Ch. 2 The Interprofessional Team
Registered Nurses (RNs) and Practical Nurses (PNs) function as integral components within the interprofessional health care team.
Each discipline on the team utilizes a specific set of skills governed by the scope of practice for that profession.
Overlap in scope of practice or skill sets often exists between different disciplines. For instance, both nurses and respiratory care therapists are trained to perform chest physiotherapy, which involves postural drainage, percussion, and vibration to facilitate the drainage of lung secretions.
The team works collaboratively to deliver holistic care to the client.
The nurse typically serves as the manager of care. This role requires a thorough understanding of the responsibilities held by other team members to facilitate effective collaboration and appropriate referrals.
Interprofessional Personnel (non-nursing) Roles and Referral Examples
Spiritual Support Staff
Role: Provides spiritual care to clients and families.
Referral Example: A client requests to receive communion, or a family requests prayer before a medical procedure.
Registered Dietitian
Role: Assesses, plans, and educates regarding nutritional requirements; designs specialized diets and supervises meal preparation.
Referral Example: A client presents with a low albumin level and recent, unexplained weight loss.
Laboratory Technician
Role: Obtains specimens of body fluids and performs diagnostic testing.
Referral Example: A provider requests immediate results for a client's complete blood count (CBC).
Occupational Therapist
Role: Assesses and plans for clients to regain activities of daily living (ADL) skills, with a focus on upper extremity motor skills.
Referral Example: A client experiences difficulty using eating utensils with their dominant hand following a stroke.
Pharmacist
Role: Provides, monitors, and evaluates medication therapy. They supervise pharmacy technicians in accordance with state regulations.
Referral Example: A client expresses concern regarding how a new medication might interact with their existing prescriptions.
Physical Therapist
Role: Assesses and plans for clients to increase musculoskeletal function, specifically regarding lower extremities and the maintenance of mobility.
Referral Example: Following a hip arthroplasty, a client needs assistance with learning to ambulate and regaining physical strength.
Provider (Medical Doctors, Doctors of Osteopathy, Physician Assistants)
Role: Assesses, diagnoses, and treats disease and injury. Note that state regulations vary regarding the level of supervision required for PAs by a physician.
Referral Example: A client has a temperature of (), reports feeling cold, is achy, and is shaking.
Radiologic Technologist
Role: Positions clients and performs X-rays and other imaging procedures to assist providers in diagnosing disorders.
Referral Example: A client reports severe hip pain following a fall, and the provider prescribes an X-ray of the hip.
Respiratory Therapist
Role: Evaluates respiratory status and provides treatments including oxygen therapy, inhalation therapy, and mechanical ventilation.
Referral Example: A client with respiratory disease is short of breath and requests a nebulizer treatment.
Social Worker
Role: Coordinates inpatient and community resources for clients and families to address psychosocial and environmental needs necessary for recovery and discharge.
Referral Example: A client with terminal cancer wants to return home but cannot perform ADLs, and their partner requires home medical equipment to provide care.
Speech-Language Pathologist
Role: Evaluates and provides recommendations on the impact of disorders or injuries on speech, language, and swallowing; teaches techniques to improve these functions.
Referral Example: A client experiences difficulty swallowing a regular diet following trauma to the head and neck.
Interdisciplinary Team Collaboration and Client Care Conferences
An interdisciplinary team is a collaborative group of providers working together to coordinate skills for optimal client outcomes.
Team members include physicians, nurses, nursing assistants, respiratory therapists, radiology therapists, laboratory assistants, dietitians, case managers, social service providers, and pharmacists.
Other support staff facilitate care even if they do not deliver it directly.
Client care conferences serve as a venue for problem-solving and decision-making when a situation requires input from various team members.
Case Study: Interdisciplinary Problem Solving for Mr. Carlo Marino
Client Profile:
Name: Carlo Marino.
Age: 81 years.
History: No chronic illnesses or significant cognitive deficits.
Current Condition: Fractured left hip due to a fall five days ago; three days post-total hip arthroplasty.
Clinical Concerns:
The client is not following postoperative hip restrictions.
