A Guide to Nurse Provider Collaboration

The American Nurses Association (2013) describes how effective collaboration in health care is associated with numerous positive outcomes. For example successful collaboration can be linked to an increase in job satisfaction (Nair et al., 2012).  On the other hand, The Joint Commission (2013) found that communication issues were among the top reason for death related to a delay in treatment, and identified communication issues as the third highest root cause of sentinel events. 

There were many resources identified including the American Nurses Association, The Joint Commission, and The Institute of Medicine.  All the literature reviewed described how effective communication between providers and nurses leads to positive measurable outcomes, including decreased mortality in patients served, as well as improved morale for nursing staff.  Despite this, evidence suggests that physicians and other members of the healthcare team assign primary responsibility for patient safety to nurses; however, only an estimated eight percent of physicians recognize nurses as part of the decision-making team (Greene, 2002). 

Smith (2004) describes research that demonstrated the importance of a healthy nurse-physician relationship on nurse outcomes and patient outcomes. When nurses are able to demonstrate their contributions to physicians it helps to position nursing as intellectual peers, thus helping to create a partnership with demonstrated patient outcomes. Moreover, behavior expectations and communication standards, which help to set clear expectations in building a collaborative work environment, also have significant influence on nurses overall perceptions of their work experience (The Advisory Board, n.d.).

When providers and nurses work in a more collaborative environment and when adopting a partnership between the two professions, overall morale and satisfaction can be improved.  Improved patient outcomes may include decreased length of stay, decreased mortality, and improved patient satisfaction (Kupperschmidt, Kientz, Ward, and Reinholz, 2010). Improved communication fosters trust and mutual respect that enhances patient outcomes. To insure success nurses must be valued and committed partners.  As identified in the 2013 NDNQI survey, nurses scored the collegial nurse-physician subscale at 2.9, which was below the database mean of 3.1.  In addition, communication failures in 2013 and 2014 were one of the most frequently reported processes.  This data could indicate there is opportunity for nurses and physician/providers to improve communication and collaboration. To fulfill their role as advocates, nurses must be involved in making decisions about patient care (American Nurses Association, 2001).

The American Association of Critical Care Nurses (2005) describes how organizations have successfully implemented professional care models to attract and retain nurses. These models foster responsibility and respect through authorative care models that supports autonomous practice. Continuing education, specialty certification, and participation in professional organizations are valuable for life-long learning opportunities in nursing. When nurses are empowered through knowledge, the nurse and the provider become aligned in a collegial, respectful, and problem solving partnership.

Another factor identified in the literature is that communication is necessary and should be a high priority for both nurses and physicians.  In addition, the need for the healthcare team to have frequent and skilled communication is necessary to facilitate integration of care.  Integration of care between the nurse and providers is critical for optimal outcomes (The American Association of Critical Care Nurses, 2005).  The creation of a resource toolkit will enhance system knowledge and skills needed to improve communication and collaboration. This education will assist in creating a sustained culture of collaboration with the goal of improved patient outcomes. A culture of safety requires all members of the healthcare team to develop professional communication skills (The Joint Commission, 2002). 

In short, effective collaborative communication has a number of direct and indirect influences on patient care. The goal is to relinquish hierarchies and miscommunication resulting in a better collaborative practice setting around patient care. Through the use of highly integrated teams patient safety is improved and satisfaction in the professional practice setting (mainly nurse and provider) can be improved (Olenick, Allen, & Smego, 2010).