Bedside nurses’ roles in discharge collaboration in general internal medicine: Disconnected, disempowered and devalued?

Abstract

Collaboration among nurses and other healthcare professionals is needed for effective hospital discharge planning. However, interprofessional interactions and practices related to discharge vary within and across hospitals. These interactions are influenced by the ways in which healthcare professionals' roles are being shaped by hospital discharge priorities. This study explored the experience of bedside nurses' interprofessional collaboration in relation to discharge in a general medicine unit. An ethnographic approach was employed to obtain an in-depth insight into the perceptions and practices of nurses and other healthcare professionals regarding collaborative practices around discharge. Sixty-five hours of observations was undertaken, and 23 interviews were conducted with nurses and other healthcare professionals. According to our results, bedside nurses had limited engagement in interprofessional collaboration and discharge planning. This was apparent by bedside nurses' absence from morning rounds, one-way flow of information from rounds to the bedside nurses following rounds, and limited opportunities for interaction with other healthcare professionals and decision-making during the day. The disconnection, disempowerment and devaluing of bedside nurses in patient discharge planning has implications for quality of care and nursing work. Study findings are positioned within previous work on nurse-physician interactions and the current context of nursing care.

Healthcare Professionals’ and Users’ Experiences of Intersectoral Care between Hospital and Community Mental Healthcare

“…Coherent intersectoral care requires the communication of essential information to be given in a way that other units understand and accept [24,45]. We believe, in accordance with [42], that there is need for a cultural change, placing users at the center of their own recovery process.…”

“…In addition, other studies show that healthcare professionals in hospital mental healthcare are focused on disorders and symptoms and do not prioritize the involvement of users in the treatment and rehabilitation [ 44 , 45 ]. The lack of a common language and culture becomes a barrier to improving coherence in intersectoral care, as is also shown in other studies [ 24 , 30 ].…”

“…As Bonfils et al emphasize, differences in language and culture are visible through the healthcare professionals’ different views about when a person is ill and in need of help [5,20.26]. Coherent intersectoral care requires the communication of essential information to be given in a way that other units understand and accept [ 24 , 45 ]. We believe, in accordance with [ 42 ], that there is need for a cultural change, placing users at the center of their own recovery process.…”

The impact of intersectionality on nursing leadership, empowerment and culture: A case study exploring nurses and managers’ perceptions in an acute care hospital in Aotearoa, New Zealand

“…It speaks to the value placed on nursing work at the bedside. Goldman et al, (2018) suggest that nurses are disempowered by the lack of value placed on their bedside clinical work and lack of input into decision-making. Ironically, the separation between clinical care and leadership means those closest to patients with the best knowledge of real clinical issues maintain only a localised view lacking a broader organisational context (Carryer, 2020), which further limits their ability to contribute to decision-making.…”

Are perspective‐taking outcomes always positive? Challenges and mitigation strategies

“…Imagining what the other is thinking and feeling can be threatening if the other person views oneself negatively . For example, acute care nurses do not think their opinions about patient discharge are always respected, but rather, are perceived as misguided or irrelevant . Nurses lack confidence, fear being incorrect or humiliated, and believe that their opinions do not matter to physicians .…”