4.2 Nurses' experiences of nurse–nurse collaboration
Six categories were identified in the analysis as follows: (i) equal and smooth collaboration towards a common goal with the patient in the centre; (ii) professional collegiality; (iii) functioning working environment; (iv) clear communication; (v) sharing of knowledge and skills; and (vi) support and sharing of work (Table 2
). In the following sections, direct quotations are presented with the interview number in parentheses.
Table 2Nurses experiences of nurse—nurse collaboration.
4.2.1 Equal and smooth collaboration towards a common goal with the patient in the centre
Nurses experienced intraprofessional collaboration as working together with a spirit of togetherness: “It means that the work is done in collaboration so that the patient receives the care they need” (FI9). Collaboration was referred to as: "Working in teams and complementing each other in work tasks that must be done in relation to the patient” (NO1); “In practice it means professional cooperation” (FI9); “We should experience equality at work, be on the same level” (FI2). Intraprofessional collaboration was also linked to patient safety, for example, “It is about quality assurance…We double check medication together” (NO5).
The participants reported that work experience facilitates collaboration: “Those who have experience, manage to take it easier, things go a bit automatically, and faster, and one can simply use more time to strengthen collaboration” (NO4). Further, some nurses said that collaboration is more about interpersonal skills: “Good collaboration is formed when you get along, enjoy each other and are able to work together” (NO5). Another nurse stated, “It is always easier to work with like-minded people” (FI9). One said, “They should be knowledgeable and social, they should be talkative” (FI1).
4.2.2 Professional collegiality
Collegiality was mentioned as an important part of collaboration, professional networking and interaction by the Finnish nurses. One nurse said, “You should respect your colleagues and give both good and bad feedback in a positive spirit” (FI14) and another nurse said “A flow of information should be unified for all” (FI2). One described, “Colleagues are also important in larger networks, when planning and agreeing on patient care. Collegiality is collaboration with co-workers, colleges, and of course with physicians…collaboration with different professional groups” (FI3).
Every participating nurse spoke about cohesion, for example, one nurse said, “Let say that we are a kind of family within this work community” (FI4). Most of them said that nurses’ personalities can influence intraprofessional collaboration both positively and negatively: “We are not all alike when it comes to collaboration” (FI3). However, one nurse said, “Collaboration is supported when you are motivated to work” (FI7). A nurse stated, “It is not just about personalities, it is about human behaviour” (FI11). One said, “Collaboration depends on how one is as a person and if different types of personalities get along” (NO11).
4.2.3 A functioning working environment
The atmosphere in the workplace and collaboration between nurses depended strongly on the nurse leader: “The management culture must support collaboration” (FI5) and “It's of course the management, how they have posted collaboration, how they speak about it on the unit and generally” (NO7). An encouraging and open atmosphere with a positive attitude and humour gives strength. One nurse described, “Collaboration is important not only for me but also for well-being at work” (NO8). Another nurse shared, “It is about clear division of labour, good routines and good communication methods” (NO4). A third of the Norwegian nurses stated that collaboration was associated with a good working environment and well-being, for example, “It can give joy, which makes the day float, things go smoothly and hopefully includes some humour” (NO3).
Successful collaboration requires adequate unit-level resources. A nurse said, “Of course, we need resources, we need sufficient staffing, we need enough working time, we need appropriate tools and space to perform tasks properly” (FI6). Some Finnish nurses underlined thoughtful planning of work, for example, “Collaboration is strengthened if the working environment is functional, the shifts are functional” (FI8), while the Norwegian nurses highlighted good practices, “I'm very fond of routines and guidelines, because I like that we have certain things to relate to” (NO4).
A good work environment was promoted by social interaction. A nurse said, “It is important to get to know each other within the team, that you are socialising” (NO1) and “We have our breaks, which I consider really important, because we can get to know one another, exchange ideas and thoughts” (NO10). However, many participants mentioned that the physical premises of their units sometimes made this challenging. Interaction was facilitated within stable and smaller units. A nurse said, “We have started to work in smaller groups, which means a lot” (NO8).
4.2.4 Clear communication
Several Norwegian nurses felt that clear communication promotes good collaboration and was essential for mutual understanding. One said, “You should be open to each other's opinions, and willing to hear others’ opinions…there should be no problems communicating with one another” (NO5). The importance of common courtesies and nonverbal communication were stressed: “You kind of have a good attitude” (NO13) and “It's nice when you don't have to say what should be done, when it's already done” (NO3).
According to the Norwegian nurses, poor communication and understanding were barriers to good collaboration. As one nurse said, “It can be many things, for example, poor communication of course, that you misunderstand each other, that you don't speak the same language” (NO1). One nurse shared, “It can be the personality, some can be difficult to approach when you need help…or it is just the body posture” (NO7).
4.2.5 Sharing of knowledge and skills
Nurses stated that it was important to be able to discuss issues professionally with colleagues. Flexibility, positivity and bidirectional knowledge sharing were considered to enhance intraprofessional collaboration. One said, “Collaboration is about exchange of knowledge, it's about sharing patient information” (FI5) and “Nurse—nurse collaboration is assistance, guiding, teaching, advising…everything is done for the benefit of the working community” (FI14). The nurses also emphasised the importance of further training and professional development, and the need for nursing leaders to enable it: “You are interested in the work you are doing; with patients you like; it is exciting, and you are in environment where you feel you can grow and develop yourself in your profession” (NO1).
4.2.6 Support and sharing of work
The nurses found it fulfilling to help one another with daily tasks. One nurse said, “It is helping a friend in need…and reciprocally you receive help when you need it” (FI10) and “We often need help from each other; we must check things together…we depend on each other” (NO9). The nurses expressed some disablers of collaboration: “Collaboration is weaker, if you don't have time to help each other and the day is really busy” (NO8) and “Collaboration is not implemented properly, if we lack resources, we lack support from each other, because we don't have time to discuss” (FI16) and “You have to trust one another, rely on their competence…if they are insecure, they must ask for help” (NO4). Collaboration was also jeopardised when the nurses felt that their colleagues’ attitudes towards their work was lacking: “You have to be generally interested in your work and in your patients, and not only with an attitude that I'm only working here” (FI4).