Table 2.

B
Collaborative Nursing Practice of Student and Staff Nurse
in terms of Coordination

Student Nurse Staff Nurse

Coordination
Mean Interpretation Mean Interpretation

1. Coordinating the goals regarding patient care 3.17 GCNP 3.46 VGCNP
2. Planning with health care provider regarding 2.83 GCNP 3.44 VGCNP
patient cares
3. Working with health care provider in charge
to solve the problem which arise regarding 3.36 VGCNP 3.54 VGCNP
patient care
4. Get social support from health care provider
in charge in the planning of patient care while 3.16 GCNP 3.42 VGCNP
maintaining good interpersonal relationship
3.54 VGCNP 3.56 VGCNP
5. Avoiding conflict regarding patient care
TOTAL 3.21 GCNP 3.48 VGCNP

t (188) 1.646 = P.003 t (188) 3.050 < 0.05

Legend:
3.26 - 4.0 Very Good Collaborative Nursing Practice (VGCNP)
2.51- 3.25 Good Collaborative Nursing Practice (GCNP)
1.76 - 2.5 Poor Collaborative Nursing Practice (PCNP)
1.0 - 1.75 Very Poor Collaborative Nursing Practice (VPCNP)

Table 2.B shows the collaborative nursing practice of student and staff nurses according
to coordination.

The statement Avoiding conflict regarding patient care was perceived by student nurses
having Good Collaborative nursing practice. This finding is related to the Filipino trait of being
non-confrontational due to submissiveness. Most Filipino allow themselves to be ordered around
caused by the feeling of general inadequacy, doubt and uncertainty about the self, and would not
like to be at the forefront of a situation if it goes out of control (Hutt, 2007). This idea is reflected
in the clinical area where on student nurses tend to keep quiet when they should speak up, nod
their heads when they dont know the answer, and smile when they misunderstand something, in
this sense they prevent conflicts to arise and have a smooth and harmonious relationship with the
staff nurses. According to Bonifacio (1975), as early as childhood, Filipinos are trained to learn
to accept the various ways of social life without questioning them. They were taught to perceive
and interpret adult behavior as something designed for their own good or "para sa kanyang
kabutihan." When one asks too many questions, he is perceived to be stubborn or "matigas ang
ulo" and the usual consequence is for him to be punished. When the child begins to answer back,
they are considered to be challenging authority. In other words, Filipinos are trained to perceive
adult authority as something not to be questioned, thus starting the cycle of submissiveness.
Submissiveness 'of Filipinos stems from two fundamental sources: one, the need to conform to
adult authority; and two, the many restrictions imposed on his exploratory behavior. In the
clinical area students were afraid and more reluctant to approach the staff nurses if the staff nurse
seemed too busy and staff appeared too overworked to have time for the student (Atack, Comic,
and Kenny, 2000).This reluctance to approach the staff nurses often is a cause of student nurses
thinking that staff nurses will have a negative thought about them that could result to a
conflict .On the other hand, Staff nurses perceived this statement as having Very Good
Collaborative Nursing practice ,this finding is associated with the role being carried out by staff
nurses to student. Staff nurses act as a facilitator in the learning process of student nurses. So,
staff nurses guide and supervise student nurses in the clinical area to avoid conflict in the care
being rendered for the patient. This finding is supported by the study of Cavanagh and
Valentine (1988, 1995) which states that staff nurses commonly use avoidance as they feel they
need to prevent open conflict, preserve relationships, and be exemplary role models for students.
In return student nurses perceived staff nurses as a good mentor who is supportive, acts as a good
role model, and assessor (Andrews & Chilton, 2000; Gray & Smith, 2000; Neary, 2000; Wilson-
Barnett et al., 1995). Although conflicts do still happen in the area from time to time, staff nurses
see conflict as energy draining, focus reducing, and causes discomfort and hostility within the
healthcare team, on top of their already existing priorities which is why they avoid it as much as
possible (Kelly, 2006).

The statement Working with health care provider in charge to solve the problem which
arise regarding patient care also was interpreted as Very Good Collaborative Practice by the
student nurses and staff nurses.Filipinos are not only known for their resilience, but also for
being adaptive. The nursing academic system is highly westernized making Filipino nurses more
adept in the provision of undivided nursing care regardless of race, culture, and gender, this has
made Filipino nurses one of the most sought-after nurses in the global horizon (Ballad, 2016).
Jeffreys (2008) states that Filipino nurses have a high level of efficacy on affective construct,
because they are culturally diverse. Basically, Filipino student nurses can pretty much fit
anywhere because of their adaptive ability to work with anyone regardless of age, gender, and
ethnicity. Student nurses can therefore be termed as social chameleons. Fisher (2009) describes
this as the ability to change color (a metaphor for performance) to suit either the cultural
ideology had by individuals or a counter position to the ideology, depending on the need.

