17.4 Collaboration

17.4 Collaboration

Quick Answer: Collaboration is working with others—patients, families, and healthcare providers—so each person's contribution advances optimal, realistic goals. It includes intra- and interdisciplinary work and the community. In the NICU the parent is a team member. Use SBAR with covering clinicians and transport teams. If you disagree with a plan, say so with a safety phrase and the chain of command, not silence and not a scene in the hallway.

Collaboration is PC-D in the 20% Professional Caring share. It is easy to confuse with being nice. The exam tests whether the right people are in the plan, whether the handoff is structured, and whether a nurse who sees danger speaks. OpenExamPrep independent teaching uses NICU rounds, neonatal transport, and parent-as-team-member stems. An adult SICU essay about consulting cardiology for a STEMI is the wrong movie.

Facilitation of learning (how you teach) and systems thinking (how you move resources across the hospital) are later Professional Caring characteristics. This section stays on working with others toward a shared, realistic goal.

Handbook meaning

Synergy collaboration is working with others in a way that promotes each person's contributions toward optimal and realistic patient and family goals. Intra-disciplinary means nurse to nurse (charge, transport RN, lactation RN, NNP). Interdisciplinary means across professions (neonatology, respiratory therapy, pharmacy, surgery, OT/PT, social work, chaplain, dietitian). Community means the referring nursery, EMS or a neonatal transport team, WIC, early-intervention programs, home phototherapy vendors, and the pediatrician who will see a 26-week graduate.

Realistic is the word that keeps this characteristic honest. A goal of 'home this week' for a 24-week infant still on a high-frequency ventilator is not realistic. Collaboration names a nearer goal: treat the infection, protect the brain, get to full feeds, then revisit discharge. False cheer is not collaboration.

The parent as team member

The neonate cannot sit on rounds. The parent or guardian can. Collaboration treats that adult as a contributor of history ('we already failed that feed advance'), values, and caregiving—not as a visitor who receives a summary later if convenient.

Behaviors that match the definition:

• Introduce the parent by role: 'This is Jordan, the infant's parent,' not 'mom is visiting.'
• Invite a 30-second parent report at the start of multidisciplinary rounds.
• Translate MAP, FiO2, PMA, and UOP into plain language without skipping the medical content the team needs.
• When the parent cannot be present, offer a scheduled update or a secure video-in—not 'they never come, so we decided.'
• Include the parent in transport updates: where the infant is going, who is driving the ventilator, and how to travel.

Family-systems coaching and crisis de-escalation are Clinical Judgment behavioral content. Here the test is whether you share the work with the family as colleagues in the goal, including when you disagree.

Multidisciplinary NICU rounds

A working rounds team for a critically ill neonate often includes the bedside nurse, neonatologist or NNP, respiratory therapist, pharmacist, dietitian, and, as needed, surgery, cardiology, or palliative care. The nurse's collaborative job is to bring the last 12 hours as data plus judgment: not only 'FiO2 0.40' but 'FiO2 climbed from 0.25 to 0.40 after a desat cluster, transillumination negative, last gas pH 7.22, PCO2 68.' Then a recommendation: evaluate for failure of CPAP, consider intubation, hold the feed advance.

Worked rounds: 27 weeks, day 4, CPAP 6 cm H2O, FiO2 from 0.25 to 0.50, HR 175–190, temperature 36.4 °C, glucose 48 mg/dL on a GIR near 6 mg/kg/min. Collaboration is simultaneous: RT on the interface leak, pharmacy on whether caffeine was given, the parent on whether the infant has been harder to settle, neonatology on the gas and a chest film, the nurse on thermal and glucose rescue. Sequential silos ('I'll page them later') are how pneumothorax waits until bradycardia.

SBAR that sounds like a NICU

SBAR is Situation, Background, Assessment, Recommendation. It is the collaborative grammar for 02:00 calls, transport handoffs, and disagreement.

Worked 02:00 call for a 27-week infant:

• Situation: Acute desaturation cluster and rising oxygen on CPAP.
• Background: Day 4, 27 weeks, birth weight 980 g, currently 950 g, CPAP 6, FiO2 was 0.25, now 0.50, last caffeine given at 18:00, last glucose 62 mg/dL.
• Assessment: Possible pneumothorax, worsening RDS, or sepsis; perfusion a bit cooler; abdomen soft; transillumination pending your exam.
• Recommendation: Please come now; I have a transilluminator and the intubation box at the bedside.

That is collaboration. 'The baby looks bad, can you come?' is not. Reading 40 monitor values without an assessment or a request is not. Texting a photograph to a personal group chat is a privacy violation, not teamwork.

Transport SBAR adds airway, glucose, and thermal plan before wheels move: ETT depth or CPAP settings, last glucose and a dextrose source on the isolette, hat and polyethylene wrap or a thermal mattress, and who talks to the parent. Community collaboration includes calling the receiving NICU with the same structure and sending placenta or culture information that changes antibiotics.

Disagreement with a plan

Collaboration is not rubber-stamping. If the planned extubation is unsafe—secretions pouring, PCO2 75, FiO2 0.60, a difficult airway last time—you speak.

A usable sequence:

1. Restate the shared goal (successful extubation, not ego).
2. Give SBAR with the numbers.
3. Use a safety phrase such as CUS (I am Concerned, I am Uncomfortable, this is a Safety issue).
4. If the plan still ignores a clear danger, activate the chain of command (charge nurse, covering fellow, attending, house supervisor) while staying with the infant.
5. Document facts, who was notified, and the infant's response.

Do not extubate 'to be a team player.' Do not argue loudly during family visiting as your first move. Do not document nothing so nobody is blamed. Intra-nurse disagreement (you versus the incoming RN about a drip concentration) uses the same spine: stop, verify, include pharmacy, do not infuse a mystery milliliter.

Worked disagreement: a surgeon wants to roll a 600 g infant to the OR now; you have a glucose of 32 mg/dL and a temperature of 35.8 °C. Collaboration is delaying for a glucose rescue and a thermal rescue, explaining that a cold, hypoglycemic ELBW infant is a worse operative candidate, and getting neonatology in the same sentence as surgery—not blocking the door as a lone hero and not saying nothing.

Community and the continuum

Community collaboration is easy to forget inside a Level IV unit. A Level II nursery calling for transport, a postpartum floor sending a late-preterm readmission, early-intervention referrals, and a community pediatrician all change outcomes. The realistic goal might be 'safe arrival with a glucose >50 mg/dL and a temperature in the 36.5–37.5 °C band,' not a perfect discharge summary. Close the loop: call back the referring nurse with what you found. That is still this characteristic.

Independent practice at /practice/ccrn-neonatal often hides collaboration inside a clinical stem. Look for the option that includes the missing teammate, uses SBAR, keeps the parent in the plan, or escalates disagreement—not the option that does the whole job alone.

Exam traps

• Confusing collaboration with uncritical agreement.
• Excluding RT, pharmacy, or the parent because the nurse is 'efficient.'
• Transport without a thermal and glucose plan.
• Adult rapid-response theater without neonatal roles.
• Hallway decisions that the family hears as rumors.