Collaboration with Interdisciplinary Team: NCLEX-RN
In this section of the NCLEX-RN examination, you will be expected to demonstrate your knowledge and skills of collaboration with interdisciplinary teams in order to:
- Identify the need for interdisciplinary conferences
- Identify significant information to report to other disciplines (e.g., health care provider, pharmacist, social worker, respiratory therapist)
- Review plan of care to ensure continuity across disciplines
- Collaborate with healthcare members in other disciplines when providing client care
- Serve as a resource person to other staff
Healthcare and the provision of healthcare services are highly complex with a vast number of disciplines or professions that contribute to the total care of the patient. For this reason, interdisciplinary, or multidisciplinary, client care conferences are a highly effective way for all these interacting professions and departments to come together in order to discuss and solve complex patient care problems in hopes that this collaboration will lead to high quality outcomes for the patient.
Interdisciplinary, or multidisciplinary, client care conferences also give the registered nurse the opportunity to advocate for the client, to serve as the leader of an interdisciplinary group, to serve as a member of an interdisciplinary group, to enhance the nurse's commitment to clients and client care, to employ group skills such as negotiation, compromise, conflict resolution, and achieving consensus, and to utilize creative problem solving and decision making skills to achieve desired patient outcomes and goals.
Registered nurses identify patient cases that could potentially benefit from an interdisciplinary client care conference, they plan and arrange for these conferences and they participate in them.
Planning interdisciplinary client care conferences is often challenging. An agenda is developed, information is collected for presentations, healthcare team members are invited, a time, a date and a room is decided upon and the client and significant others are encouraged to attend.
Participating in groups, including an interdisciplinary client care conference, requires preparation; therefore, nurses should be prepared for these meetings. They should have data and information readily accessible to discuss and they should also have some recommendations for future care that may enhance the client's outcomes of care.
In addition to expressing their own thoughts, nurses should listen attentively to the thoughts and suggestions of others in a respectful manner and also be able to compromise and negotiate the best plan of care for the patient.
Nurses assess and reassess clients throughout the continuum of their care and they also communicate and report significant information to other disciplines when the occasion arises.
For example, the nurse will report changes in the client‘s arterial blood gases or oxygen saturation levels to the respiratory therapist when a client is being weaned off mechanical ventilation; a nurse will report significant change in the client's psychological or emotion status after the administration of a new psychotropic medication and they will also report significant changes in terms of the client's vital signs after a diagnostic test or treatment, to the client's attending physician; the nurse will report adverse reactions to medications to the pharmacist; and they will report a client's change in their social support systems to the social worker, a discharge planner and/or a case manager.
This reporting is done in order to insure unfragmented, timely and appropriate care to the client or groups of clients that meet their current, and often changing, needs as the result of significant changes in terms of their biological, emotional, and social status.
Nurses, as the collaborator, the manager and the coordinator of client care, consistently and continuously review the plan of care to insure that all of the appropriate disciplines within the multidisciplinary team are contributing their services according to the plan of care and that this care seamlessly moves the client toward their expected outcomes and goals.
Broadly described, collaboration is working with others in a collegial and mutually respectful manner.
Nurses collaborate with patients, significant others, families, other nurses and other healthcare providers to solve patient care problems and to provide the optimal quality level of care to the patient or group of patients.
Some of the skills that the nurse must possess in order to be an effective and credible collaborator include superior interpersonal and communication skills, respect for others, the ability to establish and maintain trust, critical thinking skills, problem solving skills, decision making skills, and the ability to understand and be able to identify the contributions of others that can improve the quality of the patient's care.
The titles and numbers of the many different healthcare team members that nurses collaborate with are vast and diverse.
Now, you will learn about some of these team member roles and responsibilities so you can identify and utilize their distinct and unique perspectives and contributions to the plan of care and patient problem solving.
Nursing Assistants, Patient Care Technician and Other Titles
These members of the nursing team are unlicensed assistive personnel who assist nurses in the provision of direct and indirect care under the direct supervision of the nurse. They perform nonsterile functions like the provision of and assistance with the patient's activities of daily living, measuring and recording urinary output and oral intake, helping the patient with exercises such as range of motion exercises, taking and documenting vital signs, measuring patients' height and weight, collecting some specimens, the provision of comfort measures like a back rub, patient transport, and clerical duties including running errands.
