It’s Time to Collaborate!

Nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression.

Nurses should be full partners, with physicians and other healthcare professionals, in redesigning health care in the United States. 

The NPR commentators in both forums had expected conflict or at least disagreement between the NP and the physician. Both commentators expressed surprise at the amount of harmony between the two practitioners, which I also noticed. For years, NPs have been struggling to create a favorable practice environment in the face of opposition from the medical establishment. Now the tide seems to be turning toward working together. Just imagine what we could accomplish if all of us healthcare practitioners (HCPs) worked together toward a common goal instead of constantly being at odds with each other. We could channel all our energy toward achieving optimal health care for all Americans instead of wasting this energy on turf battles and petty disputes.

The word collaborate is being used more often lately. This word is derived from Latin words meaning work together. Collaborating makes sense. Jeff Susman, MD, editor-in-chief of The Journal of Family Practice, wrote a bold editorial in the December 2010 issue entitled “It’s time to collaborate—not compete—with NPs.” He wrote, “It is time—time to abandon our damagingly divisive, politically Pyrrhic, and ultimately unsustainable struggle with advanced practice nurses (APNs). I urge my fellow family physicians to accept—actually, to embrace—a full partnership with APNs.”² (Pyrrhic: a victory with devastating cost to the victor; it carries the implication that another such victory will ultimately cause defeat.³)

This type of collaboration with NPs—a two-way collaboration—is a relatively new concept. I recall working in a state in which NPs had a dependent practice. Back then, collaboration was really just a euphemism for supervision by physicians. We needed to have a collaborative practice agreement that was, in essence, a plan entailing physician supervision. The plan outlined who would be the supervising physician and how that supervision would manifest (eg, through chart review). These agreements did not represent collaboration in the true sense of the word. Dr Susman captured the essence of what collaboration really means: to embrace a full partnership, not a competitive role, refocusing our energies together rather than in opposition.

This new entente between MDs and NPs is both an opportunity and a challenge for us. It does not mean that all of us must go out and start our own independent NP practices. But being free of supervision allows us to work within the full scope of our practice—without restrictions. In the real world, this is happening more and more often. In many states in which physician supervision is still required, the letter of the law is not truly being followed; instead, a supervising physician simply places his or her signature on a chart. (Remember, co-signing just means that a chart is co-signed; it doesn’t mean that the co-signer has read the chart!)

Support safe and proven expansions of the scope of practice of other healthcare professionals. Let’s not do to others what has been done to us. Let’s collaborate from the get-go, look at the information, and see whether the outcome is better patient care. We must not follow the example of the opposition. Let’s not criticize others and not fight safe practices of other HCPs. Let’s set a new precedent of cooperation and collaboration. 

Remember that we are part of a bigger healthcare system. We must do our best in each individual case, but we should also know that other resources are available to us. Relying on others ranges from asking a colleague to check which test to order to referring a patient to someone with more experience or expertise in a specific area. 

Don’t label ourselves as something less than physicians or as mid-levels. We are not inferior or submissive to anyone. We are members of a healthcare team, working together to provide high-quality care for our patients. We must never sell ourselves short in this process. I meet too many NPs who want to be supervised. Our attitude needs to be one of collegiality, not submissiveness.

Tom Bartol can be reached at .(JavaScript must be enabled to view this email address)