Cancellation of programs because of insufficient enrollment, difficulty in securing quality resource personnel at affordable prices, and the ever-increasing demands of the nursing profession were the underlying factors which brought together the representatives of nine state approved providers of continuing education for nurses in a metropolitan area of northeast Iowa. The identification of these mutual problems created a need for cooperation and collaboration among the providers. What follows is a description of the development of a consortium, the issues that surfaced, and some strategies for resolving these issues.
It is estimated that 3,100 licensed nurses reside within the ten counties of northeast Iowa with nearly 1,500 residing within the metropolitan area of Cedar Falls and Waterloo. Since 1979, the Nurse Practice Act in Iowa has required 1.5 Continuing Education Units (CEUs) per year. Prior to 1981, these opportunities were provided by the nine area Iowa Board of Nursing approved providers, often with competitive duplication of programs and personnel. A review of the literature relative to continuing education for the nursing profession documents that the duplication and competition experienced by the metropolitan providers are common concerns.1
The providers represented four metropolitan hospitals: Allen Memorial Hospital, Saint Francis Hospital, Sartori Memorial Hospital, and Schoitz Medical Center; two professional organizations: Cedarloo Chapter of the American Association of Critical Care Nurses and the Waterloo Unit of the Iowa Federation of Licensed Practical Nurses; the American Red Cross; the area technical school: Hawkeye Institute of Technology; and a state university: the University of Northern Iowa. The initial tasks were to define the structure within which the nine separate providers would operate and to explore cooperative ventures. The process of working through these two tasks required the group to face other issues. These issues included the development of a structure for group work, and a climate that would facilitate collaborative efforts.
During the initial meeting a discussion of a title for the group resulted in the adoption of the name S.H.A.R.E. - Shared Health Care Area Resources for Education. Adopting this name reduced the isolation of the separate organizations and increased the group identification. Initially the group rotated to each organization and the representative of that organization chaired the meeting. Only after members of the group had become acquainted could a permanent site and chair be selected. Currently, the chair rotates on a yearly basis.
Over a period of several meetings a mutually acceptable set of ground rules was developed. These ground rules then formed the basis of the formalized bylaws. Not only did the bylaws facilitate the parent body's understanding of the consortium's roles and objectives, but also the representatives' understanding of each other. The drafting and discussion of bylaws allowed each member to help shape the group. By explaining S.H.A.R.E. to the parent organizations each representative was required to identify issues that were important to the separate institutions or organizations and to develop an alternative proposal for discussion. Sanctions were obtained from the leadership of the sponsoring organizations. These sanctions consisted of formal approval by the administration of the sponsoring organization or their elected officers.
The bylaws defined the goals and objectives as follows:
1. The goals of the S.H.A.R.E. consortium are to:
a. Provide a wide variety of quality continuing education programs to help meet the needs of licensed nurses in northeast Iowa.
b. Join together in a consortium a representative group of agencies/organizations concerned with continuing nursing education.
c. Encourage the communication among area providers for the improvement of continuing nursing education.
2. The objectives of the S.H.A.R.E. consortium are to:
a. Share topic areas with other providers to prevent duplication of time and effort.
b. Share audio-visuals with other providers in order to be cost-effective.
c. Assist and promote other providers' offerings.
d. Cosponsor programs with area schools and/or colleges.
e. Offer an opportunity to join together on program sharing agreements on a yearly basis - option available on a yearly basis at the first annual meeting of the year.
The bylaws also defined membership, election of officers, meeting times, parliamentary authority, and a method for future amendments.
Cooperation and collaboration are crucial elements in the climate of an effective group. Webster defines cooperation as "a dynamic social process in which mutual benefits outweigh the disadvantages"2 and collaboration infers "cooperating with an agency with which one is not immediately connected."2 Both definitions speak to the need to bend or negotiate individual goals in order to achieve group goals.
The previously described atmosphere of competition for nurse authences appears to be in direct opposition to the collaborative and cooperative goals. Honesty, risk taking, and open discussion are all crucial elements in consortium building but need to be worked through in order to resolve the competitive issues. This proved to be much more difficult than the development of the organizational structure.