They work under the direct supervision and guidance of the nurse.
Licensed Practical / Vocation Nurses
Licensed practical / vocational nurses are licensed healthcare providers who provide a wide range of nursing services to patients in all kinds of healthcare settings.
They work under the supervision of a registered nurse and they perform nonsterile and sterile procedures. They work in structured settings with patients who have predictable and relatively noncomplex healthcare problems including chronic disorders such as heart disease and chronic obstructive pulmonary disease.
PLEASE NOTE: Vocational nurses are only called such in California and Texas.
Registered nurses are licensed healthcare providers who, unlike licensed practical nurses, are independent practitioners who render nursing care services in a wide variety of healthcare settings.
They can work in unstructured environments and with patients who have unpredictable and complex healthcare problems and concerns.
Nursing supervisors supervise patient care and the quality of care that is delivered to groups of patients. Depending on the size and complexity of the healthcare setting, supervisors can have many titles and they may or may not also provide direct nursing care in addition to their supervision of care.
Nurses report to their nursing supervisors according to the facility's chain of communication and command. For example, they report to their "supervising registered nurse/charge nurse/head nurse", then their "nursing supervisor" and then to the "assistant director of nursing" and then "the director of nursing or vice president of nursing."
Vice President for Nursing Services/The Director of Nursing
The Vice President for Nursing Services, also referred to as the Director of Nursing or the Director for Nursing Services in some facilities, is the chief nursing officer of the healthcare setting. They are ultimately accountable for all aspects of patient care, the adherence to regulations and a wide variety of other responsibilities.
At times, this Vice President for Nursing Services may have one or more Assistant or Associate Directors of Nursing.
Nurse Clinical Specialists
Nurse Clinical Specialists are mastered prepared advanced practice registered nurses with an area of specialty who have successfully passed and maintained their American Nurses Credentialing Center's (ANCC) certification as a clinical nurse specialist in a specialty area of practice. Some possible specialty areas of practice are pediatrics, psychiatric mental health, adult health and community health.
Nurse Practitioners, similar to Nurse Clinical Specialists, are mastered prepared advanced practice registered nurses with an area of specialty who have successfully passed and maintained their American Nurses Credentialing Center's (ANCC) certification as a nurse practitioner in a specialty area of practice. Some possible specialty areas of practice are pediatrics, psychiatric mental health, family health and community health.
A Member of the Nursing Team and the Obstetrics Team
Nurse midwives are advanced practice registered nurses who work with nonrisk pregnant women during the pregnancy under the supervision of an obstetrician.
A Member of the Nursing Team and the Anesthesia Team
Nurse Anesthetists are advanced practice registered nurses who work under the supervision of a anesthetist in the provision of all types of anesthesia.
Medical doctors are licensed professionals who provide medical care. Many doctors serve as primary care doctors but there is a wide variety of medical doctors who perform different roles and who have a specialty area of practice such as cardiology, endocrinology, pulmonary medicine, gastrology, neurology, dermatology, pediatrics, gerontology, ophthalmology, nephrology, psychiatry and other specialized practices.
Physician extenders work under the direct supervision of a medical doctor and they provide care that is based on protocols and their state legal scopes of practice. They are not, like nurse practitioners, independent practitioners. A physician's assistant is an example of a physician extender.
Doctors of Osteopathy (DOs)
Although doctors of osteopathy are, in some respects, similar to medical doctors, they are also different. The educational preparation is different, their licensing examination and their scopes of practice are different, but they can be found in acute care, long term care and community based healthcare settings. Doctors of osteopathy may also have specialty areas of practice, but most function as primary care doctors. Additionally, they can also provide care, write prescriptions, and perform surgeries.
Doctors of Chiropractic Medicine
Chiropractors work primarily in the community setting and they focus their nonpharmacological treatments of musculoskeletal and neuromuscular disorders such as scoliosis, chronic headaches, back pain, and neck pain. They too are licensed professionals who have their own state mandated scope of practice.
