Registered Nurses' Association of Ontario

Nursing Best Practice Guidelines

Recommendations

Recommendations

For the detailed discussion of evidence and framework for the healthy work environments best practice guidelines project, please consult the full guideline, available for download at www.RNAO.org/bestpractices.

Individual/Teams Recommendations

Physical/Structural components

  • Work demands – physical effort and requirements of the work such as changing schedules and shifts
  • Work design – task interdependence, role clarity, unit-level policies that influence scope of practice and role autonomy
  • Work characteristics – workload and characteristics of the patient/client population that necessitate teamwork by the nursing team (the complexity of patient/client needs and acuity of their health condition could influence the number of different nursing providers involved in care and the frequency of team interactions)
  • Team composition – collective work experience, educational preparation

The Cognitive/Psychological/Social/Cultural components

  • The requirements of the work that necessitate cognitive, psychological, and social capabilities and effort
  • Team relationships – team communication patterns, decision-making, conflict resolution, and team member mentoring
  • Role clarity
  • Role strain
  • Emotional demands
  • Job security
  • Clinical complexity
  • Clinical knowledge, coping skills, communication skills

Professional/Occupational Components

  • Experience, skills and knowledge
  • Personal attributes
  • Teamwork skills
  • Motivational factors

1.0 Nursing Collaborative Practice Individual/Team Recommendations

1.1 Nurses develop knowledge about the values and behaviours that support teamwork and the impact of teamwork on patient/client safety and patient/client outcomes. As such nurses:

  • Inform themselves about the attributes of supportive teams
  • Articulate their belief in the value of teamwork
  • Demonstrate their willingness to work effectively with others

Type of evidence = A

Teamwork Attributes

  • Mutual Respect
  • Shared Planning
  • Open Communication
  • Cooperation
  • Shared Expertise
  • Shared Decision-making
  • Common Goals
  • Coordination

1.2 Nurses contribute to a culture that supports effective teamwork by:

  • Demonstrating accountability for actions, enthusiasm, motivation and commitment to the team
  • Actively and constructively participating in the nursing team
  • Understanding their own roles, scope of practice and responsibilities as well as seeking information and developing an understanding about other roles and scopes of practice
  • Being accountable for and respectful in the manner in which they communicate
  • Being proactive in seeking out information they require about their work and workplace
  • Seeking opportunities and assuming the responsibility to share a nursing perspective in interprofessional forums, including informal and formal settings

Type of evidence = A1, C, D and D1

Team Communication

  • Active Listening
  • Timeliness
  • Openness
  • Sharing
  • Respect
  • Trust

1.3 Nurses initiate and maintain collaborative processes within the team, especially in situations of increasing patient/client complexity, to improve patient/client outcomes.
Type of evidence = A1, C, D

Attributes of Collaboration

  • Cooperative endeavor
  • Willing participation
  • Shared planning and decision-making
  • Recognizing and sharing expertise
  • Nonhierarchical

Key Features of Collaboration

  • Active and assertive contribution of each party
  • Receptivity and respect of the other party’s contributions
  • Negotiating process that builds upon the contribution of both parties to form a new way of conceptualizing the problem

1.4 Nursing teams establish clear processes and structures that promote collaboration and teamwork that leads to quality work environments and quality outcomes for patients/clients by:

  • Establishing processes for conflict resolution and problem solving
  • Establishing processes to develop, achieve and evaluate team performance, common goals and outcomes
  • Developing systems and processes to recognize and reward successes
  • Building capacity for systematic problem solving and improving quality of care
  • Participating in the development and implementation of guidelines to support enhanced collaboration at the functional and organizational level
  • Incorporating non-hierarchal, democratic working practices to validate all contributions from team members
  • Incorporating processes that support continuity of care with patients/clients to enhance staff satisfaction, staff self-worth and patient/client satisfaction
  • Developing and implementing processes that clarify their understanding of the unique and shared aspects of roles within the team
  • Ensuring that the composition of the team is adequate to achieve their goals and meet their responsibilities to the needs of the patient/client population
  • Establishing processes for decision-making for a variety of circumstances such as:
    • emergencies;
    • day-to-day functioning;
    • long-term planning;
    • policy development; and
    • care planning.

