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Balancing Autonomy & Collaboration: Team Dynamics in Clinical Practice

What makes a successful nurse practitioner or physician associate? For nurse practitioners and physician associates, the answer lies in striking a balance between autonomy and collaboration.  

In clinical practice, self-reliance and interdependence on one’s team are critical for success. APPs have unique strengths and weaknesses in different areas, and so must learn to rely on one another as well as themselves to deliver well-rounded care and cover any gaps in knowledge.  

If that sounds complicated, it’s because it is! The unique balance of independence and teamwork within clinical practice poses many challenges, especially for those just entering the field. How do you know when to rely on your own knowledge, and when to ask for help? How do you foster effective communication? And what should you do when conflict inevitably arises? In this blog, we’ll highlight the value of both collaboration and autonomy, explore tensions between them, and propose helpful strategies for achieving balance.  

Understanding Autonomy in Clinical Practice 

In clinical practice, autonomy for NPs and PAs is the ability to make decisions and follow care protocols without deferring to a supervisor or outside source.  Clinical autonomy is marked by certainty in one’s actions, and by self-reliance in one’s thoughts. Autonomous, confident care providers understand their patients’ needs and how to fulfill them without having to be told.   

Autonomy in this context also includes practicing to the full scope of practice. Our profession does not suggest that we want to do everything all by ourselves; rather, we want to do what we were trained to do by ourselves. It is a common misconception that APPs want all the control, when they just want to be able to do what they were taught and are board certified to do. 

Autonomy in clinical practice is critical to providing efficient and patient-centered care. It empowers NPs and PAs to make independent decisions regarding patient care and enables them to tailor treatments and interventions to meet individual patient needs effectively. This ability to act autonomously fosters a more responsive and personalized approach to healthcare delivery, where APPs can promptly address patient concerns and adapt treatment plans as necessary, resulting in improved patient outcomes and satisfaction.  

In practice, autonomous decision-making can include the ability to prescribe medications based on patient assessments and diagnostic findings. It can also look like adjusting treatment plans in real-time to accommodate changes in patient conditions or preferences. Autonomy enables NPs and PAs to engage in patient education and advocacy, empowering individuals to take an active role in managing their health and well-being. Ultimately, autonomy is a cornerstone of providing high-quality, patient-centered care, enhancing the efficiency and effectiveness of healthcare delivery—but it’s not enough on its own. 

The Value of Collaboration  

In contrast, collaboration in clinical settings is the act or process of working together as a team with other providers to achieve broader healthcare and patient-specific goals. Collaboration is significant to healthcare teams as it allows individuals to join forces for the good of the patient, bringing together disparate skills, approaches, and experiences to determine the best path forward. When healthcare teams collaborate effectively, patients benefit from their combined expertise, receiving quality care informed by evidence and experience. Healthy collaboration typically leads to improved patient outcomes, shorter recovery times, and better adherence to treatment plans down the line.  

Effective collaboration can also benefit NPs and PAs themselves. As new and aspiring APPs spend time collaborating with more experienced care providers, they begin to develop their own skillset and expertise, forming a foundation of knowledge to draw on and refer to when deciding treatment options for future patients. Collaboration in clinical practice also provides an abundance of professional development opportunities as NPs and PAs expand their networks, meet potential mentors, and create pathways to grow their careers. Examples of successful collaboration in clinical practice include interdisciplinary team meetings, collaborative patient education efforts, and development of comprehensive care plans across specialties.  

Challenges in Balancing Autonomy and Collaboration 

Because autonomy and collaboration hold equal importance for APPs, challenges often arise in knowing how to balance them. Potential conflicts crop up when the two are not properly weighed. For example, an overabundance of autonomy and self-reliance can lead to siloed practices, where healthcare providers work independently without sufficient communication with others. Communication challenges in general emerge as a major theme when navigating autonomy and collaboration, hindering the sharing of information, coordination of care, and alignment of treatment goals among team members. 

On the other hand, collaboration can lead to its own share of issues, including role clashes, conflicting priorities, and disagreements over final decision-making authority.  In interdisciplinary teams, different healthcare professionals may have overlapping or conflicting roles and responsibilities, leading to uncertainty and further disagreements. This ambiguity can create tension and undermine collaboration, particularly if role boundaries are not clearly defined or respected.  

Strategies for Achieving Balance 

To address these conflicts, healthcare organizations must emphasize the importance of both autonomy and collaboration. This requires intentional efforts to foster effective communication, clarify roles and responsibilities, and promote interdisciplinary approaches to patient care.  

Communication strategies play a pivotal role in enhancing collaboration while respecting individual autonomy. This includes encouraging open and transparent communication among healthcare team members, actively listening to diverse perspectives, and fostering a culture of mutual respect and trust. By promoting clear and constructive communication channels, healthcare professionals can exchange information, share insights, and coordinate care plans, while also allowing for autonomy in decision-making based on individual expertise and judgment. 

Establishing clear roles and responsibilities within the healthcare team is essential for optimizing collaboration and minimizing conflicts. This involves defining the scope of practice for each team member, clarifying expectations regarding their contributions to patient care, and recognizing the unique expertise and strengths that everyone brings to the team. By delineating roles and responsibilities clearly, healthcare professionals can work together more effectively, leveraging their respective skills and knowledge to provide coordinated, comprehensive care for patients.  


Interdisciplinary approaches involving collaboration across different specialties can also enhance patient care. This may include holding interdisciplinary team meetings, implementing care coordination protocols, and promoting cross-disciplinary education and training opportunities. By embracing interdisciplinary collaboration, healthcare teams can leverage the diverse perspectives and expertise of team members to address complex patient needs and achieve optimal outcomes. 

The Role of Continuous Learning and Adaptation 

To remain effective collaborators and communicators, NPs and PAs should prioritize continuous learning and adaptation. Because the field of medicine is ever evolving, those inside it must constantly educate themselves on new and emerging information, methods, and practices. When every member of an interdisciplinary team is on the same page, collaboration and communication become a lot easier—and a lot more effective.  

For busy APPs on the go, keeping up with ongoing education credits can prove challenging. Consider enrolling in  continuing education and professional development training for a comprehensive curriculum, expert instruction by practicing board-certified faculty, and access to an established professional network of care providers.  

APPs should embrace professional development opportunities wherever they arise to remain both competitive and collaborative. When it comes to career progression and growth, hospitals and other healthcare providers prioritize NPs and PAs with experience, a well-rounded professional network for consultation and referral needs, and healthy collaboration and communication skills to facilitate the best care possible for patients.  

Embracing feedback and constructive criticism is also crucial for continuous improvement in healthcare settings. Feedback provides valuable insights into areas of strength and opportunities for growth, helping healthcare professionals enhance their clinical knowledge and performance. By actively soliciting and receiving feedback from colleagues and supervisors, healthcare professionals can identify areas for improvement, address gaps in their practice, and refine their clinical skills and decision-making processes.  

Achieving a balance between autonomy and collaboration is essential to ensure efficient, patient-centered care. Autonomy empowers healthcare professionals to make independent decisions based on their expertise, while collaboration promotes effective communication, teamwork, and interdisciplinary approaches to patient care. By fostering a collaborative culture that respects individual autonomy, healthcare teams can harness the collective expertise and strengths of team members to optimize patient outcomes. Ultimately, by striking a balance between autonomy and collaboration, healthcare professionals can navigate complex clinical challenges, enhance care quality, and promote a culture of continuous learning and improvement. 

For more tips & clinical pearls of wisdom, apply to enroll in one of the ThriveAP transition to practice curriculums.