Exploring Human Potential

Health Professional Collaboration Inside and Outside The Hospital

Posted on | January 26, 2011 | 5 Comments

Mike Magee

Ten days ago, my wife and I were blessed with the arrival of our 8th and 9th grandchildren – two little girls, Charlotte and Luca. We were also introduced for the first time, as health consumers, to the Neonatal Intensive Care Unit (NICU). The girls came early, at 34 weeks, and are working their way up to their due date. They are doing great, but it’s not easy on them or their parents or the care teams committed to their well being.

Viewing them from my grandparent bias, the Connecticut Childrens Hospital Center NICU team at Hartford Hospital  is doing a great job, balancing high tech with high touch, providing wisdom and reassurance, inclusion and training to the girls’ parents who are clearly part of the team.  Viewing it all from my bias as a former surgeon, hospital administrator and health policy analyst, I am equally impressed but not surprised.

When people claim that “America has the best health care”, they’re talking about these kind of complex care settings within our elite teaching hospitals. Specifically they are referencing groups of highly skilled doctors and nurses, committed to their patents and to each other, armed with experience, judgment and technology to – collectively – heal and provide health, and keep us whole in the process. It’s really a holy thing to observe, and reinforces why I chose this life way back in 1965 as a 17 year old college student.

Translating this type of in-patient care, and specifically these models of nurse – physician cooperative care teams into the outpatient setting, however, has remained problematic. Inside they are professional collaborators; outside they are often business competitors.

Ground zero in the battle is Nursing scope of practice. Sixteen states have liberalized scope of practice for advanced practice nurses, but most have not.(1)  The Institute of Medicine and multiple studies say nurses are up to the task and the patients will benefit.(2,3) But major medical organizations like the American Medical Association, the American Osteopathic Association, the American Academy of Pediatrics, and the American Academy of Family Physicians disagree, despite the growing body of evidence that supports the move. (1)

In this week’s lead article in the New England Journal of Medicine, the authors emphasize the urgency to act now. They say, “This is a critical time to support an expanded, standardized scope of practice for nurses. Economic forces, demographics, the gap between supply and demand, and the promised expansion of care necessitate changes in primary care delivery. A growing shortage of primary care providers seems to ensure that nurses will ultimately be required to practice to their fullest capacity. Fighting the expansion of nurse practitioners scope of practice is no longer a defensible strategy.” (1)

Furthermore they say “Effective implementation of new delivery models, such as medical homes and accountable care organizations, which would provide chronic disease management and transitional care, requires the establishment of interdisciplinary teams in which nurses provide a range of services, from case management to health and illness management.” (1)

It is on this last point that I would like to focus your attention – creating the kinds of high performance teams as I witnessed the past 10 days in our granddaughters’ NICU, but in outpatient settings. My message to the House of Medicine: Step one in delivering excellent home –centered health care is to eliminate the distraction of a continued protracted fight with the Nursing Profession over scope of practice. Step two is to create elite outpatient teams focused on patients, families, and community. Step three is active inclusion of home caregivers in the team as both providers and consumers of care. Step four is to embrace modern technology to accomplish 24/7 connectivity. (4)

This approach is being utilized by a number of systems including the VA, Geisinger Health System  and Kaiser-Permanente with good results. With 32 million new health care consumers gaining coverage  with the Affordable Care Act, it’s time for all of us – doctors and nurses – to act like professionals. (1)

For Health Commentary, I’m Mike Magee


  1. Furman JA et al. Broadening the scope of nursing practive. NEJM 364:3, 2011, 193-196.
  2. Laurant M et al. Substitution of doctors by nurses in primary care. Cochrane Database  System Review 2005;2:CD001271
  3. Institute of Medicine. The future of nursing:leading change, advancing health. Washington, DC:National Academies Press, 2010.
  4. Magee M. Home-Centered Health Care. 2007 Spencer Books, NY, NY.


5 Responses to “Health Professional Collaboration Inside and Outside The Hospital”

  1. Dr I.O.Omotosho
    January 26th, 2011 @ 11:28 am

    The issue of a holistic team approach to health care delivery by the providers is definitely long overdue. The need for such is better appreciated in the developing world where there is a serious vacuum in health care services. In some places, the vacuum is so much that other members of the health team are the ones readily available to provide basic health care needs of the people. it is therefore heart warming that people like Mike Magee could make this comment and I hope the comment as earlier stated should be extended to other members of the heath team-physiotherapists, medical laboratory scientists, dietitians, radiographers, pharmacists etc.

  2. E. Mary Johnson
    January 27th, 2011 @ 7:59 pm

    Absolutely correct in your assessment about the need for nurses to be practicing @ highest level of licensure ..No on can live w/o nurses- ” patients need nurses to implement the plan of care- physicians need nurses to implement the plan of care!
    am forwarding you aritcle to colleagues –
    Hope your grandaughters do well- and are soon safely home ! emj

  3. Patsy Stinchfield, CPNP
    January 29th, 2011 @ 9:49 pm

    I totally agree with your premise that patients would be better served if professionals worked to their full capacity, not in a hierarchy but in an overlapping set of circles. Take ambulatory multi-disciplinary teams and immunizations, both childhood and adult and what our rates would be if we brought RN’s back into the clinic and allowed them to “own” vaccinating patients according to the established recommendations? We need to have the right person delivering the right care at the right time not a system dependent on “orders” from one over-worked person at the top. Protocols, clinical pathways, national recommendations, standards of practice, etc will help deliver safe and up-to-date care. It’s time to set professional politics aside.
    I wish your beautiful grandchildren the best and am happy they were able to receive that miraculous multi-disciplinary care.

  4. Christian Lerbaek
    March 23rd, 2011 @ 1:12 pm

    I am seeking to study medicine in the near future in the UK. In the UK, the universities love to see you gain some work experience. One of the things I learned when I was at the hospital doing work experience, I saw the importance of nurses. To be honest, everything in the hospital would be completely chaotic. So I completely agree with you that nurses should be focused more on because of their importance in the field of medicine.

    At one point in the post, I noticed that you stated that the American health care system was the best in the world. This is of course an opinion and I truely respect that but I just think that you ought to have a look at the very successful free health care system in Denmark. (Yes, I am Danish but thats not the point). This is a completely different discussion, so I’m sorry.

  5. care home hampshire
    May 27th, 2011 @ 4:16 am

    Nurses and patients are indispensable things when the care is concerned. A doctor treating a patient needs a nurse for all kind of cooperation, doctors get advice and patient get care and nurse play doublet role to continue with the process. I agree with Mary Johnson’s view and the person analyzed it correctly. Thanks for the post here.

Leave a Reply

Show Buttons
Hide Buttons