The intraprofessional and interprofessional relations of neurorehabilitation nurses: a negotiated order perspective

AIMS: To report a study of the negotiation practices of neurorehabilitation nurses with one another and with allied health professionals to understand nursing relations. BACKGROUND: Negotiated order theory offers a promising theoretical lens with which to explore negotiation between nurses and other professionals. This study is the first to apply the perspective to nurse-nurse and nurse-allied health professional relations. DESIGN: The study is a secondary analysis of findings from a multi-site arts-based intervention to improve patient-centred neurorehabilitation practice. METHODS: Interviews and ethnographic observations were conducted (2008-2011) in two neurorehabilitation units in Ontario, Canada. Participants (n = 31) included registered and practical nurses, nurse leaders, and allied health professionals from physical, occupational, and recreational therapy, speech language pathology, and social work. FINDINGS: Neurorehabilitation nursing is characterized by heavy workload, high patient acuity, and poor interprofessional collaboration. This practice context was negotiated by nurses through two strategies: (1) intraprofessional collegialism, accomplished through tactics including task and knowledge sharing, emotional support, coercive threats, and suppression of dissension; and (2) vying for an autonomous essential nursing role in interprofessional practice, accomplished by claiming unique nursing knowledge based on 24/7 nursing proximity, the expansion of the division of professional labour with allied health professionals and modifying physical therapy care plans. CONCLUSION: The intraprofessional context and negotiations therein were linked in significant ways to interprofessional negotiations. Understanding this complexity has important implications for improving patient safety and interprofessional practice interventions.