Episode panel discussion on interprofessional collaboration on Nursing Notes Live this month. We learn how inter-professional collaboration between nurses and other health professionals impacts patient care. In this episode of the Nursing Notes Live podcast, I got the chance to sit down and chat with our panel of nursing experts including Heidi Sanborn, clinical assistant professor at the Arizona State University College of Nursing and Healthcare Innovation in Phoenix, Ariz. and Mary Meyer, clinical associate professor and director of the clinical learning laboratory at the University of Kansas Medical Center in Kansas City, Kan. Here’s that discussion.
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Jamie Davis: Heidi and Mary, it’s great to have you both here on the show with us this month. We’re going to be talking about interprofessional collaboration here in this episode but before we get to that I always like to ask my nurse guests here on the show a little bit about their background in nursing. Heidi, we’ll start with you. Why don’t you tell us a little bit about why you wanted to become a nurse?
Heidi Sanborn: Well, I actually came to nursing from the business world. I had started my career, got a degree in business, worked in business for several years. In that process, I was working as a paralegal in the medical malpractice suit, a law firm that dealt with asbestos litigation. I found that I would spend more and more time with my clients talking about diagnoses and navigating healthcare and who they should call and what does diagnosis might mean. That was the trigger for me that maybe I might be in the wrong profession. I did a lot of soul-searching and realized that, “Well, I was going down the wrong career path.” So made the leap into nursing from there and just haven’t looked back. It was clearly the right move for me. It was where I was meant to be. Now I find that I’m sort of merging those two experiences into one career.
Jamie: I also come from another background. I was originally a journalist before a nurse and it’s very interesting to see how you bring something from a previous career into nursing. They actually were able to complement things very well. Do you find that to be true as well?
Heidi: Absolutely, especially with business. The business world really is about interprofessionalism. You take it for granted. That different disciplines are going to be sitting down side-by-side in a meeting working collaboratively towards a solution. Healthcare, surprisingly, didn’t have that perspective. For a long period of time, it was a nursing meeting. It was a provider meeting. Everybody was very specialty-focused. So switching from business into health care, for me, I’ve always looked at things interprofessionally. Those skill sets really have proved to be very fruitful for me in my own career. But yes, I agree those skills I think are much-needed in healthcare and they’re very valuable.
Jamie: Mary, how about you? Why did you want to become a nurse?
Mary Meyer: Well, opposite end of the spectrum here. When I was in high school and we needed to make our decision about our futures – I have been a nurse for 35 years, so you can think back 35 years ago – we women were teachers or nurses. I came from a family of teachers and I did not want to be a teacher – and how funny that that’s exactly where I landed some 30-some years later. I chose nursing because it was so versatile. I didn’t really know if I would be a good nurse or if that’s what I really wanted to do. But I knew that surely somewhere in acute care, community-based healthcare, office and clinics, somewhere there must be a fit for me. I did it totally because of the versatility. I guess, like Heidi said, I have not looked back either. It’s been a wonderful career. Most of my career has been with cardiovascular surgical practices, but I came to academia probably around 12 years ago now. The reason I made that shift was because the best days that I had when I was in practice were days that I spent with students. So that’s kind of my journey in a nutshell.
Jamie: Do you find, Mary, that students are really coming out prepared for that interprofessional practice? Is this something that nursing schools are focusing on? I know in the program I help out with there seems to be a lot of focus there, but is this something that’s happening across the board?
Mary: I believe that we are getting more information about it. I think that curriculum revisions tend to come in – they’re kind of cyclic. So the fact that we just had a curriculum revision approximately five years ago has made a big difference for us. So we’re embracing all of the new competencies that have come out on the interprofessional education front. I think most schools are in some version of that.
Jamie: Heidi, what are your thoughts?
Heidi: Well, I agree with Mary. I think that most schools, at this point, have interprofessionalism on their radar map. I think that, to some degree, interprofessionalism and interprofessional education are not new concepts. It’s been around since the 1970s as far up the World Health Organization. So this isn’t a new idea, but as we know with research practice gaps, right, there is a lot of knowledge that we need to go here, but it takes a lot of time to get there. I think only in recent years, probably in the last decade, the whole concept of preparing nursing students to be interprofessional practitioners has only just started to really gain attraction and momentum that it needs to. I think we’re getting better at it. I think we’re still in a where we know where we need to go, we’re not entirely sure the best way to go about doing that. Part of that is the diversity in education, right? Some nurses come through as online program. Some nurses come through in traditional face-to-face classes and every gamut in between those two extremes. How do you educate every nurse in every type of program to meet the same end? I think that’s where we’re still exploring and trying on different ideas and seeing what works. I think we’re getting closer and closer to the goal, which is having nurses fully prepared to practice interprofessionally.
