Collaborative practice: the nurse practitioner's role in its success or failure.

This study critically analyzes the underlying values, beliefs and behaviors of 18 family nurse practitioners and physicians who identified themselves as being in a joint practice relationship. Participants in the study were interviewed separately and in pairs around issues related to their reasons for joint practice, their interactional patterns, and how these patterns could be different. Transcribed interviews and data summaries for each practice were returned to the participants for review, discussion and validation. Results of the study suggested that the language, values and behaviors of the nurses continued to support, to varying degrees, the authoritarian and dominant position of the physician. In addition, nurses tended to demonstrate distorted communication and non-meaningful interactions. The possibility for nurses to create conditions in the practice relationship oriented toward mutual understanding and effective collaboration was clearly apparent in a few of these practices. Steps essential in achieving these conditions include the following: 1) self reflection; 2) clarification of goals; 3) examination of interactional patterns; 4) analysis of the level of commitment to mutual understanding; 5) willingness to risk calling issues into question; 6) conscious commitment to maintaining this level of communication over time; and 7) facilitating the physician partner's commitment to these goals.