Absence of regular visitors to provide reminders or cues.
Lives independently at home; the nearest relative (daughter) lives away.
The client desires a quick return home, but the team is concerned about safety.
Specific Hip Restrictions Defined:
No adduction of the hip.
No internal or external rotation of the leg.
No flexing of the hip more than .
No crossing the midline of the body with the leg.
Observed High-Risk Behaviors:
Leaning over to tie a shoe during physical therapy.
Bending down to pick up a dropped spoon.
These actions require "multiple cueing" to prevent dislocation of the prosthesis.
Medical and Cognitive Factors:
Although the client has a history of dementia, current confusion may be exacerbated by age and anesthesia.
The client is medically stable; incision and lab results (hemoglobin and hematocrit) are satisfactory.
Risk Factor: The client will not feel pain until the hip actually dislocates, making adherence to restrictions crucial.
Collaborative Plan:
The team agrees the client cannot return home immediately.
Coordination for a long-term rehabilitation facility located near the daughter's home.
This arrangement allows the daughter to visit more frequently and reinforce the necessary safety cues.
Nursing Personnel Roles and Educational Preparation
Registered Nurse (RN)
Role: Functions as the lead team member; solicits input from the nursing team and set priorities for care coordination.
Preparation: Must meet State Board requirements; completion of a diploma, associate, or baccalaureate degree in nursing for licensure.
Responsibilities: Legal performance under state nurse practice acts; performing assessments; establishing diagnoses, goals, and interventions; conducting evaluations; developing interprofessional plans; initiating referrals; and identifying community resources.
Practical Nurse (PN)
Role: Works under the supervision of the RN; collaborates in the nursing process and assists with plan of care delivery.
Preparation: Must meet State Board requirements; requires vocational or community college education for licensure.
Responsibilities: Technical knowledge and skills; participation in the nursing process framework; consulting with team members to recognize need for referrals.
Assistive Personnel (AP)
Included Roles: Certified Nursing Assistants (CNA) and Certified Medical Assistants (CMA).
Preparation: Formal or informal training requirements vary by state; most states require specific training and examination for CNA status.
Responsibilities: Works under direct supervision of RN or PN; tasks include feeding, grooming, lifting, bathing, transferring, toileting, positioning, and recording vital signs.
Advanced Practice and Specialized Nursing Roles
Advanced Practice Nurse (APN)
General Requirements: Minimum of a master's degree; advanced education in pharmacology and physical assessment; certification in a specialized area. Supervision requirements by physicians vary by state.
Clinical Nurse Specialist (CNS): Specializes in a specific practice setting or clinical field.
Nurse Practitioner (NP): Delivers non-emergency primary health care in collaboration with providers.
Certified Registered Nurse Anesthetist (CRNA): Administers anesthesia and provides procedural care under an anesthesiologist's supervision.
Certified Nurse Midwife (CNM): Delivers care to maternal-newborn clients and their families in collaboration with providers.
Additional Specialized Roles
Nurse Educator: Teaches in nursing schools, staff development, or client education departments.
Nurse Administrator: Provides leadership and management to nursing departments in healthcare facilities.
Nurse Researcher: Conducts research aimed primarily at improving the quality of client care.
Questions & Discussion
Scenario Inquiry regarding APN Roles: A nurse is teaching newly licensed nurses about career aspirations after mastering nursing skills.
Response - Identifying Five APN Roles:
Clinical Nurse Specialist: Specializes in clinical fields or specific settings.
Nurse Practitioner: Collaborates to provide primary care in various settings.
Certified Registered Nurse Anesthetist: Provides anesthesia care under an anesthesiologist.
Certified Nurse Midwife: Provides maternal-newborn care.
Nurse Educator: Teaches in academic or staff development environments. (Additionally: Nurse Administrator and Nurse Researcher contribute through leadership and improving care quality respectively).", "title": "The Interprofessional Health Care Team and Professional Nursing Roles"}
Nurse Administrator: Oversees nursing staff and ensures compliance with healthcare regulations.
Nurse Researcher: Conducts studies to advance nursing knowledge and practice.