all of which are necessary in todays apace changing health care environment. One study by (Baggs & Schmitt, 1997) lay out some(prenominal) major positive outcomes form nurses and physicians charming together, they were described as improving patient care, feeling better in the job, and controlling costs. In another study (Alpert et al. , 1992) also put that collaboration among physicians and nurses led to change magnitude functional status for patients and a decreased time from admission to discharge.along with improved patient outcomes, nurse-physician collaboration has several other reasons why it has sound significant in todays health care environment. some(prenominal) examples of which are, as identified by (Jones, 1994) the cost containment effort, changing qualitys for nurses a nd physicians, the Joint complaint on Accreditation of Health Care Organizations focus on total timbre management, and emphasis by professional organizations and investigators have focused attention on this area.The challenge of creating an environment for patient care in which collaboration is the norm can be grueling and belongs to the domain of the nurse manager. In allege to create a cooperative work environment several conditions must(prenominal) be achieved and several natural barriers to nurse-physician collaboration must be overcome. In creating this environment for collaborative practice, (Evans, 1994) identified several more(prenominal) barriers to overcome. She expresses that the most difficult to overcome is the time-honored tradition of the nurse-physician hierarchy of relationships, which encourages a tendency oward superior-subordinate mentality.Keenan et al. (1998) found that nurses expect the physicians to manage combat with a ascendent/superior attitude. They also found that nurses are oriented towards being passive in conflict situations with physicians. A second barrier to collaboration is a lack of savvy of the scope of each others practice, lineaments, and responsibilities. Evans (1994) feels that one cannot appreciate the contribution of another mortal if one has only limited understanding of the dimensions of that individuals practice.It is equally true that appreciation of ones give birth contribution is blurred if the understanding of ones own role is limited. A third constraint to collaborative practice ability be related to this perceived constraint on effective communication. Although there might be individual differences causing restraint in communication, the organizational and bureaucratic hierarchies of most hospitals hinders lines of communication. Several final factors cited by (Evans, 1994) as barriers to collaborative practice include immaturity of both physician and nurse groups, coupled with self-effacing nurse behaviour and aggressive physician behaviors.Factors that promoted collaboration between nurse and physicians were identified by (Keenan et al, 1998). She explained that nurse education was sighted as one of the most outstanding variables that promoted collaboration. The more educated a nurse was the more apparent they were to take action in disagreements with physicians. Additionally, when nurses expected physicians to collaborate and to not exhibit strong aggressive behaviors or controversial styles, they were more likely to approach and discuss patient conditions with them.Researchers also found that male nurse were more likely than female nurses to confront physicians and not avoid dominant or aggressive behavior. Expectations for physicians to collaborate and to not handle situations aggressively appeared to be a stronger predictor of nurse-physician collaboration than any expected normative beliefs. The first metre a nurse manager should take in the emergence of ach ieving a practice environment that facilitates collaboration is to conduct an appraisal of the aim or absence of barriers leading to collaborative practice.According to (Evans, 1994), the environmental and role variables to assess include role identification and the professional maturity of both the nurses and physicians, communication patterns, and the flexibility of the organizational structure. By assessing the work environment for barriers and facilitators to collaborative practice, the nurse manager can achieve a general view of how ready the unit is to begin a collaborative practice. The next step would be to plan an effective way to initiate a collaborative practice model of delivering health care on the unit.This can be done by instituteing what is called a Joint Practice Committee, and including nurses and physicians to be a part of this work group. Its purpose would be to examine the needs assessment results of the units readiness for collaborative practice, designing, utilizeing, and evaluating the operation of transforming the unit. This step is an constitutional part of the process of establishing a collaborative practice and was identified by the National Joint Practice Commission (NJPC) as a necessary element in the process. The NJPC began in 1971 and the delegating was dissolved in 1981.The commissions work resulted in the publication of track downlines for collaborative practice in hospitals. The NJPC defines a joint-practice commissioning with a composition of equal number of nurses and physicians who superintend the inter-professional relationships and recommend appropriate strategies to support and maintain those relationships. The NJPC identifies four other geomorphologic elements necessary for a collaborative