Nurse–nurse collaboration among millennial emergency room nurses in government hospitals in Metro Manila, Philippines: a cross-sectional study

Nurse–nurse collaboration among millennial emergency room nurses in government hospitals in Metro Manila, Philippines: a cross-sectional study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Nurse–nurse collaboration among millennial emergency room nurses in government hospitals in Metro Manila, Philippines: a cross-sectional study Ma. Jessica Zyra Cunanan, Diannie Buensalida, Jamaica Capunong, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9122922/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 4 You are reading this latest preprint version Abstract Background: Effective collaboration among nurses is essential for delivering safe and high-quality patient care, particularly in high-acuity environments such as emergency departments. Ineffective collaboration may lead to poor communication, mistrust among team members, and an increased risk of medical errors. Millennials currently comprise a substantial proportion of the global nursing workforce and bring unique communication styles, work values, and career expectations into clinical practice. However, limited evidence exists regarding nurse–nurse collaboration among millennial emergency room nurses in the Philippine healthcare setting. Methods: A quantitative descriptive cross-sectional study was conducted among millennial emergency room nurses working in selected government hospitals in Metro Manila, Philippines. A total of 173 respondents were selected through simple random sampling. Data were collected using the Nurse–Nurse Collaboration (NNC) Scale, a validated 22-item instrument measuring four domains: conflict management, common goals, communication and coordination, and professionalism and autonomy. Descriptive statistics, weighted mean, Fisher’s exact test, and Pearson correlation were used to analyze the data. Results: Most respondents were 30 years old and below (38.7%), female (68.8%), and had 2–9 years of clinical experience (76.9%). Respondents reported a high degree of collaboration in all domains including conflict management (M = 1.556), common goals (M = 1.550), communication and coordination (M = 1.633), and professionalism and autonomy (M = 1.586). No significant relationship was found between collaboration and demographic factors such as age and gender (p > 0.05). However, length of experience showed a significant relationship with collaboration in terms of common goals (r = .161, p = .034) and professionalism and autonomy (r = .178, p = .019). Conclusions: Millennial emergency room nurses demonstrated a high level of nurse–nurse collaboration across all domains. While age and gender were not significantly associated with collaboration, clinical experience was positively related to collaboration in specific aspects of professional practice. Strengthening professional development and collaborative workplace cultures may further enhance teamwork and patient care outcomes in emergency departments. nurse–nurse collaboration millennial nurses emergency nursing teamwork nursing workforce Philippines Background Effective collaboration among healthcare professionals is essential for ensuring safe and high-quality patient care. Poor communication and ineffective teamwork have been consistently identified as major contributors to adverse events in healthcare settings [ 1 , 2 ]. In high-acuity environments such as emergency departments, where rapid decision-making and coordinated clinical actions are required, collaboration among nurses is particularly critical for maintaining patient safety and efficient care delivery [ 3 ]. Nurse–nurse collaboration refers to the cooperative interaction between nurses working together toward shared clinical goals, characterized by effective communication, mutual respect, shared decision-making, and professional autonomy [ 4 ]. Previous research has demonstrated that collaborative nursing environments are associated with improved patient outcomes, higher job satisfaction, and reduced burnout among nurses [ 5 , 6 ]. Conversely, poor collaboration among nurses may lead to workplace conflict, decreased morale, and compromised quality of care [ 7 ]. Healthcare organizations today are increasingly characterized by generational diversity in the workforce. The nursing profession currently includes multiple generations, including Traditionalists, Baby Boomers, Generation X, Millennials, and Generation Z [ 8 ]. Among these groups, Millennials—individuals born between 1981 and 1996—represent a growing proportion of the global nursing workforce [ 9 ]. Millennial nurses are often described as technologically adept, collaborative in their approach to work, and motivated by opportunities for professional development and supportive work environments [ 10 ]. Despite these positive attributes, generational differences may also create challenges in workplace communication and teamwork. Studies have suggested that variations in work values, communication styles, and expectations between generations can influence collaboration within healthcare teams [ 11 ]. Understanding how millennial nurses interact and collaborate with their colleagues is therefore essential for creating supportive and effective clinical environments. Emergency departments present unique challenges for teamwork and collaboration. Nurses working in emergency settings must manage unpredictable workloads, critically ill patients, and complex clinical situations that require rapid interdisciplinary coordination [ 12 ]. In such contexts, effective nurse–nurse collaboration plays a crucial role in ensuring timely interventions and maintaining patient safety [ 13 ]. The present study is guided by Social Learning Theory, which proposes that human behavior develops through interactions between personal experiences, environmental influences, and observed behaviors [ 14 ]. Within healthcare organizations, nurses may develop collaborative practices by observing colleagues, learning from shared experiences, and adapting to the norms of the workplace environment. Although several studies have explored collaboration among nurses in various healthcare contexts, limited research has examined nurse–nurse collaboration specifically among millennial emergency room nurses in the Philippine