There is growing consensus on the urgent need for interprofessional teams in health care. Many experts recognize the need for a new theoretical framework and practical tools to shift health care relationships from hierarchies of domination and isolated professions to high-functioning, collaborative teams, but how can we ensure that this emerging approach is successful?
This is especially important for nurses, who are often at the bottom of the old hierarchies of domination and, studies show, all too often buy into their own subordination.
Research has shown that nursing education has unwittingly reinforced this devaluation. For example, one study published in the Journal of Clinical Nursing found that students often leave their nurse training with lower self-esteem than when they started. In re-examining nursing education, we have to look not only at relations between faculty and students, but also at the curriculum. Nursing texts exclude nurse-led models of care and nursing midwifery and fail to provide examples of historical partnerships between nurses and other providers.
To change this devaluation of nursing requires both an understanding of its larger cultural context and nursing education that empowers nurses to be equal partners in interprofessional teams.
If we look at the past, present, and potential future of nursing, we can see the two opposing social configurations of partnership and domination. In domination-oriented systems, communication is one way (top down) and those on top use power to maintain the status quo, creating cultures of fear and mistrust that negatively impact safety, quality, and employee engagement. In partnership-based systems, communication flows both ways, and leaders empower workers to reach their full potential.
The common wisdom has been that top-down hierarchies are necessary to ensure efficiency. Certainly our society and health care organizations need hierarchies, but there is a difference between hierarchies of domination, where accountability and respect flow only from the bottom up, and the hierarchies of actualization of partnership-oriented cultures where accountability and respect flow both ways, and power is used to empower rather than disempower employees.
As nursing managers will note, many of the demonstrated benefits of a partnership culture support the outcomes sought by health care. They include:
• Employees feel valued and empowered to contribute and participate.
• Conflict can be used creatively to explore alternatives.
• Innovation is promoted through less fear of making mistakes, and permission to be inquisitive and explore.
• Quality and safety improve because employees are not afraid to report errors or suggest systems change.
Nurse managers and executives can improve patient satisfaction and employee engagement by shifting their organizational model from domination to partnership. Moreover, the partnership model is the necessary foundation for successful interprofessional collaborative practice.
Transformation of traditional health care hierarchies begins with the faculty/student relationship in nursing education. If we use cultural transformation from domination to partnership to guide our actions related to social dynamics and relationships in both educational institutions and health care organizations, we can make the changes needed so nurses take their equal place in health care.