Dieticians assess, plan, implement and evaluate interventions including those relating to dietary needs of those patients who need regular or therapeutic diets. They also provide dietary education and work with other members of the healthcare need when a client has dietary needs secondary to physical disorders such as dysphagia.
Physical therapists are licensed healthcare professionals who assess, plan, implement and evaluate interventions including those related to the patient's functional abilities in terms of their strength, mobility, balance, gait, coordination, and joint range of motion. They also provide patients with assistive aids like walkers and canes and exercise regimens.
Physical therapists practice in all healthcare environments including the home and the community and, similar to occupational therapists, physical therapists are often found in the rehabilitation and restorative care area of a large acute care or long term care facility.
Occupational therapists assess, plan, implement and evaluate interventions including those that facilitate the patient's ability to achieve their highest possible level of independence in terms of their activities of daily living such as bathing, grooming, eating and dressing.
They also give patients adaptive devices like special long shoe horns so the patient can put their shoes on, sock pulls so they can independently don socks, special adaptive cutlery to facilitate independent eating, grabbers so the patient can pick items up from the floor, special mouth care tools, and special devices to manipulate buttoning so the person can dress and button their clothing independently.
Occupational therapists also assess the home for safety and the need for assistive devices when the patient returns to the home. They may recommend modifications to the home environment such as ramps, grab rails and handrails to insure safety and independence.
Like physical therapists, occupational therapists practice in all healthcare environments including the home and the community and, similar to physical therapists, they are often found in the rehabilitation and restorative care area of a large acute care or long term care facility.
Speech pathologists or therapists assess, diagnose and treat primarily communication disorders such as aphasia and swallowing disorders such as dysphagia. For example, speech therapists may help patients with the formation of words and speaking when they have an impaired ability to communicate with others using words. This deficit is referred to as expressive aphasia. They also assist the patient with word boards and other electronic devices to facilitate communication.
Dysphagia and other swallowing disorders are also assessed, diagnosed and treated in collaboration with other members of the healthcare team like nurses, dietitians and medical doctors.
Respiratory therapists, like other members of the healthcare team, collaborate with other discipline in solving respiratory related healthcare problems.
They draw arterial blood gases, maintain patient with mechanical ventilation, provide CPAP, Bi PAP, incentive spirometry and intermittent respiratory treatments like IPPB, they administer respiratory medications, they intubate patients, assist with bronchoscopy and other respiratory related diagnostic tests, perform pulmonary hygiene measures like chest physiotherapy and serve an integral role during cardiac and respiratory arrests.
Social workers have a number of different roles in the healthcare environment. They counsel patients and provide psychological support, they liaison with the community in terms of patients' financial needs, they serve as part of the team that insures care along the continuum of care after the person is discharged, and they sometimes serve as case managers.
Psychologists and Psychiatrists
Psychologists and psychiatrists provide mental health and psychiatric services to those with psychiatric mental health disorders both long term and acute. They also provide psychological support family members and significant others as indicated.
Podiatrists provide care and services to patients who have foot problems. They often work with diabetic patients to assess the feet to prevent diabetic foot complications. They recommend special footwear, they often clip toe nails and they also treat other non-diabetic patients with disorders of the foot.
Prosthetists, in collaboration with other members of the healthcare team, assess patients and then design, fit and supply the patient with an artificial body part such as a leg or arm prosthesis. They also follow-up with patients who have gotten a prosthesis to check and adjust it in terms of proper fit, patient comfort and functioning.
Nurses are the center of care that is provided. Registered nurse have the professional responsibility to serve as a resource person within their areas of expertise to other staff including those in other disciplines in order to increase their understanding of nursing, nursing care, the needs of the clients, and how the nursing staff interact and collaborate with them.
RELATED NCLEX-RN MANAGEMENT OF CARE CONTENT:
- Advance Directives
- Assignment, Delegation and Supervision
- Case Management
- Client Rights
- Collaboration with Interdisciplinary Team (Currently here)
- Concepts of Management
- Confidentiality/Information Security
- Continuity of Care
- Establishing Priorities
- Ethical Practice
- Informed Consent
- Information Technology
- Legal Rights and Responsibilities
- Performance Improvement & Risk Management (Quality Improvement)