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As nurse's role evolves, practice teamwork dynamics continue to face challenges


We get by with a little help from our friends — the hook of a seminal pop track and the essence of a thriving practice.

[See also: PCMH model a success to be reckoned with according to PCPCC report]

It’s a well known datum that every strong business venture has behind it a team of employees rapt and ready to tackle any obstacle that stands in the way of progress. Flanked by individuals of extensive medical merits, the physician’s practice not only aides its own perseverance through professional comradery; it allows patients to endure as well.

“A growing appreciation of the role of teamwork has evolved as concerns for patient safety within healthcare has,” said Deborah Boyle, RN, MSN, AOCNS, FAAN, an oncology clinical nurse specialist at the University of California Irvine Medical Center Chao Family Comprehensive Cancer Center and blogger for TheONC.org. “A frequent analogy, is that of aviation safety, the role of communication and the group dynamic to ensure all is correct in decision-making and prevention of potential negative sequelae.”

“As new knowledge has grown in exponential proportions, there has been an increasing awareness that the old paradigm of the physician being the repository of all things important, is no longer a viable one,” Boyle continued. “Particularly in cancer care, physicians can’t function in isolation. A team is required. However, the nature of the ‘team’ is in large part related to the setting of cancer care.  In the office setting, physicians can’t practice without high-quality oncology nurses administering therapies and overseeing the numerous needs of their patients, and front office staff knowledgeable about community resources, insurance and reimbursement.” 

[See also: Nurse practitioners not meant to lead PCMHs, AAFP report argues]

As Boyle mentioned, a pivotal component of the practice unit, alongside the physician, has always been the nurse. Like doctors, nurses are directly involved with patients throughout the day, running specific preliminary tests and drafting reports of current ailments, oftentimes before the physician even enters the pod.

According to Boyle, the role of the practice nurse has also weathered a drastic transformation via years of technological and business model advancements as well as regulation shifts.

She listed the following phenomena as the major nurse morph drivers:

  1. The change from the primarily hospital-based setting of care to an ambulatory focus of care. “Much of what was historically done in the in-patient setting is now done in an out-patient one. This has been driven by the growing use of technology to deliver care such as the introduction and utilization of monitoring devices, pumps and diagnostic modalities that promote early identification of problems.  The use of computers as a primary communication tool has also facilitated change in how the health care team relates to each other. These organizational trends have prompted the development of new skill sets in nurses, namely, problem-solving how to deliver technology-based care outside of the hospital setting. This also includes providing significant patient and family education as more responsibility for care is assumed by lay people. Nurses must also consider how to provide high-tech care without losing the humanistic side of caregiving.”
  2. The growing trend to educate nurses at the bachelor’s level and above.  “A strong basic academic preparation offers new nurses especially, a well-grounded platform for practice. They enter the work setting with a broader understanding for the rationale and evidence base that underlies not only how nurses practice, but also how their interdisciplinary colleagues practice as well.  The increasing number of advanced practice nurses in the United States is indicative of the acceptability of nurses functioning in a wide variety of roles. Nurses with master’s degrees practice in expanded roles such as nurse practitioners, clinical nurse specialists, nurse educators, nurse researchers and chief executive roles.”

Naturally, with such changes in allowances, the teamwork dynamic between nurses and physicians must also alter, but this sort of transference doesn’t always come swiftly, Boyle noted.

“In large part, my experience has formed the belief that physicians are highly influenced by their medical education and post-graduate residency and fellowship training in terms of their appreciation of the team dynamic. Those who have witnessed the efficacy of this model of patient care first-hand are more likely to be team-oriented and to appreciate the added value of a true team approach. I remain convinced that the ideal team that should be emulated by all specialties, is that of rehabilitation. When a patient has a spinal cord injury, stroke or major head trauma, for example, there is an operationalized mutual respect for the knowledge and skill required of many professionals – physiatrist, nurse, physical therapist, dietician, speech therapist, social worker, occupational therapist, psychologist and vocational counselor. To me, this is the ideal we should aspire to…”

When speaking of the nurse-nurse dynamic, Boyle referenced the impressive girth of the RN workforce now as well as some of the issues that arise when different generations of nurses overlap: “The RN nurse workforce, over three million strong, and representing the largest cohort of professionals in healthcare, is currently unique in that it consists of three generations of nurses, the first ever of employed licensed registered nurses. Baby boomer, millennials and gen X’ers, who now work side-by-side, and each generation comes with its own set of norms, expectations and work style. This presents a unique set of issues and challenges in terms of education, communication and management imperatives. Individualizing approaches that address professional development, career planning and teamwork are influenced by the nurses’ formative norms.”

In closing, Boyle spoke of the development of an interactive forum online where physicians and nurses could correspond, profession-to-profession, as is available to oncology nurses exclusively through TheONC.org.

“While physicians might focus on pharmacologic treatment, nurses could offer their experiences with this, as well as the efficacy of complementary approaches, comprehensive assessment of symptom burden and a sensitivity to the demands of self-care,” she said. 

Comments (1)

Daniela: Oh, here we go again, another Bush bleamr. When you can't explain the mindless spending spree and shameless socialistic policies of our current administration, revert to pointing the finger at the last one. Bush had NOTHING on Obama's spending. Obama QUADRUPLED the national deficit in his first six months. He's spent more than all presidential administrations combined up to and including Carter. If McCain and Palin had won, I doubt we'd have paradise, but we wouldn't have hell.

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