Clinical narratives are used for the articulation and sharing of knowledge and experience which has been acquired over time and through experiential learning and is a way of enabling nurses to "tap into the thought processes and best practices of expert clinicians" through sharing of stories based on experience. Professional conferences involve the attending of conferences, which expose nurses to ideas that are new and best practices of other institutions than the one in which they work. Finally, formal education addressed "technical excellence and an over-arching understanding of the art and science of professional practice..." (Massachusetts General Hospital Patient Care Services, 2002) a very important aspect of the program is "collaborative decision-making" which involves: (1) Quality committees; (2) Ethics in Clinical Practice Committee; (3) Nursing Research Committees; (4) staff nurse advisory committees; and (5) professional development committees. Quality Committees. It is related that the 'Ethics in Clinical Practice Committee' has the responsibilities of: (1) Design and implement programs to support the education of all staff in the area of healthcare ethics; (2) Identify strategies to improve quality; (3) provide increased communication and awareness of systems-improvements; (4) provide an arena to evaluate and promote quality initiatives not specifically initiated by this committee; and (5) review findings and recommend departmental actions. (Massachusetts General Hospital Patient Care Services, 2002) The work entitled: "Common Denominators in Shared Governance and Workplace Advocacy" published in the Online Journal of Issues in Nursing (2004) relates that the work of Porter-O'Grady (IOM, 2004) relates that "Principles embedded in conflict resolution (collaborative) strategies can enhance nursing empowerment, however, conflict resolution is an area in which nurses typically have limited skills. In the ideal world, health care organizations would embrace conflict resolution strategies as the standard way of doing business. In reality, nursing may have to take the lead by adopting the principles of conflict resolution." (Journal of Issues in Nursing, 2004) WPA groups are reported to responsible in the healthcare industry for the development and modification of the effective use of conflict resolution strategies. Specifically stated is that 'use of these strategies moves health care from a hierarchical model of communication or a model where conflict is resolved at the lowest level, the level at which conflict occurs. For nurses this is often at the bedside level. The effective use of conflict resolution reduces costs, provides more empowered and satisfied workers, and results in higher quality outcomes. This strategies can also reduce the use of costly litigation can serve nurses, other professionals, patients and the organization." (Journal of Issues in Nursing, 2004) This work states that it is essential for the organization to effectively utilize conflict resolution strategies as: "...nurses need to develop skills in conflict analysis, collaboration, and mediation." (Journal of Issues in Nursing, 2004) the use of outside coaching to assist the conflict resolution process is stated to be encouraged which involves calling a hotline or certified nurse ombudsman.

The work of Lassen, et al. (1997) entitled: "Nurse/Physician Collaborative Practice: Improving Health Care Quality While Decreasing Cost" published in the Journal of Nursing Economics relates a study using a collaborative approach that served to enhance "nurse-physician relationships, resulting in cost savings as well as diminished anxiety and confusion among the patients of neonates diagnosed with R/O sepsis." (Lassen et al., 1997) Additionally relate is the fact that medical journals have failed to focus only but very little attention to: "...possible benefits resulting from nurse/physician collaboration. One possible explanation is found in the historical nature of that relationship." (Lassen et al., 1997) Lassen et al. relates that collaboration may be defined as: "...a flexible process of ongoing interaction, assertiveness, and creativity between individuals from two or more disciplines which influences the direction of patient care." (1997) Required in this process is communication and "interdependent decision making regarding patient care." (Lassen et al., 2007) Outcomes measurements are stated to include: (1) patient mortality/morbidity rates; (2) hospital costs; and (3) hospital readmissions in the work of Baggs, et al. (1992), Knaus et al., (1986) and Mitchell et al. (1989) who reported "significant reductions in patient mortality and readmissions in adult ICU units with implementation of collaborative practice. (Lassen, et al., 1997; p.1)

The work entitled; "Healthy Work Environments: Best Practices" published by the Registered Nurses Association of Ontario (RNAO) relates specific recommendations that "Nursing teams recognize how their goals contribute to impact and/or complement the goals of other teams and the organization in achieving quality patient/client care." This is stated to require that nursing teams "...establish processes which promote open, honest and transparent channels of communication by: (1) Establishing processes to ensure that full-time, part-time and casual staff seek out and receive effective communication on all shifts; (2) Establishing verbal, written and/or electronic processes in order to effectively document the communication; and Developing skills in active listening. (nd) Recommendations for implementation of specific strategies that provide encouragement to teamwork as well as enable teamwork are stated to include: (1) Physical space or technology that enables people to...

(Ibid) This type of framework for enabling conflict resolution will include the requirement of the organization in ensuring a culture that is supportive of "effective teamwork and conveys administrative support" (Ibid) through (1) Ensuring that team members are included in the development and implementation; (2) of unit policies; (3) Supporting a culture in which participative decision-making is promoted; (4) Developing clear and consistent policies concerning role responsibilities; (5) Developing values, structures and processes to foster effective intra and interprofessional collaborative relationships; (6) Ensuring that resources are allocated for teams to balance delivery of care and professional practice development and evaluation; (7) Endorsing a professional practice model that supports practice accountability, autonomy and decision authority related to the work environment and care; and (8) Incorporating behavioral objectives into the performance development and management processes related to effective teamwork (Ibid) the best practices require the development and utilization of specific outcomes in evaluation of the effectiveness of teams while simultaneously ensuring high quality nurse being delivered through: (1) evaluation of the impact of nursing teams on patients/clients, nurses and the organization; (2) Systematically evaluating nursing teams; and the identification of obstacles in completion of processes of evaluation. (Ibid) the government classified as external system recommendations is stated capable of ensuring "sustainable financial resources to support collaborative teamwork" through fund allocation for: (1) Team development and evaluation initiatives; (2) Professional nursing development initiatives; (3) Direct and indirect patient/client care activities; (4) Developing strategies for professional practice; (5) Collaborative patient/client centered practice; (6) Interprofessional education initiatives; (7) Practice evaluation; (8) Technologies to support team interaction; and (9) Research. (Ibid) Educational provisions are stated to "value, promote and role model a culture of professionalism and effective team functioning" through the following means: (1) Identifying and implementing a leadership/champion role accountable for the implementation of the infrastructures required to support team focused curriculum; (2) Utilizing a variety of teaching and learning strategies that provide opportunities to learn about effective teams and teamwork; and (3) Opportunities may include but are not limited to: (a) case studies depicting realistic team issues and scenarios that become increasingly; (b) complex throughout the educational program; - course electives which focus on teams and team functioning; (d) course electives which focus on conflict resolution; and; (e) learning objectives that focus on social/relational domains. (Ibid)
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