Mary: I realized that Heidi was speaking that one of the big important things that happened was to actually get a definition of what is “interprofessional education”. Because I think maybe we thought we were doing it and by putting students from multiple professions in the same classroom and teaching them some healthcare topics that we’re shifting across professions but when the I-TECH competencies came out they actually told us that interprofessional education happens when students from two or more professions learn about, with, and from each other. So having that definition to fall back on now I think makes us better at planning our education opportunities.
Jamie: It’s interesting you said that about definition because that was something that I was going to ask next. It’s not just teamwork, is it, Heidi? That’s the simplistic way of looking interprofessional practice, but it’s more than just saying, “We’re going to work as a team.”
Heidi: Yes, you’re right, teamwork is a very – or collaboration is really nice buzzwords that make a lot of sense and resonate with just about everybody out there. We understand that that’s how we have to practice. But really implementing that is the nugget of that. How do you have two different disciplines who’ve gone to school and learned completely different discipline-specific languages, different ways to look at a diagnosis, for example, and how to go ahead and treat that diagnosis and now we have to merge our to-do list, if you will, and work on that from a similar perspective where we’re both been educated on two different ends of the spectrum. That’s really the nugget. Yes, is teamwork the right word? To some degree it is, but there is certainly much more to that. It’s learning to speak a similar language. To go back to what Mary said about the definition, that’s exactly right. If we learn from, about, and with other disciplines that is very robust. We understand the language other disciplines are speaking. We understand the priorities that other disciplines may have. So we all may look at a patient with heart failure, for example, but we’re all looking at very different aspects of that and neither aspect is incorrect or correct. It’s certainly not all-consuming, but when you merge those altogether that’s when we really reach a goal of providing care that is efficient with both time and resources be that money, staff, what have you. That’s really where it is. Teamwork is a very simplistic definition.
Mary: I would add that one of the things that has sort of evolved for me as I’ve helped with these interprofessional programs with the students is we talk about everyone’s role. What the students told me is our roles are really more alike than they are different. So I think a big component of this, especially as we try to control the cost of healthcare, is to try to figure out where our roles overlap and then manage that.
Jamie: That’s interesting. I like that thought because there is more we have in common. We’re all focused centrally on that patient and the positive outcome but we come at it from different directions. I know I initially got into healthcare as a paramedic before I was a nurse and so I learn more of a medical approach to patient care. When I got into nursing I really had to shift my brain a little bit. But training together seems to help with that understanding. Mary, have you seen this in practice with your students?
Mary: I believe, yes, we have, but on the other side of that coin, our students are in our little ivory towers where we train them in team steps or in the best practices for communication and that may not be what they see when they go out on to the units and to practice. So that’s a challenge.
Heidi: That’s a good point, Mary, because that’s absolutely true. I think unfortunately, in some ways, academia is almost leading the thought process here, which is that we all need to work together to get a job done. Yet our students are going out into clinical situations and the clinical setting really has not effectively implemented interprofessionalism top to bottom. There’s still a lot of room for improvement in that. Nursing students are getting a very mixed message sometimes from what they get in the classroom pie-in-the-sky idealism of this is how it’s going to work. Then they go into a situation clinically where they’re learning the nuts-and-bolts and the how-to’s of everything and they are not seeing it modeled effectively in a clinical environment. That’s a big gap that we still need to work on.
Jamie: What’s the solution, Heidi? Do we just have to wait until there is enough new nurses out there to create a critical mass and other professionals educated this way to create that critical mass to move this process forward clinically or is there a way that a nurse listening to this program can begin to be a champion for that?
Heidi: Well, I think there’s two elements to that and I think you hit on both of them. One certainly is a culture shift. We need to move to a culture where discipline see themselves as having value, as having a voice at the table and having something to contribute and being comfortable contributing that. So yes, there is a culture shift that needs to occur across all disciplines to start looking at each other as equals with different important aspects that they contribute to the process rather than a hierarchical structure where this clinician is the decision-maker and this clinician is the worker bee if you will. So there is certainly that culture shift that has to happen but can new graduates – can nurses at any stage of their career hone the scale and develop it on their own? Absolutely. And this is what I found in my own career is that being unafraid to speak up is really where it starts. If I saw something happening from a different disciplines that I didn’t understand I would take the time to insert myself in the conversation, introduce myself and say, “I was trained to do this with this patient and I noticed that you’re doing something different, can you explain to me why you’re doing that? Well, how can I have a role what can I do to support you making that happen?” So something as simple as just making that collaboration happen in your day-to-day interactions with other disciplines. That step number one being unafraid to connect with other disciplines and learn from each other and being self-directed with that. Number two is really getting involved in interdisciplinary events at your clinical site wherever that may be. There are so many committees now at hospitals, acute care facilities, community health organizations that are truly interdisciplinary. They want to hear all the disciplines at the table contributing. So volunteer to be on that committee. Be the nursing voice in a committee that is only populated by speech language pathologist and come in and be part of that process. As we’re willing as clinicians to break down those walls it only helps that culture shift that we need to see happen.
