1. Modic, Mary Beth DNP, RN, CDE

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Caring for patients in today's complex healthcare environment requires great skill, tremendous knowledge, and an interdependence on other disciplines, as no single healthcare professional can do it all. This opinion is shared by the Interprofessional Education Collaborative, which was formed in 2009. Six national educational associations representing allopathic and osteopathic medicine, dentistry, nursing, pharmacy, and public health recommended core competencies and a curriculum that would foster and promote interprofessional learning experiences. It is no longer acceptable to have physicians and nurses working side by side and not appreciating the magnitude of the others' contributions.


Benner, Hooper Krykiakidis, and Stannard (2011) have eloquently captured the clinical wisdom and skilled know-how of acute and critical care nurses in the following aspects of care: anticipating and preventing potential problems, preventing hazards in a technological environment, diagnosing and managing life-sustaining functions in acutely ill and unstable patients, caring for patients' families, and ushering patients into death.


The Interprofessional Education Collaborative wants to ensure that these unique skill sets of nurses are appreciated by every healthcare professional entering the practice arena. Its goal is to foster a deeper understanding and appreciation for the work of all healthcare professionals, and this awareness extends beyond the interactions of nurses and physicians. The definition of professionalism espoused by Green, Zick, and Makoul (2009) is that professionalism "is the commitment to carrying out professional responsibilities and an adherence to ethical principles" (p. 571). Although there is no consensus for a definition of interprofessionalism, the following definition will be offered as a frame of reference for the continued use of the term in this column. Interprofessionalism is the provision of comprehensive care by an ensemble of disciplines who work collaboratively to provide safe, high-quality, and seamless care. Gambino (2008), an expert on complexity theory, posits that "interprofessionalism is predicated on the understanding that information in isolation becomes less and less useful in decision making as patient conditions increase in complexity" (p. 65).


How do we as preceptors and nursing professional development specialists promote interprofessionalism? We start with the basics. We begin by calling and recognizing each other by each individual's preferred name. This may seem remarkably simple, but it is not.


In interviews conducted with attending and resident physicians who were identified by nurses as collaborative and collegial, only 15 of 76 physicians could provide the name of a bedside nurse using his or her full name when asked to do so. Most of the physicians were embarrassed by this revelation and suggested that there were so many excellent nurses, they "could not name just one." Others could describe the physical characteristics or social anecdotes of a particular nurse but could not provide a name. Of the 15 physicians who could identify a nurse by first and last name, 12 were pediatricians. Knowing the names, personalities, and practice patterns of their colleagues, and most especially the nurses, was considered essential to providing family-centered care. (Modic & Siedlecki, 2011).


Think about how you introduce a new nurse into the work environment. Is there a formal process where he or she is introduced at interprofessional rounds? Is the use of names egalitarian? Do you ensure that the other healthcare professionals and caregivers meet and introduce themselves to the new nurse? How do you encourage the new nurse to seek out unfamiliar faces and introduce himself or herself? How do you intervene when you notice that there is important dialogue occurring and the parties involved do not know each other names or roles? How do you as an educator model introductions not only to new staff members but also to students?


The famed surgeon, author, and quality advocate, Atul Gawande (2011), notes in his book, The Checklist Manifesto, "that people who don't know one another's names don't work together nearly as well as those that do" (p. 108). Calling a person by his or her name conveys respect and value, helps the person feel recognized as an individual, and invites and encourages the person to participate in decision making and problem solving.


The REDE to Communicate Model can serve as a framework for establishing interprofessional relationships (Windover et al., 2014). There are three phases to the REDE Model: establishing, developing, and engaging a relationship. The model is designed to enhance communication between healthcare professionals and their patients. However, the principles have applicability to interprofessional communication as well. To facilitate the easy recall of the behaviors, each phase has been codified into a mnemonic. Table 1 below illustrates the different behaviors that can be used to build relationships when participating in interprofessional rounds.

Table 1 - Click to enlarge in new windowTABLE 1 Comparison of Feedforward versus Feedback

Interprofessional rounds are one of the most important clinical activities in relationship building and encouraging interprofessionalism. They can also be exclusive, intimidating, and hierarchical. In this complex, high-tech, fast-paced healthcare universe, we have to create workgroups that can negotiate and navigate multiple, interconnected relationships, situations, and activities usually quite rapidly (Lingard, 2012). Although the bedside nurse may not be the leader of the rounds, he or she should be the emotional barometer as well as the gatekeeper for the group. The following statements provide a few examples of gatekeeping statements:


Before we begin rounds this morning, I would like to introduce one of our new nurses, Jane Smith. She will be observing the rounding process and how the plan of care is reviewed and communicated to everyone. Jane, I don't think you have met Rob Johnson, he is one of our physical therapists.


I know that we are running behind, but I just want to check in to see that I have fully communicated the patient's daughter's concerns about her ability to manage her care at home.


I want to make sure that we have grasped the issue that Amy has raised about Mr. Taylor's tube feeding rates. Amy, do you feel you have been heard?


Thank you Mike, for explaining the rationale for the change in antibiotic therapy. The plan makes sense to me now.


The need for interprofessionalism and relationship building has never been greater. Preceptors are critical players in promoting this movement because "it is the nurse who lives where the patient lives and is the link between all healthcare professionals and systems that support the patient" (Wiggins, 2008, p. 6). Preceptors have intimate knowledge of their patients' physical, emotional, and social needs as well as the political environment in which the care is provided. They have working knowledge of the practice patterns of the other healthcare professionals with whom they interact and consult. Because of this experience, preceptors are able to provide unique perspectives on how to effectively collaborate and foster interprofessional relationships. After rounds, the preceptor can debrief with the new nurse to highlight behaviors that reflected interprofessional behavior: the welcoming and acknowledging of each member rounding, acknowledging contributions, addressing differences of opinions, negotiating differences, and obtaining agreement. The preceptor can also provide reflection by inquiring about how the rounds could have been managed differently next time.


Nursing professional development specialists can advance the interprofessionalism movement by being conversant with the IPE literature, creating interprofessional educational opportunities beyond simulation, and seeking out opportunities for interprofessional feedback about educational offerings. This is our time to embrace interprofessionalism and relationship building. Let us not waste 1 minute!




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Gawande A. (2011). The checklist manifesto: How to get things right. New York, NY: Metropolitan Books. [Context Link]


Green M., Zick A., & Makoul G. (2009). Defining professionalism from the perspective of patients, physicians, and nurses. Academic Medicine, 84(5), 566-573. [Context Link]


Interprofessional Education Collaborative. Retrieved from


Lingard L. (2012). Rethinking competence in the context of teamwork. In Hodges B., Lingard L. (Eds.), The question of competence: Reconsidering medical education in the twenty-first century (pp. 42-54). Ithaca, NY: Cornell University Press. [Context Link]


Modic M. B., & Siedlecki S. L. (2011). Collaboration, cooperation and collegiality. Unpublished research. [Context Link]


Sheard T. (1980). The structure of conflict in nurse-physician relations. Supervisor Nurse, 11(8), 14-18.


Wiggins M. (2008). The challenge of change. In C. Lindberg, S. Nash, Lindberg C. (Eds.), On the edge: Nursing in the age of complexity (pp. 1-21). Bordentown, NJ: Plexus Press. [Context Link]


Windover A., Boissey A., Rice T., Gilligan T., Velez V., & Merlino J. (2014). The REDE model of healthcare communication: Optimizing relationship as a therapeutic agent. Journal of Patient Experience, 1(1), 8-13. [Context Link]