Chapter 8: The Kaleidoscope of Collaborative Practice

Question 1

PARADOX IN PRACTICE

Answer 1

Significant progress toward practice autonomy

The growing demand for teamwork and collaborative practice

Question 2

COLLABORATION DEFINED

Answer 2

“Recognition of the expertise of others within and outside one’s profession . . . some shared functions, and a common focus on the same overall mission.”
Social Policy Statement

“Dynamic, transforming process of creating a power-sharing partnership . . . for purposeful attention to needs and problems in order to achieve likely successful outcomes.”
Sullivan, 1998

Question 3

FUTURE SHOCK

Answer 3

The duration of relationships is shortened

Sense of reality, sense of commitment, and our ability to cope are seriously challenged

Flow of change is no longer linear

Forced to adjust to novel situations for which we are unprepared

Consequently, there is lag between change and our response to that change

Question 4

PRECURSORS TO COLLABORATION IN ADVANCED PRACTICE

Answer 4

Role clarification

Scopes of practice delineated

Common practice elements defined

Support from professional colleagues and consumers

Question 5

CERTIFIED REGISTERED NURSE-ANESTHETIST (CRNA)

Answer 5

Autonomy varies with state and institution

Constant battle with surgery and anesthesiology since the early 1900s

Question 6

CERTIFIED NURSE-MIDWIFE (CNM)

Answer 6

Origins of professionalism in the Appalachian clinics of Kentucky

Interdisciplinary practice is the sine qua non of CNM practice

Need for collaboration indicated by the health status of the client rather than statute

But nature of collaboration dictated by the state

Question 7

CLINICAL NURSE SPECIALIST (CNS)

Answer 7

Originated in the 1930s as the “nurse clinician”

Collaboration is always an essential part of the role

First established in psychiatry

Not originally concerned with prescriptive authority

Question 8

NURSE PRACTITIONER (NP)

Answer 8

Medical opposition related to control and competition in practice

Early opposition from nursing leadership

Moved to graduate-level education from certificate programs, many in medical schools

Acute-care NP role forced differentiation of role

Ultimately authority is shared, and referrals are bilateral

Question 9

COMPONENTS OF COLLABORATION

Answer 9

Separate and unique practice spheres

Common goals

Shared power control

Mutual concerns

Question 10

THE COMPLEXITY OF PRACTICE

Answer 10

Unidisciplinary practice
Multidisciplinary practice
Interdisciplinary practice
Transdisciplinary practice

Question 11

DETERMINANTS OF THE COMPLEXITY OF COLLABORATION

Answer 11

Visible: Organizational policies, clinical objectives, systems of communication, and role descriptions

Invisible: Power networks, values, and norms

Question 12

BARRIERS TO COLLABORATION

Answer 12

Educational isolation

Professional elitism

Organizational hierarchy

Unrecognized diversity

Role and language confusion

Inadequate communication patterns

Professional dissonance

Question 13

STRATEGIES FOR SUCCESS

Answer 13

Create an effective team

Accept growth and development as joint responsibilities

Use protocols and guidelines wisely

Watch your language

Question 14

COLLABORATIVE MODELS

Answer 14

Primary nursing model

Differentiated practice model

Collaborative practice model in a clinic

Shared governance

Collaboration in long-term care

APN employed by an organized setting, the physician, or self-employed

A specialty APRN and a specialty physician

Care Manager APRN model.