healthcare setting. Understanding collaborative dynamics within this population may provide valuable insights for nursing leaders, healthcare administrators, and policymakers seeking to strengthen teamwork and improve patient outcomes in emergency care environments. Therefore, this study aimed to assess nurse–nurse collaboration among millennial emergency room nurses in selected government hospitals in Metro Manila and determine whether demographic factors influence collaborative behaviors. Methods Study design This study utilized a quantitative descriptive cross-sectional research design to assess nurse–nurse collaboration among millennial emergency room nurses. Study setting The study was conducted in selected government hospitals located in Metro Manila, Philippines, where emergency departments provide acute and urgent healthcare services to a large and diverse patient population. Participants and sampling Participants were millennial nurses aged 28–43 years currently employed in emergency departments of government hospitals in Metro Manila and with at least six months of clinical experience. Simple random sampling was used to select participants from the target population. A sample size of 173 respondents was determined using G*Power statistical software with the following parameters: significance level ( α ) = 0.05 effect size = 0.30 (medium) statistical power = 0.95 These parameters ensured adequate statistical power to detect potential relationships between demographic variables and nurse–nurse collaboration. Instrument Data were collected using the Nurse–Nurse Collaboration (NNC) Scale developed by Dougherty. The instrument consists of 22 items distributed across four domains: Conflict management Common goals Communication and coordination Professionalism and autonomy Responses were measured using a five-point Likert scale ranging from “Always” to “Never.” The questionnaire included three sections: Informed consent Demographic profile (age, gender, length of experience) Nurse–Nurse Collaboration Scale Validity and reliability Content validity of the instrument was evaluated by three nursing experts. A pilot study was conducted to assess reliability. Cronbach’s alpha for the questionnaire was 0.749, indicating acceptable internal consistency. Data collection Data were collected between March and June 2024 using both face-to-face surveys and online questionnaires administered through Google Forms. Prior to data collection, permission was obtained from the Dean of the College of Health Sciences and ethical clearance was secured from the Institutional Ethics Review Board of Pamantasan ng Lungsod ng Marikina. Participants were provided with informed consent forms explaining the purpose of the study, potential benefits, and their right to withdraw at any time. Data analysis Data were analyzed using the following statistical techniques: Frequency and percentage distribution for demographic variables Weighted mean to assess levels of nurse–nurse collaboration Fisher’s exact test to examine relationships between gender and collaboration Pearson correlation to examine relationships between age, length of experience, and collaboration Statistical significance was set at p < 0.05. Ethical considerations Ethical approval was obtained from the Institutional Ethics Review Board of Pamantasan ng Lungsod ng Marikina. Participation in the study was voluntary, and informed consent was obtained from all participants. Confidentiality and anonymity of respondents were strictly maintained throughout the research process. Results Demographic characteristics A total of 173 millennial emergency room nurses participated in the study. Most respondents were 30 years old and below (38.7%), female (68.8%), and had 2–9 years of clinical experience (76.9%), indicating that the majority of participants were early-career nurses. Table 1. Demographic characteristics of respondents (n = 173) Variable Frequency Percentage Age ≤30 years 67 38.7% Female 119 68.8% Male 54 31.2% 2–9 years experience 133 76.9% ≥10 years experience 40 23.1% Note: Percentages may not total 100 due to rounding. Degree of nurse–nurse collaboration Respondents demonstrated a high level of collaboration across all four domains of the Nurse–Nurse Collaboration Scale. Table 2. Level of nurse–nurse collaboration among millennial ER nurses Domain Mean Conflict management 1.556 Common goals 1.550 Communication and coordination 1.633 Professionalism and autonomy 1.586 Note: Lower mean scores indicate stronger agreement with collaborative behaviors. All domains indicate high levels of collaboration. Relationship between demographic variables and collaboration Pearson correlation analysis showed that length of clinical experience had a significant positive relationship with collaboration in terms of common goals and professionalism and autonomy. No significant relationships were observed between collaboration and age or gender. Table 3. Relationship between demographic variables and nurse–nurse collaboration Variable Domain r p -value Interpretation Length of experience Common goals .161 .034 Significant Length of experience Professionalism & autonomy .178 .019 Significant Age All domains — >.05 Not significant Gender All domains — >.05 Not significant Note: r = Pearson correlation coefficient; p < .05 indicates statistical significance. Discussion The findings of this study indicate that millennial emergency room nurses demonstrate a high level of nurse–nurse collaboration across all measured domains, including conflict management, common goals, communication and coordination, and professionalism and autonomy. These findings highlight the importance of teamwork in emergency healthcare settings where coordinated actions and rapid communication are essential for safe patient care. Previous studies have similarly reported that effective collaboration among nurses contributes to improved patient outcomes and enhanced workplace satisfaction [5,15]. Collaborative nursing environments promote open communication, shared problem-solving, and mutual support among healthcare professionals, which are essential for maintaining high standards of patient care in complex clinical environments [16]. The absence of significant relationships between collaboration and demographic factors such as age and gender suggests that collaborative behaviors may