Study guide
16.1 Collaboration & Interdisciplinary Teamwork
AACN CCRN Adult
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1 Introduction & Exam Strategy
1.1 Exam Facts, Format & the Synergy Model Blueprint 1.2 How to Study & Test-Taking Strategy
2 Cardiovascular I — Hemodynamics & Shock
2.1 Hemodynamic Monitoring & Values 2.2 Shock States 2.3 Vasoactive & Inotropic Pharmacology
3 Cardiovascular II — ACS, Heart Failure & Dysrhythmias
3.1 Acute Coronary Syndrome & Myocardial Infarction 3.2 Heart Failure & Mechanical Circulatory Support 3.3 Dysrhythmias, ECG & ACLS
4 Respiratory I -- Failure, ABGs & Acute Conditions
4.1 Respiratory Failure & ABG Interpretation 4.2 Acute Respiratory Distress Syndrome (ARDS) 4.3 Pulmonary Embolism, Pneumothorax, COPD & Asthma
5 Respiratory II — Mechanical Ventilation
5.1 Ventilator Modes & Settings 5.2 Weaning, Airway & Ventilator Complications
6 Endocrine Emergencies
6.1 Glycemic Emergencies 6.2 DI, SIADH, Thyroid & Adrenal Crises
7 Renal & Genitourinary
7.1 Acute Kidney Injury, Electrolytes & Acid-Base 7.2 Renal Replacement Therapy
8 Gastrointestinal
8.1 GI Bleeding & Acute Hepatic Failure 8.2 Pancreatitis, Acute Abdomen, Bowel Ischemia & Nutrition
9 Hematology, Immunology & Integumentary
9.1 Coagulopathies & Transfusion Therapy 9.2 Immunocompromise & Oncologic Emergencies 9.3 Integumentary - Wounds & Pressure Injuries
10 Neurological I — Stroke, TBI & ICP
10.1 Ischemic & Hemorrhagic Stroke 10.2 Traumatic Brain Injury & ICP Management 10.3 Seizures, Status Epilepticus & Neuromonitoring
11 Neurological II & Musculoskeletal
11.1 Spinal Cord Injury & Neuromuscular Emergencies 11.2 Encephalopathy, Coma & Brain Death 11.3 Musculoskeletal
12 Behavioral & Psychosocial
12.1 Delirium, Agitation, Sedation & Pain 12.2 Substance Withdrawal, Psychiatric Emergencies & Patient Safety
13 Multisystem I — Sepsis & MODS
13.1 Sepsis & Septic Shock 13.2 Multi-Organ Dysfunction Syndrome 13.3 Resuscitation Priorities & Rapid Response
14 Multisystem II — Trauma, Burns & Toxicology
14.1 Trauma & Burns 14.2 Toxicology, Anaphylaxis & Temperature Emergencies
15 Synergy Model, Advocacy & Caring
15.1 The AACN Synergy Model 15.2 Advocacy & Moral Agency 15.3 Caring Practices
16 Collaboration, Systems Thinking & Diversity
16.1 Collaboration & Interdisciplinary Teamwork 16.2 Systems Thinking 16.3 Response to Diversity & Facilitation of Learning
17 Clinical Inquiry, Ethics & End-of-Life
17.1 Clinical Inquiry & Evidence-Based Practice 17.2 Ethical/Legal Issues, End-of-Life & Goals of Care
16.1 Collaboration & Interdisciplinary Teamwork
Key Takeaways Explain This Topic AI
Collaboration is one of the eight nurse competencies in the AACN Synergy Model and is tested within Professional Caring & Ethical Practice (20% of the CCRN).
SBAR stands for Situation, Background, Assessment, Recommendation and is the standardized framework for urgent provider communication.
Closed-loop (check-back) communication is a three-step loop: the sender gives a message, the receiver repeats it back, and the sender confirms it.
TeamSTEPPS (AHRQ/DoD) is built on four competencies: communication, leadership, situation monitoring, and mutual support, and supplies tools such as CUS words and the two-challenge rule.
When a nurse disagrees with a potentially harmful plan, the correct action is to voice the concern clearly and escalate up the chain of command.
Last updated: July 2026
Collaboration as a Synergy Model Competency
In the AACN Synergy Model for Patient Care , collaboration is one of the eight nurse competencies. AACN defines it as working with patients, families, and the entire healthcare team in a way that promotes and encourages each person's contribution toward achieving optimal, realistic patient goals. On the CCRN, collaboration is tested within the Professional Caring & Ethical Practice domain (20% of the exam). The competency is relational : the high-level nurse builds trust, negotiates conflict, and coordinates the ICU team so the plan of care reflects shared decision-making rather than siloed disciplines.
