What Exactly is a Nurse?
According to the American Nurses Association, “Nursing is the protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities, and populations” (American Nurses Association, 2014). While this summary of nursing may appear to be somewhat vague and all encompassing, it is an accurate representation of the profession as well as nursing models. Though there are multiple different models, most take on a holistic approach that focuses on treating the patient as an entirety: seeking health physically, mentally, psychologically, socially, and spiritually. Nursing, in short, is a profession in which you help people to function their best through the many different avenues of life. The path traveled may be one of remission from cancer, transition into motherhood, or something entirely different. In order to gain a more comprehensive perspective on what a nurse does, visit the ANA website at http://www.nursingworld.org/especiallyforyou/what-is-nursing.
A person seeking to work as a nurse has the option to pursue any one of the multiple educational pathways that will allow them to gain eligibility to take the National Council Licensure Examination (NCLEX)-RN (ANA, 2014). The various pathways include: a Diploma in Nursing which is offered through hospital-based schools of nursing, an Associate Degree in Nursing (AND) which is a two-year degree at a community college or hospital-based school of nursing, or a Bachelor of Science in Nursing (BS/BSN) which is a four-year degree at a college or university (ANA, 2014). While the AND degree focuses more on the technical aspects of nursing, a BSN allows a person to participate in a wider scope of practice and more flexibility to work in various health care settings.
Lastly, nurses have the option of returning to school in order to obtain a graduate degree. Registered nurses can gain further expertise by completing one of the following advanced degrees: a Master’s Degree (MSN) to prepare an RN for advanced practice nursing such as a nurse administrator or a nurse educator; a Doctor of Philosophy (PhD) program in which individuals can become involved in teaching and/or conducting research; and a Doctor of Nursing Practice (DNP) program, which focuses on leadership in clinical practice (ANA, 2014).
Other Members on the Health Care Team
In addition to nurses, there are a number of other professionals that help to comprise a functional health care team. Each member of the team travels a different route to begin practice, allowing them to have a unique perspective and valuable input which are necessary for the achievement of optimal patient outcomes. Joint collaboration of team members with differing perspectives and expertise allows for increased insight and problem solving techniques that may not otherwise be utilized by a single health professional (Westberg & Jason, 1993). In order to appreciate what fellow team members with differing backgrounds bring to the table, it is important for each health professional to have an understanding of their fellow members’ backgrounds and scopes of practice. There are many advantages to interdisciplinary team care, including: improved care for patients by increasing coordination of services, increased professional satisfaction, heightened appreciation and understanding of other disciplines among students and educators, as well as a greater maximizing of health care resources and facilities (Grant & Finocchio, 1995).
*Physician
One of the more recognizable health professionals, both to patients and health care staff, is the physician or doctor. To many, the physician is the person who is ultimately in charge, calls the shots, and makes the important decisions. The medical model, which is disease focused and centers on diagnosis and treatment of illness, is the model which most patients associate with health care. This model also helps to illustrate one of the most important responsibilities within a physician’s scope of practice: making a medical diagnosis. After speaking with a doctor practicing in emergency medicine on how he perceived his role within the healthcare team, he stated, “As a doctor here in the ER, you are forced to make a lot of big and important decisions in a relatively short period of time. This is why you spend so much time in school and preparing before actually practicing. In many ways I do see myself as a leader of the health care team, but also a collaborator with others. Without others [health professionals] doing their part, it would be a lot tougher for me to do mine.”
When asking a medical student on the extent of education that was required to achieve a Doctor of Medicine Degree, she responded, “First you get your undergrad, and then do four years of med school, and then you must do a residency program in order to begin practicing.” After asking about more specifics, she stated that a typical residency program is three years long, however, specialties such as cardiac surgery, require an individual to partake in a longer residency program lasting up to five years.
The medical student was then asked about her opinion of nurses. It cannot be determined whether or not her response was influenced by the fact that she was aware she was speaking to a nursing student, but her answer consisted of the following, “I think nurses do a lot. We go through separate training programs, but it’s not like one is more important than the other. I know there are a lot of nurses out there who really know their stuff, and once I start my practice I plan to use them as a resource, at least until I know what I am doing more.” While this is the response of an aspiring doctor still enrolled in medical school it would be fascinating to know whether or not her opinion of nurses would change over time. She was aware of the fact the in order for an individual to obtain a nursing degree, they were required to do college coursework. She was a bit confused about what an actual nursing model would be, and defined nursing scope of practice more by what was not included in it: diagnosing conditions.
*Unit Clerk
Unit clerks, sometimes referred to as receptionists, can be found working in almost every type of health care facility. While many of these positions do not require a college degree in a specific area, many who work in this role have some advanced education. Depending on their specific place of employment, job duties include, but are not limited to: answering phones, ordering supplies, and helping both health professionals and patients “navigate” their surroundings. In order to gain more insight about a unit clerk’s role, an interview was conducted with a young woman working as a unit clerk at a long-term care facility. She stated that each day was different, some slow and some overly busy. She is responsible for what some people may take for granted, such as ensuring appointments are arranged and kept. In regards to her education, she stated that she has a high school degree and her Certified Nursing Assistant (CNA) license. In addition to working as a unit clerk, she works as a CNA on other days of the week. Though asked, the unit clerk stated that she was unaware of any practice model that pertained to her job.
