The nurse-physician dynamic has been found to shape various aspects of the healthcare environment. Research has uncovered that nurse-physician collaboration can affect patient care, patient satisfaction, hospital costs, and turnover. But as a nurse, how do you see it affecting your facility?

HCPro, Inc., recently surveyed 67 nursing professionals in the healthcare industry about the issue of nurse-physician collaboration within facilities of various sizes and settings nationwide. Participants responded to questions about nurse-physician collaboration barriers, strategies facilities are using to improve nurse-physician collaboration, and the influence poor nurse-physician collaboration has on stress. Take a look at some of the results:

• 91% of nurses that rated their facility as having "excellent" nurse-physician communication came from organizations that employed fewer than 100 nurses
• 82% of nurses surveyed said positive steps have been taken at their facilities to create work environments with better nurse-physician collaboration
• 80% of nurses said poor nurse-physician collaboration brought stress to the workplace
• 75% of nurses admitted to knowing other nurses who have vacated positions due to poor nurse-physician collaboration

What are your first impressions of these results?

As a nurse, the obstacles you face on a daily basis increase the difficulty of your job regardless of the pressure for you to deliver quality patient care. You might feel many of these obstacles are unnecessary and unfair. If the sufficient amount of nurses were employed at your facility-- these obstacles might not even exist.

Have you ever wondered how staffing issues at your facility measure up to those around the country? Take a look at the results below from the American Nurses Association's Safe Staffing Poll that more than 10,000 nurses participated in. The findings emphasize the ongoing need for adequate staffing.

• 73% of nurses asked don't believe the staffing on their unit or shift is sufficient.
• 59.8% of those asked said they knew of someone who left direct care nursing due to concerns about safe staffing.
• 51.2% of nurses believe the quality of nursing care has declined in their unit over the past year.
• 48.2% would not feel confident having someone close to them receiving care in the facility where they work.
• 46% of nurses that were considering leaving their position associated it with inadequate staffing.
• 36% rarely or never take their full meal break.

Do these results surprise you?

A new way to look at competencies, from the pages of our Briefings on Long-Term Care newsletter:

Making sure nurses are competent in their skill sets is one of the most important responsibilities of a director of nursing. But as the need for validation goes beyond technical skills and focuses on professional development as a whole, the traditional methods of assessing competencies need to be examined in a new light.

"It has always been important to validate competencies, but how some institutions are choosing to look at it is taking a different spin," says Sheila St. Cyr, MS, RN-BC, OCN, performance-based development system coordinator at the University of Oklahoma (OU) Medical Center in Oklahoma City. "Now we're not just looking at technical skills, we're validating interpersonal skills as well. It used to be more about the technical skills checklist. And that's just not how it should be."

With the recent shift in focus, directors of nursing must arm themselves with the necessary tools and information to think beyond simply validating skill sets.
St. Cyr says there are two main areas of assessment on which to focus: competency validation and performance evaluation. Recently, the shift has been to combine the two efforts rather than have an instructor simply check off that a nurse is able to complete a particular skill.

Developing a definition of competency validation for your facility must take place prior to any assessments, says Diana Swihart, PhD, DMin, MSN, CS, APRNBC, clinical nurse specialist in nursing education at the Bay Pines (FL) VA Healthcare System.

When you begin working with staff members to validate competencies, St. Cyr says one of the best strategies toward education is to play the what-if game. "Use a questioning technique with staff members," she says. Give your nurses a scenario, then ask the following questions:

• What complications can happen?
• What are the signs or symptoms?
• Would you need to call the doctor?
• What assessments would you need to make?

Other methods for validation, adds Swihart, can include:

• Case studies, which can help measure critical thinking
• Quality improvement monitors, which are a strong determinant of competency because they reflect an individual's overall performance
• Mock events, which are useful in measuring cognitive knowledge

What methods are used at your organization?

By Diane M. Billings, EdD, RN, FAAN

Following our discussion during today's audioconference, we realized that one big component of implementing new classroom technology includes bringing in a Learning Management System (LMS). Basically, an LMS includes software tools designed to manage learning. Many LMSs are Web-based and are able to facilitate "anytime, any place, any pace" access to administration and learning content. LMSs are especially relevant in healthcare as compliance training remains essential. Characteristics of LMSs often include:

• The ability to manage users, courses, and instructors
• The inclusion of a course calendar
• Access to messaging learners
• The chance to display scores and transcripts

There are many different types of LMSs that are available, including Blackboard Inc., Saba Software, and ATutor. What have your experiences been with using LMSs, and which ones have you found to be most effective (or ineffective) in your educational endeavors?

Is there a physician, possibly your medical director, who has been non-supportive behind your back?

You know who these people are. At a meeting or in front of your boss, they are supportive and, at times, encouraging of your work and efforts. But once the meeting is over and everyone goes their own way, they are completely different. You would think it was a "Jekyll and Hyde" experience!

This is not to take away from all the providers we collaborate with who are ethically strong and committed to being part of a team. This hot topic is not about them; we are grateful for  strong collaboratives with many providers we work with.

But believe it or not, some people are unhappy when they see your successes. Now that I spurted that out, think about it. You already knew that, but most people won't say it. You are that multi-tasking, confident, caring, empowering nurse leader and some folks out there want to burst your bubble.

How do they burst your bubble?

• Going behind your back and planting seeds among those who look up to you. What are they planting seeds for? They are hoping to grow their own cheerleaders and take your squad away from you.
• Relaying misinformation about what you said or wrote
• Discouraging staff from following policy or procedure
• Verbally defaming your ability to perform your role
• Identifying staff members vulnerable to getting on their bandwagon

How would you approach this professional? Or, if you have already faced a situation similar to this one, how did it go?