What is the Role of the Nurse in Inter-professional Healthcare Team Working?
Florence Nightingale earned the nickname ‘the lady with the lamp’ for her nursing of British soldiers during the Crimean War. She led a group of three dozen nurses to Constantinople to serve in British military hospitals there: highly controversial because female nurses had not served in such wartime field hospitals before. She pressured army officials to improve the terrible conditions in the hospitals, and when she returned to London she continued her reform campaign there. She helped create changes in hygiene and overall treatment of patients and also founded the pioneering Nightingale Training School for nurses. More recently, the role of the nurse has developed dramatically, building on the foundation of the pioneering work of Florence Nightingale.
Nurses work in a variety of different inter professional care teams. They can work as part of
a general practitioner’s team, in a hospital, or in a community setting. All the work carried out by nurses is necessarily carried out in collaboration with other health professionals. Each professional brings their own type of expertise to the team and each holds mutually exclusive skills. It is important, however, for the team to work as a whole and provide the patients with the blend of these skills.
Today, the real focus of health care is the patient: “every patient who is treated in the NHS wants to know that they can rely on receiving high quality care when they need it”. (NHS, 1997). Clinical governance means that for the first time health care providers have a statutory duty for quality improvement to ‘continually improve the overall standard of clinical care’.
The team will comprise a variety of health care professionals – doctors, nurses physiotherapists, dieticians, pharmacists, receptionists, to name just some. All these occupations have different levels of expertise. It may be that a nurse is qualified in general nursing skills, or it may be that they have a particular field of care. Nurses can take charge of certain clinics within the practice: e.g. Asthma, child development, vaccinations, sexual/ contraception advice.
In order to have an effective professional team it is necessary for each individual to understand and respect the roles of each member of the whole team.
There should be agreement on aims, goals and objectives in order to facilitate the efficient running of the practice or ward. Feedback can enhance working relationships and this can encourage reflection and self awareness (Boswell, 2005:389).
The team needs to be fully aware of all issues of concern in their environment and show an ability to deal with problems or areas of stress experienced by individual members of the team or by the group as a whole.
There will, of course, be a clearly designated hierarchy of accountability and responsibility in any team setting. This will be defined by strict policy guidelines. A nurse carries out procedures ordered by a doctor in collaboration with other team members. “Teamwork is suggested to be the most effective way to deliver services to a variety of individuals or groups”. (DHSS: 1986:107)
Respect between all health care professionals is a vital aspect to meet the individual needs of a patient (Hale 2003:361). An awareness of how other professionals work may improve the quality of care a patient receives and may also allow other healthcare professionals to advance their own learning.
Failure to address the dynamics of team working will produce barriers within the process. Barriers can cover issues such as lack of respect for others, unwillingness to communicate effectively or lack of interest in the views of others. There may be stereotypical and deeply-held beliefs within the work place of various individuals’ occupational responsibilities, and this could impede any advancement to excellence of care.
There have been suggestions that unless professionals communicate well with each other they are unlikely to be effective in their interactions with the patients and carers. Nurses have, however, been reported to communicate better with patients than with their colleagues. It could be that this is due to power difference, role confusion or simply variations in communication styles and philosophies of care. One important way of resolving these difficulties is for nurses to reflect on how they influence communication and at times to attempt to put themselves into their colleagues’ shoes and communicate using their language. Regular team meetings will help with this development of empathy. It should be stressed that it is not only nurses who experience this and all of the team must be aware of power and roles within the working environment.
It is often the case that the closest relationship between patient and health care professionals will be between patient and nurse. Sometimes the stereotypical, or archetypal, ‘god-like’ status of the doctor will be quite intimidating to a patient. That patient may then turn to the nurse to voice concerns about the medical condition, medication and general care. The nurse has a responsibility to the patient to be sympathetic to any insecurities or problems. Often the patient will discuss confidential information concerning many issues – for example, family issues. Any information which the nurse deems important to the care of the patient should be passed on accordingly but there should be discretion about passing information between other patients. Often information given by the patient can be helpful in tailoring and personalising the particular care plan which will be most effective for that individual. This is essential where patient-centred care is the approach. The nurse can help the patient feel they are being treated as an individual and that their care plan is structured to their particular needs.
The nurse also has a responsibility to the other team members and details of these other members personal and professional lives should not be discussed with any patients. The nurse should be professional at all times and never refer to any issues arising within the care setting.
In conclusion, the role and responsibilities of nurse in the twenty-first century varies greatly from the work carried out by Florence Nightingale and her nurses. Nurses are no longer viewed as having a single particular role to carry out and to be subservient to those of a perceived higher status. There are now many male nurses as well as female, (although there has been a male nursing presence for decades), and there is a general appreciation of how they contribute to the care of patients just as well as female staff. Nursing covers many aspects of care in social, emotional and general medical ways. When the nursing role is integrated into a professional working team, it is the patient who ultimately benefits from their support and mutual cooperation in general. The nursing profession is held in great respect by most individuals and it is the role of each nurse to earn this respect by attention to continued learning and advancement of techniques within the team.
Bibliography
Bowman M (1995) The Professional Nurse. Chapman & Hall. London. Glasgow. New York. Tokyo. Melbourne. Madras.
Department of Health (2003) Essence of Care. Patient Benchmarking for Health Practitioners. London.
Department of Health (1992) The Nutrition of Elderly People. Report of the Working Group on the Nutrition of Elderly People of the Committee on Medical Aspects of Food Policy. Report on Health and Social Subjects No. 43. London.
Faulkner A (2002) Effective Interaction with Patients. Churchill Livingstone. London.
Edinburgh. New York. Oxford. Philadelphia. St. Louis. Sydney. Toronto.
Hilton A P (2005) Fundamental Nursing Skills. Whurr Publishers. London & Philadelphia.
Johnson M, B. & Webber B.Pamela (2005) An Introduction to Theory and Reasoning in Nursing. 2nd Edition. Lippincott Williams & Wilkins. Philadelphia.
Jolley and Brykczynska (1992) Nursing Care. The Challenge to Change Hodder & Stoughton. London. Melbourne. Auckland..
Nicol M & Bavin C et al (2005) Essential Nursing Skills. Mosby. Edinburgh. London, New York. Oxford. Philadelphia. St. Louis.
Peate I (2007) Becoming a Nurse in the 21st Century. John Wiley & Sons Ltd. West Sussex.
.
Smith P J (1994) Models, Theories and Concepts. Blackwell Scientific Publications. London. Edinburgh. Boston. Melbourne. Paris. Berlin. Vienna.
The Nursing and Midwifery Council: Code of Professional Conduct (2004-7), Planning, Standards for conduct, performance and ethics.
Taylor J Beverley (2003) Reflective Practice. A guide for nurses and midwives. Open University Press. Buckingham.
Tschudin V ( 1999) Nurses Matter. Reclaiming our professional identity. MacMillian. London
Turnbull A (2001) Plain Words for Nurses.. writing and communicating effectively 1st Edition. The Foundation of Nursing Studies. London.
Wright S G (1990) My Patient – My Nurse. Scutari Press. London
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Journals
Nursing Times (Feb 2008) Vol 104 No 5 “The important symbols of nursing have not been eradicated – they have changed”.