Unit clerks are great members of the health care team to utilize if you have a question. They may not know the answer themselves, but they are often able to point you in the right direction. At another time, the Director of Nursing (DON) of this facility was heard saying, “[name of the unit clerk] is the mortar between the bricks of this building. Without her the whole thing may just fall apart.”
After asking the unit clerk about how she perceived nurses, she replied “They seem busy, really busy. And stressed out. I’m glad I don’t do what they do. I think I would be too stressed out.” While nursing, or rather any personalized care of individuals, has the potential to be a highly stressful job, it is somewhat concerning that the impression given off by some nurses is that nurses are constantly stressed. This may blind others to the rewarding sides of nursing, such as seeing a patient improve and overcome a major hurdle on the road to becoming healthier. The unit clerk was knowledgeable about the education required to become a practicing nurse, knowing there are several different education pathways that can be taken, some two and others four years in length. She defined the nursing model as “helping patients to get better and back to their old selves.” In regards to scope of practice, she felt that nurses may technically have a limited number of things they can do, though exercise a lot of decision-making. In her mind, nurses at the facility often were the leaders in patients’ care, and involvement of the physician usually just consisted of gaining his or her approval by the nurse.
*Pharmacist
For many in the community, the pharmacist is a person whose role is easy to define: they are experts when it comes to medications. They can tell you what a medication is used for, as well as its side effects. What many do not always realize is the amount of education it takes to become a pharmacist. In order to be an expert on medications, the pharmacist must first understand the body. To practice as a pharmacist, one must obtain their Doctorate of Pharmacy Degree (PharmD). The requirements for obtaining this degree include: two years of undergraduate coursework, a passing score on the Pharmacy College Admission Test (PCAT), followed by a four-year pharmacy program, accompanied by a series of 7-10 rotations in a variety of clinical and pharmaceutical settings each lasting 4-6 weeks in length (About.com, 2014). Though all this education could potentially be completed in six years, most students will end up taking eight years of college to finish with their degree (About.com, 2014). More information on becoming and practicing as a pharmacist can be found by clicking on the following link: http://healthcareers.about.com/od/healthcareerprofiles/p/PharmacistJobs.htm.
When asking a pharmacist about his practice he said “Yes, we [pharmacists] do make pretty good money, but there is a lot we are expected to know.” With the ever increasing number of drugs on the market, the reliance on a knowledgeable pharmacist continues to increase. It is clear that doctors, nurses, and other health professionals utilize pharmacists as a valuable resource in the emergency room setting. During a trauma situation, the pharmacist is often present in the room, drawing up drugs and handing them over to be administered as the doctor orders. In an emergency setting, this is the most effective and efficient way in which a doctor can order a medication to be administered based on assessment findings and the pharmacist can check and approve the order before actual administration.
After asking the pharmacist about his opinion of the nursing profession he pointed out that nurses do more hands on work with patients than pharmacists do. As a pharmacist, he felt that he needed to be able to communicate with patients, but he thought patient communication was even more important for someone going into the nursing profession. He also stated that he enjoys when people [doctors, nurses] come to him with questions because it makes him feel useful and respected that others acknowledge his expertise. His impression of the nursing model, was that nurses are to help the patient achieve optimal functioning. Working with a lot of nurses, he was well aware that a lot of practicing nurses, at least employed at hospitals, had acquired a Bachelor of Science in Nursing Degree.
Barriers to Effective Teamwork Among Health Professionals
After investigating interview responses, it is clear that one’s perspective about nurses or other health professionals is strongly influenced by where one actually practices. While most professions have an idea of the amount of education required of other professionals (extensive education, undergraduate coursework, etc.), many are unaware of the exact requirements and clinical experience obtained. This leads to an undermining of the expertise associated with different professions, resulting in decreased effective collaboration and utilization of valuable members on the health care team.
One point of interest was the perception of nursing that was held by other health professions. While many acknowledged the fact that nurses play an important role in patient care, many healthcare members seemed unfamiliar with what nurses actually do and where their expertise lies. This lack of knowledge about the nursing profession is not necessarily a bad thing, but rather shows the beauty of nursing. Nurses have the ability to fill so many different roles, in so many different settings, working with very diverse populations. While this expansive variation makes nursing a very exciting profession to enter, it makes it a challenging profession to define to others.
The struggle to define one’s profession to others can very easily be misunderstood. It can be perceived as a lack of competence and knowledge regarding one’s own practice. Perceptions such as this lead to decreased confidence in the health team member, resulting in decreased collaboration and non-optimal teamwork. To overcome this, individuals should be asked to reflect on their roles and scopes of practice, as well as encouraged to share this information with others on the health care team. This may help to increase the level of trust and understanding amongst team members, helping to set the stage for enhanced quality care.
