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Adapting to the new workplace reality: maximizing the role of RNs within a collaborative nursing practice model.


Editor's note: This is the fourth of six articles looking at how registered nurses can best adapt to changes in the mix of nursing care providers in the healthcare system. The topics previously covered are: "Professional Nursing Practice: Requisite Capacities," "Professional Nursing Practice: Rule of Three," and "Organizing Nursing Care."

It is the hope of the Practice Department that each article will provide information to registered nurses on how to interpret professional nursing practice from a registered nurse point of view and to assist the registered nurse in understanding their professional role and responsibilities in the context of a collaborative practice setting which includes other nursing care providers.

This article focuses on collaboration, working together to meet a common goal for the provision of safe, ethical and competent nursing care. Collaboration is important in the development of professional nursing practice and as a way to improve patient outcomes.

Part 4: collaborative Working Relationships

There are a variety of patient care delivery models in which nursing care can be provided to ensure appropriate use of nursing resources. These models may include registered nurses, licensed practical nurses, and unregulated health care workers. Regardless of the delivery model being implemented, the model must be structured to support collaboration and cooperation among the nursing team, to improve the coordination and communication of patient care and to optimize continuity and timely delivery of patient care.

As other nursing care providers and new skill mixes are introduced as nursing care delivery evolves in response to workplace and human resources realities, relationships between nursing care providers must also be reconfigured. This requires that all nursing care providers understand each other's roles and unique contributions.

Collaboration is like a handshake. Prior to joining hands, two individuals stand separately. The character of the hand-shake influences the interaction that follows between the two individuals. Collaboration is characterized by an atmosphere of mutual respect for one another's knowledge and competence and a mutual concern for the provision of quality care.

Practice Expectations for Working with Others

The 2005 Standards of Practice for Registered Nurses outline expectations for RNs when working with others. Each nurse:

* collaborates with health care team members about the client's care;

* demonstrates knowledge of, and respect for, each other's roles, knowledge, expertise and unique contribution to the team;

* establishes and maintains collegial professional relationships;

* articulates nursing's contribution to the delivery of health care services;

* provides feedback to others to support their professional development;

* demonstrates the values and beliefs of the profession in professional conduct; and

* recognizes the impact of their own attitudes, values and beliefs on practice.

Additionally, the revised 2008 Code of Ethics for Registered Nurses builds on these practice expectations by stating that nurses relate to each other and colleagues in a respectful manner.

Inherent in these practice expectations for RNs regarding collaboration and working with others are the following competencies:

* Effective communication and interpersonal skills

* Mutual respect and trust

* Understanding the role of all nursing care providers

* Professional judgement and decision-making

* Understanding teamwork

* Leadership skills

* Accepting accountability for one's own actions and decisions

Best Practice Guideline (BPG) for Collaborative Practice Among Nursing Teams

Effective nursing teamwork is essential to the work in health care organizations. To that end, the Registered Nurses Association of Ontario (RNAO) has developed a best practice guideline (BPG) that focuses on nursing teams and collaboration. The BPG was developed to enhance positive outcomes for

* patients, nurses and the organization and includes: processes and characteristics of a nursing team that support a healthy work environment; and

* communication, coordination and collaboration within the nursing team.

The Collaborative Practice Among Nursing Teams BPG can be found on the RNAO web site at


More than ever, nursing care providers need to work together collaboratively and promote a collegial work environment. Establishing and maintaining collegial relationships requires nurses to use a wide range of communication strategies and effective interpersonal skills. We all have a duty to know and acknowledge each colleague's role and unique contribution to the team effort. Respectful behavior among nursing staff contributes to the best possible outcomes for patients.

Practice Capsule

Collaborative Working Relationships: Practice Expectations for the Registered Nurse and the Licensed Practical Nurse

The Nurses Association of New Brunswick (NANB) and the Association of New Brunswick Licensed Practical Nurses (ANBLPN) believe that there must be open and ongoing communication between nursing care providers in order to foster collaborative working relationships. These collaborative working relationships must be built on the values of working together, trust and mutual respect. As scopes of practice continue to evolve over time, it is essential that there is cooperation between all nursing care providers.

Working Together: A Framework for the Registered Nurse and the Licensed Practical Nurse (2003) is a joint document between NANB and ANBLPN. This document is currently under revision to better reflect today's work environment. The revised document will be retitled Collaborative Working Relationships: Practice Expectations for the Registered Nurse and the Licensed Practical Nurse.

The revised document will highlight practice expectations and the contributions that the RN and LPN bring to the care setting.

As part of the revision process, the draft document will be distributed to a number of registered nurses and licensed practice nurses across the province in order to validate the updated document.

For more information on collaborative practice and working with others please call the NANB Practice Department and ask for a practice advisor 1 800 442-4417, 458-8731 or


Canadian Nurses Association (2008). Code of Ethics for Registered Nurses. Ottawa: Author.

Nurses Association of New Brunswick (2005). Standards of Practice for Registered Nurses. Fredericton: Author.

Nurses Association of New Brunswick and Association of New Brunswick Licensed Practical Nurses (2003). Working Together: A Framework for the Registered Nurse and the Licensed Practical Nurse. Fredericton: Authors.

By the Practice Department
COPYRIGHT 2008 Nurses Association of New Brunswick
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 2008 Gale, Cengage Learning. All rights reserved.

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Title Annotation:registered nurses
Publication:Info Nursing
Geographic Code:1CANA
Date:Sep 22, 2008
Previous Article:Promoting good practice.
Next Article:CADTH launches first-ever podcasts/audio summaries of HTA reports.

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