ABSTRACT: This article explores how chief nurse executives became and remained authentic leaders. Using narrative inquiry, this qualitative study focused on the life stories of participants. Results demonstrate the importance of reframing, reflection in alignment with values, and the courage needed as nurse leaders progress to authenticity.
Confusion exists about the intent and focus of annual performance reviews (APR) compared with professional peer reviews (PPR). To ensure that both reviews are meeting organizational, professional, individual nurse, and patient needs, it’s important to clarify the issues of ownership and intended outcomes for these processes. Understanding the purposes and expected outcomes can help managers move beyond what can feel like a dreaded task that yields a lot of paper work and little value to a meaningful process that can create individual, professional, and organizational success.
ANA/AONE Principles for
Collaborative Relationships
Between Clinical Nurses
and Nurse Managers Nurse Leader, Volume 10, Issue 4, August 2012
INTRODUCTION
What exemplifies ideal collaboration? Images of sports
teams, musical orchestras, and even airports may come
to mind. The essence of these collaborative arrange-
ments is people working together in a prescribed role
with a shared end goal in mind, whether it’s winning a
game, creating beautiful music, and getting passengers
from one place to another.
Clinical nurses and nurse managers, like athletes or
artists, work together with the shared goal of high quality
patient care. The shared goal is clear to nurses, and most
of them might say they would not be in nursing practice
without that endpoint in mind.
However, even with that shared goal, nurses could
identify practice environments where the relationship
between clinical nurses and nurse managers is exception-
al, adequate, or suboptimal. The elements of a highly
effective practice environment go beyond the surface of
shared goals, to something deeper and more humanistic
around what people need to work together.
To illustrate a highly effective practice environment,
the American Nurses Association and the American
Organization of Nurse Executives convened a group of
clinical nurses and nurse manages to develop Principles of
Collaboration. These principles guide clinical nurses and
nurse managers on their synergistic role in creating,
enhancing, and sustaining collaborative relationships.
When working relationships are strong and effective,
nurses at all levels function as a team, and they deliver on
their shared goal of high value care.
THE PRINCIPLES OF COLLABORATIVE
RELATIONSHIPS I. Effective Communication One of the most basic elements of human interaction is
the ability to communicate. Communication, particularly
in high-intensity environments such as health care, is not
merely the transaction of words. Effective communica-
tion requires an understanding of the underlying context
of the situation, an appreciation for the tone and emo-
tions of a conversation, and the accurate information.
When implemented consistently, the principles relating to
effective communication can bridge the figurative divide
of "you vs. me", and ensure a reliable and dynamic means
of relaying information and feedback.
Principles
1. Engage in active listening to fully understand and contem-
plate what is being relayed.
2. Know the intent of a message, and what is the purpose and
expectations of that message.
3. Foster an open, safe environment.
4. Whether giving or receiving information, be sure it is accurate.
5. Have people speak to the person they need to speak to, so the
right person gets the right information.
II. Authentic Relationships
Professional nurses cultivate caring relationships with
their patients, supporting them in meeting their physi-
cal, mental, and spiritual needs related to health. To
bolster the profession and the quality of care patients
receive, nurses must reciprocate that kind of relationship
with each other. And, as professionals, nurses engage in
the art and science of caring, and by their very nature,
nurses thrive when they experience caring from their
colleagues. The principles relating to authentic relation-
ships give nurses a guide for developing these types of
interactions with one another, and cultivate the nurse's
sense of being cared for that promotes their ability to do
the same for patients.
Principles
1. Be true to yourself – be sure actions match words, and those
around you are confident that what they see is what they get.
2. Empower others to have ideas, to share those ideas, and to
participate in projects that leverage or enact those ideas.
3. Recognize and leverage each others’ strengths.
4. Be honest 100% of the time – with yourself, and with others.
5. Respect others’ personalities, needs, and wants.
6. Ask for what you want, but stay open to negotiating the
difference.
7. Assume good intent from others’ words and actions, and
assume they are doing their best.
III. Learning Environment and Culture
A well-developed practice environment supports great
nursing care, and gives nurses the satisfaction of knowing
that their work is valuable and meaningful. The attributes
of a learning environment are both objective and subjec-
tive; whereas some aspects are clear and visible, some are
just a sensation or feeling. However, contrary to what it
seems, creation of a learning environment is not a top-
down phenomenon. Nurses at all levels contribute to a
learning environment by demonstrating trust, support, and representation. The principles pertaining to
learning environment allow nurses and others to
thrive and succeed at their work because they are not
afraid of failure.
Principles
Inspire innovative and creative thinking.
Commit to a cycle of evaluating, improving, and celebrat-
ing, and value what is going well.
Create a culture of safety, both physically and psychologically.
Share knowledge, and learn from mistakes.
Question the status quo – ask “what if,” not “no way.”
IMPLEMENTATION GUIDELINES
Acting on the Principles is Easy
Simple and sustained changes to the way nurses com-
municate, relate, and cultivate their environment can
make tremendous impacts towards ideal collaboration.
There are key factors that facilitate the implementa-
tion of the Principles. First, nurses are united in their
shared goal of excellent patient care, and in their sense
of “beneficence,” which means doing things for the
greater good. The Principles help encourage or even
celebrate nurses’ ability to translate patient beneficence
into coworker beneficence. A second factor is timing.
Healthcare is rapidly transforming, and the profession
of nursing increasingly being elevated, thus, the time is
optimal for encouraging or enhancing ideal collabora-
tion through these principles. Finally, there is positive
momentum from champions of collaboration, and an
emphasis on looking past the problems that are
known, and concentrating more energy on creating
the best work environment possible.
Avoid Barriers
The barriers that could hamper implementation of
the Principles are more intimidating than they are
real. Insufficient time, cost concerns, resistance to
change, horizontal or vertical distrust, or structured
improvement program “fatigue”, are all surmountable.
Changes in attitude, behavior, and work environment
can be simple, sustained, and virtually costless.
Start Doing What Works, and Stop Doing
What Doesn’t Implementing the Principles requires nurses at all
levels to start taking positive steps towards improving
relationships, and cease the things that impede them.
Blame, doubt, cynicism, reluctance hamper relation-
ships, and cause the divides between clinical nurse and
nurse managers to fester. To cleanse and renew these
relationships, and ultimately build to something bigger
and greater, nurses at all levels must take proactive,
positive approaches toward implementing the
Principles.Acting on the Principles most likely is not
an overnight process, therefore, it requires prioritiza-
tion and sustainment to ensure buy-in and dedication
from all nurses at all levels.
Conclusion
The essence of teamwork is that it is not a sum of the
parts, but how those parts perceive their contributions
toward the goal, work together, and exhibit fidelity to
one another. When clinical nurses and nurse man-
agers dedicate themselves to collaborative relation-
ships, the harmony that ensues is palpable. Nurses can
then excel at their work, and they can deliver on the
ultimate and most important goal of high value
patient care.
Acknowledgments
Development Team
Douglas Hill
Pam Baio
Annie Hellickson
Mary Reyes-Gonzales
Erik Martin
Lisa Roberts
James Biernat
Wendy Hicks
Bonnie Osgood
Linda Riazzi-Kermani
Julia Weinberg
Steve Rooney
Project Coordinators
Marla Weston
Pamela Thompson
Katherine Brewer