Opinion
Breaking down the hierarchies Science Photo Library
Riane Eisler and Teddie Potter argue that nursing needs a new organisational model built on collaborative teams
ALL TOO often teamwork and collaboration are just words. What is needed is a new theoretical framework and practical tools to shift healthcare relationships from hierarchies of domination and isolated professions to high-functioning, collaborative teams prepared to be full partners with patients, families, communities and one another. Such a move is especially important for nurses, who are often at the bottom of the old hierarchies. Studies show that nursing education has unwittingly reinforced this devaluation. For example, Randle (2003) found that students often leave their nurse training with lower self-esteem than when they started. And how can nurses become full partners in interprofessional teams if their self-esteem is weak? In re-examining nursing education, we have to look at relations between faculty and students, and at the curriculum. For example, autonomous nursing roles such as nurse-led models of care and nursing midwifery are excluded from most nursing texts, which also fail to provide examples of historical partnerships between nurses and other 12 September 2014 | Volume 21 | Number 5
providers, and only minimally touch on the collaborative skills required in health care. To change this devaluation of nursing requires an understanding of its larger cultural context and nursing education that empowers nurses to be equal partners in interprofessional teams. Interprofessional practice An important step for the latter is recognising that the nursing profession has its own form of medicine that makes a unique and essential contribution to interprofessional practice. Nursing’s unique medicine is defined by a comprehensive nursing paradigm for education, research and practice, which includes empirically tested knowledge and the essential elements of feeling, presence and care. Certainly we 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 actualisation of partnership-oriented cultures, where accountability and respect flow both ways. As nursing managers will note, many of the demonstrated benefits of a partnership
culture support the outcomes sought by health care: ■ Employees feel valued and empowered to contribute and participate. ■ Conflict can be used creatively to explore alternatives. ■ Innovation is promoted because there is less fear of making mistakes, and staff have permission to 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 organisational model from domination to partnership. If we guide our actions related to social dynamics and relationships by cultural transformation from domination to partnership, we can help nurses take their equal place in health care. Beginning with the facultystudent relationship, we can move toward greater partnership with patients, clients and families, and promote intra- and interprofessional relationships, and our relationships with communities. Riane Eisler is founder and president of the Center for Partnership Studies and teaches in the leadership graduate programme at the California Institute of Integral Studies Teddie Potter is a clinical associate professor and director of inclusivity and diversity at the school of nursing at the University of Minnesota
Reference Randle J (2003) Changes in self-esteem during a three-year pre-registration diploma in higher education (nursing) programme. Journal of Clinical Nursing. 12, 142-143.
Find out more Where does your organisation fall on the partnership-domination continuum? Go to rcnpublishing.com/r/likert-scale Eisler R, Potter T (2014) Transforming Interprofessional Partnerships: A New Framework for Nursing and PartnershipBased Health Care. Sigma Theta Tau, Indianapolis IN. NURSING MANAGEMENT
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Breaking down the hierarchies Science Photo Library
Riane Eisler and Teddie Potter argue that nursing needs a new organisational model built on collaborative teams
ALL TOO often teamwork and collaboration are just words. What is needed is a new theoretical framework and practical tools to shift healthcare relationships from hierarchies of domination and isolated professions to high-functioning, collaborative teams prepared to be full partners with patients, families, communities and one another. Such a move is especially important for nurses, who are often at the bottom of the old hierarchies. Studies show that nursing education has unwittingly reinforced this devaluation. For example, Randle (2003) found that students often leave their nurse training with lower self-esteem than when they started. And how can nurses become full partners in interprofessional teams if their self-esteem is weak? In re-examining nursing education, we have to look at relations between faculty and students, and at the curriculum. For example, autonomous nursing roles such as nurse-led models of care and nursing midwifery are excluded from most nursing texts, which also fail to provide examples of historical partnerships between nurses and other 12 September 2014 | Volume 21 | Number 5
providers, and only minimally touch on the collaborative skills required in health care. To change this devaluation of nursing requires an understanding of its larger cultural context and nursing education that empowers nurses to be equal partners in interprofessional teams. Interprofessional practice An important step for the latter is recognising that the nursing profession has its own form of medicine that makes a unique and essential contribution to interprofessional practice. Nursing’s unique medicine is defined by a comprehensive nursing paradigm for education, research and practice, which includes empirically tested knowledge and the essential elements of feeling, presence and care. Certainly we 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 actualisation of partnership-oriented cultures, where accountability and respect flow both ways. As nursing managers will note, many of the demonstrated benefits of a partnership
culture support the outcomes sought by health care: ■ Employees feel valued and empowered to contribute and participate. ■ Conflict can be used creatively to explore alternatives. ■ Innovation is promoted because there is less fear of making mistakes, and staff have permission to 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 organisational model from domination to partnership. If we guide our actions related to social dynamics and relationships by cultural transformation from domination to partnership, we can help nurses take their equal place in health care. Beginning with the facultystudent relationship, we can move toward greater partnership with patients, clients and families, and promote intra- and interprofessional relationships, and our relationships with communities. Riane Eisler is founder and president of the Center for Partnership Studies and teaches in the leadership graduate programme at the California Institute of Integral Studies Teddie Potter is a clinical associate professor and director of inclusivity and diversity at the school of nursing at the University of Minnesota
Reference Randle J (2003) Changes in self-esteem during a three-year pre-registration diploma in higher education (nursing) programme. Journal of Clinical Nursing. 12, 142-143.
Find out more Where does your organisation fall on the partnership-domination continuum? Go to rcnpublishing.com/r/likert-scale Eisler R, Potter T (2014) Transforming Interprofessional Partnerships: A New Framework for Nursing and PartnershipBased Health Care. Sigma Theta Tau, Indianapolis IN. NURSING MANAGEMENT
Downloaded from RCNi.com by ${individualUser.displayName} on Dec 03, 2015. For personal use only. No other uses without permission. Copyright © 2015 RCNi Ltd. All rights reserved.