Everyone agreed that a needs assessment was necessary. Trust began to develop when individual representatives shared their own in-house survey as a basis for the development of a joint needs assessment. The level of the group's commitment was demonstrated in the agreement to jointly finance a research project designed to describe the nurse authence, assess their educational needs, and share this methodology and information with other providers within the state.
A researcher from the University of Northern Iowa was consulted about alternative assessment methodologies. His recommendation was an in-depth phone survey of 450 nurses randomly selected from among the 3,100 nurses in northeast Iowa.
In order to accomplish this comprehensive task it was necessary to subdivide into task groups. Because each task group fulfilled an important segment of the total project, the group experienced a feeling of accomplishment. Within the smaller task groups honest, open discussion became possible and the trust level of the larger group was therefore strengthened.
The initial cost of research consulting fees, computer time, and other related expenses seemed overwhelming. However, a group desire for the kind of information that could be obtained in this manner led to some unique solutions to the logistics of conducting 450, 20-minute phone interviews in a two-week period. Because the cost of hiring professional phone interviewers was prohibitive, each agency agreed to provide volunteer interviewers, long distance telephone expenses, training time, and facilities. The use of these resources reduced the actual money outlay, and this spirit of cooperation spread beyond the nine individual representatives of S.H.A.R.E. to the parent organizations.
Furthermore, the spirit of collaboration and cooperation continues to operate through such things as 1) sharing of media resources, 2) joint calendar planning, 3) cosponsorship of needed programs, 4) exchange programs, and 5) more open communication.
There have been benefits to a number of groups involved with the continuing education of nurses. Northeast Iowa nurses have been able to take advantage of more variety in programming, better scheduling, and increased program availability.
The respective organizations have benefited in many ways from the S.H.A.R.E. effort. These include 1) more efficient use of the education dollar, 2) better prepared staff because of the quality of programming available, 3) recognition and support in the larger community for what the organizations have to offer, and 4) an opportunity to respond in a more meaningful way to the nurses' needs. A concrete example of the need for better utilization of time and resources is illustrated by the following situation:
Prior to cooperative scheduling five providers scheduled a cardiology workshop in a single month; three within one week. This emphasized for all the need to share preliminary plans. By sharing at the pencil-copy stage, now it is possible for the provider to change the focus, the date or speakers. This cooperation gives the area nurses alternative choices rather than conflicts and the providers better attendance of an interested authence.
There can be no doubt, therefore, that the community has benefited through the cooperative efforts of S.H.A.R.E. A specific example of a community benefit made possible by the communication network of the S.H.A.R.E. providers is the scheduling of seminars for mandatory reporters of child abuse. Prior to the organizing of S.H.A.R.E. each provider scheduled sessions only for their own staff without communicating dates and times to the other providers. Furthermore, nurses were not encouraged to attend continuing education sessions other than those held in their own facility. Since the organization of S.HA.R.E., it is possible for staff to attend sessions in other facilities because providers have informed each other of these dates and times and have encouraged interagency attendance.
Finally, the providers themselves have enjoyed benefits. By referral back and forth between providers each has a wider range of options to help solve staff educational problems. The developing atmosphere of support and cooperation instead of rivalry and competition is conducive to both personal and professional growth. Involvement in S.H.A.R.E. projects has allowed providers to explore and develop educational skills and techniques they would not have attempted individually
While future directions are not clear, S.H.A.R.E. is established as a mechanism for cooperation in providing continuing education for northeast Iowa nurses. These directions can be impacted if providers continue to honestly and openly discuss programmatic options and alternatives. S.H.A.R.E. exemplifies the benefits of cooperation and collaboration.
- 1. Cooper SS, Popiel E, Yoder Wise PS: Cooperation/collaboration. J Cont Educ Nurs 1982; 13(6):22-23.
- 2. Woolf HB (ed): Ykbsters New Collegiate Dictionary. Springfield, MA, G & C Merriam Company, 1979, pp 217, 247.