Mary: I think those are great points, Heidi. It’s kind of like we need to be able to understand each other’s story and our own story. I think nursing has a long history of not being very well-versed in terms of articulating what it is that we do that is different than the other professions. In fact, I think the ANA just put out the challenges for nursing that are forthcoming. One of the big challenges is: are we going to be able to assert these special talents that we bring? Are we going to be able to hold around and hold our place in this interprofessional world with so much role overlap? I think it remains to be seen and we are going to have to have nursing needs a strong voice.
Heidi: You’re absolutely right. Hasn’t that traditionally always been the issue with nursing? It’s that we’re afraid to have a voice. I think that goes back to what we’re just talking with that culture shift. If you look at nursing historically, nursing was raised to be at the bidding of another discipline. That really has shifted and I think that expectation has changed. Yet we still, to some degree, play that role as nurses. It’s very difficult to identify if somebody with values, somebody who can drive the process. That’s where we all need to be brave explorers, step up, be that voice and be present in all conversations.
Mary: Great points.
Jamie: Yes, we’re seeing that I think being driven as well by a lot of changes. I’ve seen just news announcements that I follow periodically on nursing that we see a lot more nurses entering executive positions in the hospital setting, which makes them agents for change.
Mary: That’s absolutely true.
Heidi: Yes. That is one of the big pushes I think is to get the nursing voice in the board room. Traditionally nurses tend to not escalate to those level of positions. But if we are going to have a voice in directing how care is delivered, how things are managed on a clinical basis, nursing has to be present. If we’re 80% of the workforce, we need to provide at least 50% of the voice in the conversations. We’re not there yet, but we’re getting there. I think the awareness is growing. I think there’s a lot of programs out there for nurses to attain graduate degrees, MBA/MSN dual degrees. So I think we’re starting to explore that and we see the value but we’re still in the infancy stage to some degree.
Mary: One of the things that I remember from one of our classroom interactions between medicine, nursing and pharmacy, the students were quite so focused on the number of years that they have trained. So I guess the currency is if I have a six- or seven- or eight-year education then I must be more able to lead than the person with the two-, three-, four-year education. So I think it’s those kinds of inconsistencies that will continue to trip nursing up.
Heidi: That’s a big point, Mary, and I think that’s obviously a very delicate subject that nursing has been grappling with for years and years. I graduated nursing school in the ‘90s. It was a big conversation than that I was told it had been going on for decades. Yes, I think there is a whole undercurrent of a different discussion that would have to happen to smooth out those issues. There’s a progression that needs to occur. I think you’re right. We’re still grappling to some degree with that. You’re right, that people do identify, even within nursing – I was just speaking with a colleague this morning and we were talking about the progression of nursing. I felt this acutely going from different disciplines within nursing – go from a clinician to a clinical educator to an academic educator. Each time you move to a different – whether it’s going from MedSurg to critical care, for example, that fluidity within nursing is very attractive thing. Mary, you spoke to that as to your own experience, right? I think, to some degree, we all love that about nursing. But each time you start a new identity within nursing, you go back to those questions, “Well, how long have you done this? How many years of experience you have?” Clinicians of all degree, whether it’s education or experience, we are all very focused on that number behind your name rather than what can you contribute to the conversation. What aspects of your experience, whether it was two months of experience or 25 years of experience, we all have something to contribute to the table. We undermine that process by asking for numbers behind it. Those numbers don’t always validate the value of what comes out of somebody’s mouth in a meeting.
Mary: Yes, I agree.
Jamie: That kind of brings us to the point of, in a collaborative setting, in a teamwork process where we’re dealing with patient care, we need to enable that – I don’t want to say “least” – but that person who is seen as the least member of the team give them the ability and the power to be able to speak up.