Lastly, it is clear that many health care professions require education regarding basic functions and pathophysiology of the body. It is interesting that the learning of this material is often separated for each profession. Why not let individuals from various professional backgrounds learn this information together? This could allow for connections to be made across professions, leading to enhanced teamwork down the road.
Nursing Leadership and Voice
In order for nurses to take on leadership roles when it comes to interdisciplinary health care teams, they need to have a thorough understanding of their unique profession, as well as the professions of those with who they collaborate. Without this understanding, a lack of confidence in oneself is a likely culprit for why many nurses shy away from roles as leaders. In order to increase nurses’ confidence in their leadership abilities, nursing schools should promote exercises involving interdisciplinary situations. This will help students pursuing a variety of professions to become comfortable interacting with those who have different educational and clinical backgrounds, helping each to strengthen their voice and contribute to the team.
Systems Theory
The interdisciplinary health care team is in and of itself a system. It is multiple interdependent parts (the various professions) regularly interacting with each other to form a unified whole (the health care team). What can be improved is the degree to which these parts are unified. To improve this unification, the structure of the system could be modified from a more traditional hierarchy model to one that places team members on a single level playing field. This encourages collaboration and allows each member to take full responsibility of their contribution to the group. Relationships could be improved between system parts, or rather members, by implementation of more extensive interdisciplinary education. Greater unification leads to increased efficiency, enhanced safety, and improved patient outcomes. By helping individual health professionals to understand that they are an integral part of the health care team, or “whole,” this will help the entire team to ensure that the “whole” patient is being properly cared for.
Professional and Interprofessional Practice
Changes to professional and interprofessional practice are more easily made when starting further down the totem pole, at the education level. Those who have been in practice for several years are often more resistant to change because they may be more comfortable with doing things a certain way. Young minds, still in school, are somewhat more malleable, allowing for the budding idea of increased interprofessional practice to really grow. Integrating the concepts of interprofessional practice and collaboration into educational programs and curriculum holds the potential to revolutionize health care. Health care in which the patient does not just visit with their doctor, but seeks the care and support of a comprehensive health care team. A patient will never feel comfortable doing this, unless they are confident that a team actually exists. In order to develop teams, teammates must begin to “play together” and in order to play well, the team must first practice. This practice is interdisciplinary education, a time in which team members learn to work together and develop trust.
Value: The Quality of Nursing Care and Outcomes
As stated in the article “Interdisciplinary Evidence-based Practice: Moving from Silos to Synergy,” (which can be accessed at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2998190/), “Interprofessional collaboration is foundational for improved patient care” (Newhouse & Spring, 2011). As disciplines are better aware of each others’ backgrounds and scopes of practice, each will also become increasingly aware of what others expect of them. This expectation results in a heightened sense of responsibility among nurses and other professionals, leading to a higher standard of care to be delivered. The increased collaboration between professions and the migration of an increasing number of nurses into leadership roles will help nursing maintain a strong voice regarding care provided to patients.
Implementation of Strategies to Improve Interdisciplinary Practice
The importance of interdisciplinary training and practice is evidenced by strategies included in the U.S. Department of Health and Human Services Maternal and Child Health Training Program (MCH). The program “…Provides national leadership and direction in educating and training our nation’s future leaders in maternal and child health. Special emphasis is placed on the development and implementations of interprofessional care…” (U.S. Department of Health and Human Services, 2014). Several strategies are listed as to how to achieve the program’s goal of promoting interdisciplinary training, practice, and collaboration. These strategies include supporting interdisciplinary graduate education and training programs that emphasize leadership, as well as facilitating interdisciplinary practice opportunities for students and faculty in MCH training programs (U.S. Department of Health and Human Services, 2014). MCH’s acknowledgment of the need for improved interdisciplinary practice clearly demonstrates their belief that improvement in this area will lead to better patient outcomes.
References:
About.com: Pharmacist jobs. Retrieved 4/20/14 from http://healthcareers.about.com/od/healthcareerprofiles/p/PharmacistJobs.htm
American Nurses Association: What is nursing. Retrieved 4/20/14 from http://www.nursingworld.org/especiallyforyou/what-is-nursing
Grant, R. W., & Finocchio, L. J. (1995). Interdisciplinary collaborative teams in primary care: a model curriculum and resource guide. California Primary Care Consortium Subcommittee on Interdisciplinary Collaboration.
Newhouse, R., P., & Spring, B. (2011). Interdisciplinary evidence-based practice: moving from silos to synergy. Nursing Outlook, 58(6): 309-317. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2998190/
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Retrieved 4/21/14 from http://www.nacc.org
U.S. Department of Health and Human Services: Maternal and child health. Retrieved 4/20/14 from http://mchb.hrsa.gov/training/about-national-goals-G3.asp
Westberg, J., & Jason, H. (1993). Collaborative clinical education: the foundation of effective health care. New York: Springer-Verlag.
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