Strong collaboration is an outcome driver, not a soft skill. Studies of ICU teamwork consistently associate better nurse-physician collaboration with lower mortality, fewer complications, and less moral distress and turnover. Critical care is inherently interdisciplinary: intensivists, bedside nurses, respiratory therapists, pharmacists, dietitians, physical and occupational therapists, social workers, and chaplains all touch a single patient. The CCRN nurse is usually the constant presence who integrates these voices and represents the patient's characteristics (resiliency, vulnerability, complexity) back to the team.
Interdisciplinary Rounds and Shared Decision-Making
Interdisciplinary rounds are a structured daily process where the team reviews each patient's goals, sets a shared plan, and assigns follow-up. Evidence links daily goal-setting and structured rounds to shorter length of stay and fewer errors. The nurse presents the patient, voices concerns, and confirms a daily goals checklist : sedation target, spontaneous awakening and breathing trials, lines and tubes that can be removed, mobility plan, nutrition, and VTE and stress-ulcer prophylaxis. Shared decision-making means the plan incorporates the patient's or surrogate's values, not only clinical data; the nurse ensures the patient's voice is heard.
Structured Communication: SBAR
Most sentinel events trace back to a communication failure . Standardized communication reduces that risk. SBAR — Situation, Background, Assessment, Recommendation — is the most heavily tested framework. It gives the sender a concise script and the receiver a predictable structure, and it explicitly invites the nurse to make a recommendation , flattening the traditional hierarchy.
SBAR element Purpose ICU example
Situation Who and what; the immediate problem 'Dr. Lee, this is Ana, RN in bed 7. Mr. K's MAP just dropped to 52.'
Background Relevant context 'Septic shock, on norepinephrine 20 mcg/min, lactate 4.8, received 30 mL/kg crystalloid.'
- Assessment Your clinical judgment 'I think he needs more vasopressor support or a second agent.'
- Recommendation What you want to happen 'Can you come now? Should I titrate up or add vasopressin?'
- Closed-Loop Communication and TeamSTEPPS
Closed-loop communication (also called check-back ) is a three-step verification loop: the sender gives a message, the receiver repeats it back , and the sender confirms it was heard correctly. During a code, 'Give 1 mg epinephrine IV' followed by 'one milligram epinephrine IV' followed by 'correct' prevents dose and drug errors. This is a core tool of TeamSTEPPS (Team Strategies and Tools to Enhance Performance and Patient Safety), the AHRQ and Department of Defense framework built on four competencies: communication, leadership, situation monitoring, and mutual support .
TeamSTEPPS supplies escalation tools the CCRN should recognize:
CUS words — 'I'm Concerned , I'm Uncomfortable , this is a Safety issue' — a graded assertion script.
Two-challenge rule — voice a concern at least twice; if ignored, take stronger action or move up the chain.
DESC script — Describe, Express, Suggest, Consequences — for conflict resolution.
Call-out and huddle — broadcasting critical information and regrouping quickly.
Handoff
Handoff transfers responsibility and information at shift change, transport, or transfer. A standardized format, minimized interruptions, and read-back of critical information reduce omissions. I-PASS (Illness severity, Patient summary, Action list, Situation awareness and contingency planning, Synthesis by the receiver) is a validated model; the synthesis and read-back step is what closes the loop. A safe handoff always lets the receiver ask questions.
Conflict Resolution, Moral Courage, and the Chain of Command
Disagreement is inevitable when a plan may harm a patient. Moral courage means voicing the concern clearly and, if it is not resolved, escalating up the chain of command to protect the patient — not staying silent, and not disruptively going around the team to the family. The correct CCRN answer to 'you disagree with a potentially harmful plan' is almost always to speak up and escalate through professional channels , using tools like the two-challenge rule and CUS. Collaboration does not mean deference; it means principled, patient-centered advocacy.
Shared Mental Models and Mutual Support
Effective teams maintain a shared mental model — everyone understands the plan, the priorities, and the contingency triggers the same way. Structured rounds, huddles, and read-backs all exist to build that shared picture. Situation monitoring (scanning the patient, the team, and the environment) plus mutual support (offering and requesting help, cross-monitoring for errors) are two TeamSTEPPS competencies that let a teammate catch a slip before it reaches the patient. Collaboration also extends beyond the ICU walls: when a patient meets brain-death criteria, the donation conversation is decoupled from the death notification and led by the organ procurement organization , a coordinated hand-off between the clinical team and the OPO that protects the family.
Common exam traps: carrying out an order you believe is unsafe without questioning it; documenting a concern but never voicing it; or handing off without a standardized format or read-back. The high-synergy answer keeps the patient safe and keeps the team intact.