Healthcare professionals agree that clear, timely communication is essential to ensure optimal patient outcomes. This requires that communication should include all team members across all disciplines. The promotion of interprofessional collaboration is a key element found in the DNP Essentials published by the American Association of Colleges of Nursing (2006). Therefore, interprofessional collaboration is a key foundational cornerstone for best practices.
This is particularly true when providing patient care in emergent areas such as the emergency room or the operating room. These environments require interprofessional collaboration and clear communication to ensure patient safety. Respect must be a core value to encourage open communication (Institute for Healthcare Improvement, 2021). Organizational cultures that promote safety and create environments that are psychologically safe result in improved patient outcomes (Institute for Healthcare Improvement, 2021).
Providers who work in primary care face unique challenges. Ambulatory clinics utilize a variety of providers, healthcare, and administrative professionals to deliver patient care. Many disciplines are utilized to coordinate patient care and to ensure that the patient moves through the system in an efficient manner. Most often, patients present to an ambulatory clinic for non-emergent needs. However, patients do present with acute conditions such as asthma exacerbations, and acute myocardial infarctions. Patient safety is dependent upon administrative personnel communicating to a nurse, and or provider that a patient has presented for care with an emergent condition. Interprofessional collaboration is key to ensure that this patient is triaged in a timely manner.
Fortunately, my previous employer promoted interprofessional collaboration. Providers, healthcare, and administrative members valued and respected team member opinions, as well as their contributions. Members were encouraged to participate in team building activities that occurred after work hours to promote cohesion. Members addressed each other using first names rather than using titles. Our physician was adamant that we use first names to discourage a culture that was built on hierarchy. The message was clear: all members are valued. Titles were used when we provided patient care. Organizational strengths included provision of an environment that embraced diversity, spirituality, and inclusiveness. Respect was a core value
The organization was excellent but weak on providing long term mentoring for new APRN’s coming into practice. Initial mentoring was provided through a week of general corporate orientation. Providers were then given a support person from IT to help learn the electronic health system. The organization utilized EPIC. This IT training occurred with a dedicated electronic health records (EHR) professional sitting by my side. Thankfully, the one-on-one support was helpful to help shorten the learning curve of utilizing EPIC.
Challenges and Gaps
As a new APRN coming into practice there were many challenges. This included a move into a new community many hours from home to accept a job based in pediatric primary care. The organization did not provide sufficient mentoring to ensure a successful transition into practice. The expectation was that the newly hired APRN would consult with the collaborating physician. While, this is needed, in reality the physician was extremely busy managing their own patient caseloads. The physician had little experience working with new APRN graduates. This created role stress and resulted in a communication barrier. The physician had worked with experienced APRN’s who required little support in sifting through differentials and developing management plans. The collaborating physician was very generous and supportive once the realization occurred that mentoring was needed, and this was not provided through the organization.
The physician developed a solution to bridge the gap that included early morning breakfast meetings to discuss challenging patient scenarios. We met weekly to discuss patient management. This solution was very challenging for both of us, as it required early morning meetings prior to a full workday. This was a very generous gesture.
In addition, the organization could clarify physician expectations for new APRN’s coming into a clinical practice. There should be more time during the interview that the APRN and collaborating physician could discuss expectations. The organization could provide more time to onboard their APRN’s as they transition into the role. Hospitals provide extensive orientations for new APRN’s, and this could be adopted. The reality is that time is needed for role development and assimilation. The organizations could provide a mentor who is not seeing patients to ensure a successful transition. Lastly, organizations need a neutral party who is vested in success of employee and has dedicated time to orient apart from seeing patients.
What are solutions that organizations could provide to new APRN’s to ensure a successful transition? Do you think more organizations or schools could provide a residency training period to help with role assimilation and development? There are few nurse practitioner residency programs and many of these are for new graduates. Do you think they should offer residency refresher courses to those nurse practitioners who have been in academia and are beginning to transition back into practice? Your feedback is welcomed!
American Association of Colleges of Nursing (2006). The essentials of doctoral education for advanced nursing practice. https://www.aacnnursing.org/DNP/DNP-Essentials
Dreher, H.M. & Glasgow, M.S. (2017). DNP role development for doctoral advanced nursing practice (2nd edition). Springer
Institute for Healthcare Improvement (2021). Patient safety 104: Teamwork and communication. http://www.ihi.org/education/ihiopenschool/Pages/default.aspx