Heidi: Yes, that’s certainly an issue. Again, going back to what we said that’s an issue that nursing really struggled with. Yet, what we need to focus on more is the knowledge we’re bringing to the table. One of the things with interprofessionalism that we’ve learned is that we all need to learn to speak a common language. You have to avoid disciplines with a specific terminology when you’re in a meeting with multiple disciplines sitting at the same table. They just don’t speak the same language. So that’s something that we all need to be aware of as practitioners. So if I can bring my experience to the table – my experience, maybe I’ve had 12 hours at the bedside with this particular patient. I’ve identified these eight different issues as I’ve talked about their personal situation, their social settings, and their family scenario. I can bring the knowledge to the table and that can really impact what the other disciplines may choose to do with that patient. So the value is again, not that I have 20 years of experience or two months of experience, the value is that I know my patient and I know the common terminology that we all speak together. If I can merge those two pieces and bring that to the table, everybody can benefit from what it is I have to say regardless of where I come from, what my training was. If I know my patient – interprofessionalism starts with the patient. They really are the center of that team. Nurses, more than any other discipline, know their patients very deeply because of the amount of time that were afforded to spend with them compared to other disciplines. By default, by doing our daily job, we bring more to the table in terms of knowledge of that patient. That’s the value that nursing has.
Mary: I think those are excellent points, Heidi. I’m kind of setting your thinking. Most of us went into nursing because we really wanted to help people, so we have that real caring side of us, and perhaps also enjoyed the biology and the science piece. I kind of think that describes me anyway and a lot of the students that I work with. We tend to be a little introverted. So I think any tool that we can give students and practicing nurses that can help them, and what’s coming to mind for me is some of the TeamSTEPPS tools that are out there – the IFR or the CUS – those are little strategies that a nurse who maybe isn’t as comfortable in her shoes, she can still fall back on those little communication strategies that would kind of help her be the advocate for the patient and help her speak up, he or she.
Heidi: Great point.
Jamie: That’s a great segue into my final question or topic here. That is, in this time of year we have a lot of students coming back to school or maybe starting their first year of nursing school. I would ask each of you, and I’ll start with you, Heidi, share with us that piece of advice that you share with somebody when you find out they’re a brand-new nursing student. What is it that they can bring to school that’s going to best help them move forward successfully?
Heidi: Well, my personal experience in business, and I happen to teach mostly leadership and innovation courses now, so that’s my love and that’s sort of where I view nursing and where I think the value of nursing lies in the future. For me, the piece of advice I would give is embrace the fact that you are going to be a leader. Most new nurses will say, “Well, no, I knew I don’t know anything yet. I don’t have the courage to go up and speak to another person on the floor because I’m sure I don’t have anything to contribute to the conversation.” What I hope all of my students learn as they progress through the program is that even by following effectively, we’re valuable leaders. So I think that nursing has to start embracing that idea. That you are going to go forward and become a leader in the industry because you are going to be that voice for the patient and that’s where nursing really exceeds, is developing relationships with patients and providing leadership skills to advocate for that patient. That’s really the core of what we have to do. So the sooner that we can start identifying ourselves as leaders with value in industry, that’s when we can start to realize our full potential as nurses. That starts with not being afraid to speak up. Time and time again in a clinical setting, I’ve seen a really shy nursing student identify some key aspect on a patient and have been afraid to say anything other than to me as the clinical instructor. “Well, I noticed this happened today, what should I do?” I think you need to tell somebody else about what you just witnessed. As Mary said using an organized communication format. If you can learn how to communicate those little tidbits of information, you can really impact the care that is given to each patient. So there’s a lot more value that nursing students hold than they ever realized that they’re going to hold when they walk into nursing school the first day. That would be my advice, is to be open to the fact that you contribute so much more than you will realize you are able to contribute as a nursing student.
Jamie: Wow. What you said about that clinical setting situation, like maybe flashback to my own nursing school experience. I swear I must’ve had a clinical instructor say the same thing to me at some point. That’s so important to direct students and new nurses to speak up for themselves in the clinical setting. Mary, what about you?
Mary: I teach undergraduate skills, basic therapeutic interventions and basic assessment. So when the students have to perform in the lab in front of the judge, their teacher, they get really anxious. One of my colleagues made that connection that nursing is a performance degree. I never thought about it that way but it is. We perform in front of our faculty. We perform in front of patients. We perform in front of the other health professions. So if you can put on the mantle of the nurse and say, “Nursing is a performance degree. I have to practice in order to perform well,” then I think we can get past all of our anxiety and our shyness and our introversion and maybe speak up for the patient and speak up for our profession.
Make sure you check out the entire August 2015 issue of Nursing Notes where we learn how inter-professional collaboration between nurses and other health professionals impacts patient care. You can read the entire issue online at www.discovernursing.com and don’t miss the other Nursing Notes Live episode this month where I sit down with our Get to Know nurse Shanita Williams, a program officer at the Health Resources and Services Administration (HRSA) for the National Center for Interprofessional Practice and Education (NC-IPE) cooperative agreement award in Rockville, Md. We talk about her nursing career path and the importance of providing a nursing perspective to hospitals to improve teamwork and patient outcomes. You’ll find this and other episodes of Nursing Notes Live in the podcast area on iTunes as well as our new podcast player on DiscoverNursing.com!