Collaboration Nation

By  |  October 15, 2015 | 

Hospital medicine is defined by its excellent collaboration.  We “co-manage” with orthopedics.  We reach out to primary care physicians. We enroll the nurses at the bedside. We wrap families into the medical plan.  But how good are we?  Depending on the pace of my Friday I may feel like I’m winning the war or losing the battle. I think it’s good to step back and reflect on what is going right in our world and what needs a bit of tweaking.

In that vein, and using this elegant article I read about Nurse-Physician Workplace Collaboration as a guide (Lindeke, L., Sieckert, A. (January 31, 2005).  “Nurse-Physician Workplace Collaboration”. OJIN: The Online Journal of Issues in Nursing. Vol.10 No. 1, Manuscript 4.). I’d like to review the highlights.  Feel free to score yourself (and your fellow collaborators) and break out the champagne or the Kleenex.

Question 1: I have emotional maturity as evidenced by my persistently positive and humble approach when viewing failures.

a.  Failures?! What failures?!

b.  Who cares, we are never going to survive this day anyway.

c.  I screwed up and I am really sorry but normally I never do.

d.  I screwed up, but I’m going to study what I did wrong and try not to do it again.

Question 2:  I manage my compassion fatigue by employing self renewal strategies such as:

a.  Pass that bottle of Tito’s homemade vodka, won’t you?

b.  Who cares, we are never going to survive this day anyway.

c.  Let’s go for a run, THEN pass the Tito’s.

d.  Want to go to yoga with me?  I need to de-stress about this day.

Question 3:  I understand that negotiating respectfully means balancing power and authority.  This is exemplified by:

a.  Always sitting at the head of the table. After all the physicians must be the “leader” of the team.

b.  I always list all the tasks and assign everyone the appropriate ones. For instance, you do the rectal…

c.  I don’t always have to be right, but I usually am.

d.  Whatever is best for the patient – I can get behind that plan.

Question 4:  I avoid negative behaviors that can cast a pall of dominance or negativity over the group as evidenced by:

a.  I blame the person responsible for all of the screw ups. Then they will feel better.

b.  Who cares, we are never going to survive this day anyway.

c.  We have no control, so why try?

d.  Come on!  It will get better this afternoon, let me buy you a coffee!

Question 5:  In an emergency I communicate efficiently and collaboratively by:

a.  Screaming orders.  People are deaf in an emergency.

b.  I yell random questions to all of the people present that way I’m sure to get the best information.

c.  When the systolic blood pressure falls below 80mmHG I claw my face and fall to my knees moaning.

d.  I identify the primary nurse, the primary provider and  privatize the problems all in an effortless and pleasant manner.

Now check your answers:

All “A”s?  You’re having a baaaad day in hospital medicine.

“B”s-Maybe it’s a chronic condition.

“C”s- Ok – try and work a little harder.

“D’s”- You’re doing great! Keep up the good work!

Just to Recap Best Practices of Nurse-Physician Collaboration:

1.  Develop emotional maturity

2.  Avoid compassion fatigue

3.  Negotiate respectfully

4.  Manage conflict wisely

5.  Communicate effectively in emergencies

About the Author:

Tracy Cardin
Tracy Cardin, ACNP-BC, SFHM is the Associate Director of Clinical Integration at Adfinitas Health and also serves on SHM’s Board of Directors. Prior to this, she was the Director of NP/PA Services for the University of Chicago and worked in private practice for a group of excellent pulmonologists/intensivists for over a decade. She has been a member of SHM for over ten years and has over twenty years of inpatient experience, which seems incredible as she cannot possibly be that old! Her interests include integration of NP/PA providers into hospital medicine groups and communication in difficult situations. In her free time, she likes to run and lift, read and write and hang out on the front porch of her semi-restored Victorian house with her dear family and friends while drinking a fine glass of red wine and listening to whatever music suits her whimsy.


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  1. Irene S. Klotz, LMSW, CPT October 15, 2015 at 8:25 am - Reply

    After 20+ years in medical genetics research and collaborating with medical staff including doctors, nurses, social workers, and researchers, I’ve seen the need to collaborate effectively without assuming control or domination. This article spells it out beautifully, practically, and succinctly. Congratulations to all who contributed. You hit the jackpot!

    • Tracy Cardin
      Tracy Cardin October 16, 2015 at 3:50 pm - Reply

      Thank you Irene. I really appreciate your comments.

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