Level of evidence = A1, B, C and D

1.5 Nursing teams recognize how their goals contribute to, impact and/or complement the goals of other teams and the organization in achieving quality patient/client care.
Level of evidence = A1 and C

1.6 Nursing teams establish processes which promote open, honest and transparent channels of communication by:

 

  • Establishing processes to ensure that full-time, part-time and casual staff seek out and receive effective communication on all shifts
  • Establishing verbal, written and/or electronic processes in order to effectively document the communication
  • Developing skills in active listening

Level of evidence = A1 and C

Organization Recommendations

Physical/Structural components:

  • Physical characteristics and environment of the organization including functioning equipment
  • Organizational structures and processes created to respond the physical demands of the work (e.g., span of control of managers, decision-making processes)
  • Leadership support
  • Staffing practices, flexible and self-scheduling
  • Occupational health safety policies
  • Rewards and incentives that encourage and promote collaborative practice

Cognitive/Psychological/Social/Cultural components:

  • Organizational climate, culture and values
  • Cultural norms, especially those that foster trust and respect
  • Organizational hierarchy, and how it influences power dynamics
  • Organizational stability
  • Communication practices
  • Labour/management relations
  • Culture of continuous learning and support

Professional/Occupational components:

  • Characteristics of the nature and role of the nursing within the organization, including organizational policies that influence scope of practice, level of autonomy and control over practice
  • Intraprofessional and interprofessional relationships within the organization

2.0 Nursing Collaborative Practice Organization Recommendations

2.1 Organizations implement specific strategies that encourage and enable effective teamwork. These may include the provision of:

  • Physical space or technology that enables people to come together
  • Administrative support
  • Orientation and continuing education funding
  • Compensation opportunities to promote participation
  • Recognition and rewards
  • Participative decision-making opportunities related to development and implementation of policy
  • Evaluation processes focused on the impact of nursing teams on patients/clients, nurses, and the organization and the development of specific outcome measures

Level of evidence = A1, C and D

2.2 Organizations ensure a culture that supports effective teamwork and conveys administrative support by:

  • Ensuring that team members are included in the development and implementation of unit policies
  • Supporting a culture in which participative decision-making is promoted
  • Developing clear and consistent policies concerning role responsibilities
  • Developing values, structures and processes to foster effective intra and interprofessional collaborative relationships
  • Ensuring that resources are allocated for teams to balance delivery of care and professional practice development and evaluation
  • Endorsing a professional practice model that supports practice accountability, autonomy and decision authority related to the work environment and care
  • Incorporating behavioural objectives into the performance development and management processes related to effective teamwork

Level of evidence = A1, C and D

2.3 Organizations support systems and processes that promote team functioning and continuity of patient/client care.
Level of evidence = A1, B, C and D2

2.4 Organizations develop and utilize specific outcomes to evaluate the effectiveness of teams while ensuring that high quality nursing care is being delivered by:

  • Evaluating the impact of nursing teams on patients/clients, nurses and the organization
  • Systematically evaluating nursing teams
  • Identifying obstacles to completing evaluation processes

Level of evidence = A1, B, C and D2

2.5 Organizations provide support to leaders who use evidenced-based transformational leadership practices to create healthy work environments.
Level of evidence = A and D

Transformational Leadership Practices That Improve Collaboration

  • Building relationships and trust
  • Creating an empowering work environment
  • Creating a culture that supports knowledge development and integration
  • Leading and sustaining change
  • Balancing competing values and priorities

3.0 Education

6.1 Educators/educational institutions value, promote and role model a culture of professionalism and effective team functioning by:

  • Identifying and implementing a leadership/champion role accountable for the implementation of the infrastructures required to support team focused curriculum
  • Utilizing a variety of teaching and learning strategies that provide opportunities to learn about effective teams and teamwork. Opportunities may include but are not limited to:
    • case studies depicting realistic team issues and scenarios that become increasingly complex throughout the educational program;
    • course electives which focus on teams and team functioning;
    • course electives which focus on conflict resolution; and
    • learning objectives that focus on social/relational domains.

Level of evidence = A and B

6.2 Nurse Educators select clinical placements that promote and demonstrate team effectiveness by:

  • Assuring that students obtain accurate knowledge about the roles and responsibilities of nurses and other providers in the health system
  • Developing innovative practicums that support communities of practice amongst both nursing teams and interprofessional teams

Level of evidence = A and B