practice as primary nursing, coordinated patient care records, joint patient care reviews, and emphasis on and support of nurse independent clinical decision making.These elements are an important cornerstone for creating a successful collaborative practice unit. In addition, several other factors have been identified by the NJPC as beneficial to maintaining an effective support systems when developing a collaborative practice such as appropriate staffing, committed medical leadership, standardized clinical protocols, and most significantly communication. Although a successful collaborative practice model has is a mean event. According to (Evans, 1994), it is important to realize that a collaborative relationship cannot be legislated, dictated, or mandated by anyone.It must be agreed upon and accepted by individuals who share certificate of indebtedness for patient care outcomes. The third step in the process would be to empower the nursing staff with beliefs that ful assemble their higher(prenominal) order of needs such as achievement, self-actualization, concern for others, and affiliation. Because of nursings normative behavior as passive, caring, and subservient the staff must learn to overcome expectations to severalize with this role expectation. The nurse manager must support, coach, and instill a palpate of potency into her staff in order for them to depart from those stereotypes.The idea is to fill the nursing staff with a sense of self-confidence and to lose thoughts of self-doubt, inequality, and subservience. To implement this new paradigm of nurse empowerment can be a challenge for the nurse manager within any typical hospital beaurocracy. That is why it is important to choose the correct style of leadership to guide the staff through this process of empowering or transforming. The leadership model outperform suited for this type of task and the most congruent with empowerment is the transformational model. Transformational leadership is a process in which leaders seek to shape and change the goals of followers.Cassidy & Koroll (1994) describe the process as incorporating the dimensions of leader, follower, and situation. The leader motivates followers by ident ifying and explain motives, values, and goals that contribute to enhancing shared leadership and autonomy. Transformational leaders are usually attractive so they enhance energy and drive people towards a everyday vision and shifting the focus of control from leaders to followers. It is the transformational nurse manager that will be able to empower her workers to facilitate nurse-physician collaboration, for the common comfortably of the patient.The nurse manager using transformational leadership would set the direction for the rest of the unit to follow. She would be able to charismatically appeal to the medical staff as well as the nursing staff and create collaboration beyond the daily frustrations of arguing about to which domain a certain patient care issues belong. Further more the nurse manager would have to work hard at decreasing the seeds of distrust and disrespect that have been plant between our colleagues in medicine, and vice versa with nursing.Corley (1998) desc ribed several behaviors that the transformation nurse manager would need to exhibit in supporting her staff in such a role transition. The behaviors are as follows stimulate creativity, establish an environment that facilitates team work and learning, implement change, motivate staff to cod increased responsibility, help develop employees awareness of organizational goals, delegate responsibility appropriately, communicate openly and directly with staff, and collaborate with peers. The significance of these behaviors in facilitating empowerment is seen as fundamental to creating collaborative practice environment.The final step in the process is to evaluate its effectiveness. In order to provide a can and concise evaluation of the collaborative process one must wait on at all structural elements and all indicators of collaboration as previously discussed. Once accurate measures are identified and assessed the collaborative practice committee can discuss their outcomes and effect iveness. Over time, nurses and physicians may be able to voice more clearly the changes in their practice and beliefs that have been affected by collaborating on patient care.Several of these key areas to examine would be distance of stay, patient and provider satisfaction, number of return visits, and changes in supply costs. Improvements in any of these areas could be due to favorable results from collaborative practice between nurses and physicians. In conclusion, many problems related to nurse physician collaboration are typically blamed on physicians. However the reality is that many of the barriers can be traced back to nursing as well. Collaboration is a process by which members of various disciplines share their expertise.Accomplishing this requires that these individuals understand and appreciate what it is that each professional domain contributes to the whole. The nurse manger plays a pivotal role in establishing an environment that is conducive to collaboration among t he disciplines. Although it is a difficult road to follow the benefits of an effective collaborative unit out-weigh the difficulties of establishing such a practice. However, the nurse manager has an excellent vehicle for which to begin her journey and that is the use of transformation leadership, an empowering tool for change.