Have you ever watched that TV programme, DIY SOS: The big build, where a family's house is not fit for purpose and a team of people are recruited to re-wire, re-plumb, knock walls down, put walls up, fit kitchens, and so on, all in a matter of 2 or 3 days? We are shown clips of electricians, plasterers, chippies, plumbers and decorators all working together to strict deadlines to achieve the rebuild. At the end the family are moved to tears as they view the new layout, which means they can have a new way of living. Can you imagine the amount of organisation that goes on behind the scenes to recruit and co-ordinate all those different professionals coming together on those few days of filming to complete such a major task?
Healthcare provision in the 21st century
I sometimes think that, as nurses, we become so accustomed to all the different people and professionals we work with and almost take for granted the catering, finance, building, pathology, IT, admission team, X-ray departments and all the other facilities that are part of our healthcare system. It's only when one of these services goes wrong that we become aware of quite how much we depend on other people to deliver our hands-on nursing care. This is not a criticism of how we work as nurses; it is just a reflection of the increasingly specialised and complex nature of the provision of health care in the 21st century.
Nurses' central role
Take a minute to reflect upon your average day at work: how many health professionals, care assistants and specialist support services to you liaise with each day? What about the path labs and X-ray departments? In that 60 seconds of reflection you will have probably listed over 20 different people or services that you regularly liaise with. Unlike any of the other health professionals involved, the nurse is the one to whom all the other groups tend to refer. The physio comes on the ward and asks you how Mr Jones is today, the pharmacist checks with you for any additional prescription needs, the consultant asks if Mr Smith has seen the speech therapist, the bed bureau manager wants to know if any beds are likely to be free in the next four hours, the junior doctor asks what form needs filling in for referral to social services, and that's before you've had a coffee! The vast array of support services, relatives and patients see nurses as the central person who co-ordinates and has knowledge about what is happening with regard to the general activity of a ward and to any particular patient on a ward. The nurse has a key role in the co-ordination and communication within and between the multidisciplinary team (MDT).
Positive action
Although I'm arguing that the nurse's role in the MDT is central, it is by no means well defined. The nurse is not ‘in charge’ of the MDT, there are few, if any, professional protocols of who relates to who, and in what way. The ‘rules’, if there are any, vary from unit to unit and are generally unwritten. Given this ‘cloudiness’ of communication and authority, the nurse needs to exercise gentle but positive leadership skills in this area. Listed below are some of the positive team-building actions I have seen in some clinical areas:
- Pictures and names of the various nursing staff, clearly identifying the role of each. This allows visiting MDT staff to identify with whom they need to communicate
- Pictures and names of the visiting medical, allied healthcare staff and any other regularly visiting professionals. This allows the nurses to recognise and address the professionals by name
- An established protocol for health professionals visiting the unit. This could mean that when entering they identify themselves to the nurse in charge or to the ward clerk
- If the ward or unit has a staff coffee room, making sure that it is welcoming to all and inviting any of the MDT visiting to make use of it
- Encouraging visiting MDT professionals to have a student or junior health professional with them when they see a patient. This allows the ward nurses, healthcare assistants and student nurses to understand the various roles of others and form good interpersonal relations with the different groups
- Encouraging any of the MDT to participate in the unit's social activities
- Developing formal means of communication, feedback and information sharing.
This list is just some of the positive actions I have seen as I've visited clinical areas. Each unit will have a fairly unique way in which different members of the professions work together. Like the TV programme that brings people with different skills together to achieve a specific aim, healthcare teams need to work together in a way that is co-ordinated, planned and in a way that values each other's skills and abilities. Although not having a defined role as ‘project manager’, the nurse is in a key position to co-ordinate and communicate with other key people in the team. They can use their skills of leadership, if not authority, to enhance this co-ordinated role, which keeps the needs of the patient central in the complex world of high technology and healthcare specialism.