Building collaboration between CNOs and direct-care nurses

Although the concept of collaboration (working together) may sound simple, true collaboration is a complex process. Healthcare professionals talk about collaboration a lot, but we seldom practice it to the extent we should. In a healthcare facility, the chief nursing officer (CNO) must develop the type of culture and environment that enables collaboration to exist.

Promoting collaboration creates a positive environment for nurses at all levels. Culture and environment set expectations for performance. The healthcare workplace must have a culture of mutual trust and respect—the foundation of collaboration. Developing such a culture takes years. To build mutual trust and respect, the CNO needs to appreciate what others contribute, use the skillsets of nurses at different knowledge levels and types of expertise, and include staff in shared governance models, teams, and projects.

Ideally, the CNO should connect with staff by learning each staff member’s name and using it
when meeting that person. As she goes on rounds or meets people, she must make eye contact, address individuals by name, ask about the family, recognize special days as pertinent, and go to the funeral home when a staff member suffers a close family loss.

In a large healthcare facility, this might not be possible. Nonetheless, CNOs should try their best to connect with as many staff nurses as possible.

Make a daily effort to have “face time” with staff and to connect through active listening, team meetings, rounding, and casual hallway greetings. This nurtures trust and helps staff nurses feel empowered. The CNO’s ability to speak to the work of staff nurses is essential for building trust and mutual respect. (See Three phases of collaboration by clicking the PDF icon above.)

Does collaboration thrive in your organization?

If you’re a CNO, ask yourself: Is this a friendly organization? Is it vision-driven or problem-driven? Do we support our values every day through our actions? What is my own interpersonal style? Taking the time to answer these questions will help set the tone for collaboration.


Are your decisions guided by data? When you use valid data and facts, staff members are likely to believe you’re basing your decisions on an objective review of findings. Don’t let yourself react to emotions and make poor decisions that may break down the collaboration and respect you’re striving to build.

Moving from a problem-driven to a vision-driven organization is a journey worth taking. Focus on where you want to take your nursing units, patient care, and customer service, as well as the goals you’ve set for nursing staff. Talk about these goals openly and honestly. Ask staff for their suggestions for improvement. Use the “lean” and “Six Sigma” management approaches to lead staff down the path to improvement. Creating excellence on a unit makes staff members proud of what they do. Taking pride in work and one’s unit nurtures trust and empowerment—essential traits of a collaborative workplace. (See Collaboration: A role responsibility by clicking the PDF icon above.)

Teamwork vs. collaboration

Teams, committees, and councils are a large part of the collaborative process. Although the terms teamwork and collaboration are often used synonymously, collaboration is just one prerequisite for teamwork. Team leaders demonstrate collaboration by sharing ideas, involving team members in decisions, solving problems through open communication, and mentoring team members.

Teamwork is possible only when staff members’ individual skills and talents are used to reach the highest achievement level. It takes place through a complicated dynamic; mutual trust and respect must exist for a team to succeed. Defining clear objectives for the team enhances members’ ability to achieve objectives.

Collaboration outcomes

Outcome measures to prove collaboration exists in your facility may be hard to link to cause and effect. RN satisfaction survey results may not be ideal if collaboration in your nursing units is low. The CNO’s review of these survey results with all nursing leadership team members may guide actions to enhance teamwork and collaboration.

Employee survey scores on perceptions of trust and respect may help align leaders’ thinking about the specific department’s communication and collaboration efforts. Is staff involved in both unit and organizational activities? Striving to implement such frameworks as the Magnet Recognition Program® and the Malcolm Baldrige National Quality Awards can get staff nurses involved in the process, structure, and outcomes of your organization.

Nursing competencies needed to foster collaboration include conflict resolution and negotiation skills. The same skillset applies to both nursing leaders and staff nurses. Educating staff in these areas using case studies, peer review, and mentoring helps staff nurses gain confidence in these techniques.

To help bridge the gap to collaborative practice, CNOs must be present, spontaneous, and sharing and must plan with and learn from staff nurses. The journey toward creating a collaborative culture is worth the effort. The benefits include improved patient outcomes, reduced patient stays, cost savings, increased satisfaction, better nurse retention, and improved teamwork.

Selected references

Bivin JB, Reddemma K. Different Models of Collaboration between Nursing Education and Service. Department of Nursing, National Institute of Mental Health and Neurosciences. Bangalore, India; 2010.

Gardner DB. Ten lessons in collaboration. Online J Issues Nurs. 2005;10(1):2.

The authors work at Schneck Medical Center in Seymour, Indiana. Vicki Johnson is
a vice president and chief nursing officer. TylerWessel is a staff nurse recently
promoted to perioperative nurse manager. Kerry Johnson is a staff nurse and
orthopedic navigator.

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