Staff nurses coordinating with the students in solving patient problems as soon as they
arise (or even before) not only increases the effectivity of the work and helps immerse students
in the field, but the delegation of work helps finish the job faster. Such active and interactive
learning environments encourage students to make connections between and among concepts
and engage students in the learning process (Jeffries, 2009). According to Hathorn (2006), staff
nurses had a positive attitude towards students when they could perform tasks that helped lighten
the workload, thereby increasing the effectivity and efficiency in the work area because tasks are
distributed and are finished faster.

The statement Planning with health care provider regarding patient cares was perceive
by student nurses as having Good Collaborative Nursing Practice.This finding is because
students have a hard time interacting with their superiors due to generation gap theory. The
generation of staff nurses and student nurses is one of the reasons of the cause arising conflicts in
the workplace. Conflict arises among them when the collective personalities of each group
clash with each other. As observe by the researchers nurses who belong to Baby Boomers,
Generation X and Y perceived Millennials, and the Silent Generation as arrogant and
disrespectfully when they talk. The world view of the different generation lead to workplace
friction, tension, and dissatisfaction (Sudheimer,2009).On the other hand staff nurses perceive
this as having Very Good Collaborative Nursing Practice Staff nurses have the routine in
providing health care for their patients already memorized, such as planning and nursing
interventions. The demands of work, short-staffing, and stress, staff nurses have no time to sit
down and plan together with the student nurses. Heavy workload, workforce shortages in
hospitals, and busy wards all pose as obstacles in planning with other health care providers
(Lapena-Monux, Cibanal-Juan, Orts- Cortes, 2016). The House Bill no. 151 Article IX section 48
states that the ideal nurse-patient ratio in the Philippines is 1:12. Presently, some institutions
allow a 1:30 ratio especially if it is a government institution due to short staffing and the number
of people in a ward.

The statement Get social support from health care provider in charge in the planning of
patient care while maintaining good interpersonal relationship was interpreted as having Good
collaborative nursing practice for Student nurses. For the reason that student nurses coordinates
with their clinical instructors first before getting social support from staff nurses. On the other
hand, Staff nurses perceived this as having Very Good Collaborative Nursing Practice.This
finding is related on the issues that arises in the clinical area. To exemplify this issue, staff
nurses often times are hesitant to coordinate with the student nurses regarding the planning and
allowing student nurses to carry out certain interventions to avoid instances of adverse events,
miscommunication, medical errors and chaos in the area. The miss conception in the clinical
greatly affects the development of amicable work relationships and leads to work overload that
reverts to demotivation and lack of initiative on behalf of the professionals for reaching their
optimum goal which is rendering quality patient care ( Lapena-Monux Y, Cibanal-Juan L,Marcos
Azucena, 2014). In relation, staff nurses prefer to do interventions on their own to maintain an
organized work pattern and reduce the occurrence of errors when planning with student nurses.

Staff nurses also feel that student nurses are an additional workload (Attack, 2000). This
is supported by the study of Hathorn (2006) which revealed that staff nurses have to catch up
with time lost supervising student nurses during clinical placement. Moreover, with an increased
number of patients, staff nurses barely have time to plan interventions with student nurses. In
addition, student nurses are expected to come to their clinical duties prepared with a plan of care
for their patients.

The general average weighted mean of autonomy as perceived by student nurses is 3.21
which is interpreted as Good collaborative nursing practice. This finding is due to the fact that
staff nurses allow student nurses to be given roles in caring for the patient and allow them to
exercise power even in tasks as simple as documentation, assessment, and the like. As such,
students thereby feel that they are a part of the healthcare team. Feeling part of the team was
closely linked to the opportunity to learn, emphasizing the important role not only of educators
but also clinicians in undergraduate learning on clinical placement (Nolan, 1998).

The general average weighted mean of coordination as perceived by staff nurses is 3.48
which is interpreted as Very good collaborative nursing practice. This finding is associated
with the knowledge of staff nurses that student nurses help control the workload due to short
staffing and other issues, and consider student nurses to be valuable in the area. As stated by
Levett-Jones, Lathlean, Higgins, and Mcmillan (2008) staff nurses value student nurses learning
and their important contribution in the clinical area. This idea is observed in the clinical area
wherein staff nurses coordinate with student nurses regrading patient care.

Based on the degree of freedom (188) the tabular value of t for a two-tailed test at .05
level of significance is 1.646. The absolute computed value is 3.050 and the computed P value
is .003. A computed t value greater than the tabular value and a P value less than 0.05 indicate
that there is a significant difference in the perception of student and staff nurses on CNP in terms
of Coordination. This finding is associated with the reason that the student nurses and staff
nurses have different levels of thinking and they have different perceptions regarding
coordination. The statements with the highest to lowest mean are the same for both student
nurses and staff nurses however their total mean differ giving a different evaluation. Staff nurses
perceive coordination as much evident with student nurses because they are able to give orders
and make decisions regarding patient care.