be influenced more strongly by workplace culture, professional training, and organizational support than by individual characteristics. Similar findings have been reported in previous studies examining teamwork in healthcare settings, where organizational factors such as leadership support, communication systems, and workplace culture were identified as key determinants of collaborative practice [17]. The significant relationship observed between length of clinical experience and certain aspects of collaboration, particularly common goals and professionalism and autonomy, suggests that professional maturity and clinical exposure may strengthen collaborative competencies among nurses. Experienced nurses often develop greater confidence in clinical decision-making and stronger interpersonal communication skills, which may contribute to more effective teamwork in healthcare environments [18]. Emergency departments require strong coordination and communication among healthcare professionals due to the unpredictable nature of patient care demands. Previous research has emphasized that effective teamwork among emergency nurses improves patient safety, enhances clinical efficiency, and reduces medical errors [19]. In such high-pressure environments, collaborative relationships among nurses play a critical role in ensuring timely and coordinated patient care. The findings of this study highlight the importance of fostering collaborative workplace environments through mentorship programs, continuing professional development, and supportive leadership practices. Nursing leaders and healthcare administrators may play a vital role in promoting teamwork by encouraging open communication, conflict resolution skills, and shared decision-making within healthcare teams [20]. Limitations This study has several limitations. First, the cross-sectional research design limits the ability to establish causal relationships between demographic characteristics and nurse–nurse collaboration. Second, the study was conducted only among selected government hospitals in Metro Manila, which may limit the generalizability of the findings to other healthcare settings or private institutions. Third, the study relied on self-reported responses, which may introduce response bias or social desirability bias. Future research may consider longitudinal designs and include a broader range of healthcare institutions to further explore collaborative behaviors among nurses. Conclusion Millennial emergency room nurses in selected government hospitals in Metro Manila demonstrated a high level of nurse–nurse collaboration across all domains. While demographic factors such as age and gender were not significantly associated with collaboration, clinical experience showed positive relationships with collaboration in specific aspects of professional practice. Strengthening collaborative practices, mentorship programs, and professional development initiatives may further enhance teamwork and patient care outcomes in emergency departments. Declarations Ethics approval and consent to participate Ethical approval for this study was obtained from the Institutional Ethics Review Board of Pamantasan ng Lungsod ng Marikina. Written informed consent was obtained from all participants prior to participation in the study. At the time the study was conducted, the corresponding author served as Chair of the ethics committee but recused himself from the ethical review and approval process due to a declared conflict of interest. The protocol was reviewed and approved independently by other members of the committee. Consent for publication Not applicable. Availability of data and materials The datasets used and analyzed during the current study are available from the corresponding author on reasonable request. Competing interests At the time the study was conducted (2024), the corresponding author served as Chair of the Institutional Ethics Review Board of Pamantasan ng Lungsod ng Marikina. Due to this role, the corresponding author declared a conflict of interest and recused himself from the ethical review, deliberation, and decision-making process for this study. The protocol was reviewed and approved independently by other members of the committee in accordance with institutional procedures. The corresponding author is no longer affiliated with the institution and currently holds no position in the ethics review board. The authors declare that they have no other competing interests. Funding The authors received no external funding for this study. Authors’ contributions All authors contributed to the conception, design, data collection, analysis, and preparation of the manuscript. Acknowledgements The authors thank the participating hospitals and nurses who contributed to this study. References World Health Organization. Patient safety: making health care safer. Geneva: WHO; 2017. Joint Commission. Sentinel event data: root causes by event type. Oakbrook Terrace; 2018. Rosen MA, DiazGranados D, Dietz AS, et al. Teamwork in healthcare: key discoveries enabling safer care. Am Psychol. 2018;73:433–50. Dougherty MB, Larson EL. The Nurse–Nurse Collaboration Scale. J Nurs Adm. 2010;40(1):17–25. Reeves S, Pelone F, Harrison R, Goldman J, Zwarenstein M. Interprofessional collaboration to improve healthcare outcomes. Cochrane Database Syst Rev 2017;6:CD000072. Labrague LJ, McEnroe-Petitte D, Tsaras K. Predictors of nurse burnout. J Nurs Manag. 2019. Almost J. Conflict within nursing work environments. J Adv Nurs 2010. Stanley D. Multigenerational workforce issues in nursing. J Nurs Manag. 2010. Smola KW, Sutton CD. Generational differences in work values. J Organ Behav 2002. Twenge JM. Generational differences in work values. J Manage 2010. Hendricks JM, Cope VC. Generational diversity in nursing. J Adv Nurs 2013. Considine J, Shaban RZ et al. Emergency nursing workforce issues. Australas Emerg Care. 2015. Manser T. Teamwork and patient safety in healthcare. Acta Anaesthesiol Scand 2009. Bandura A. Social learning theory. Englewood Cliffs: Prentice-Hall; 1977. Kalisch BJ, Lee H. Nurse staffing and teamwork. Nurs Outlook. 2010. Salas E, Sims DE, Burke CS. Is there a big five in teamwork? Small Group Res 2005. Almost J, Wolff AC, Stewart-Pyne A. Managing conflict in healthcare teams. J Adv Nurs 2016. Benner P. From novice to expert. Addison-Wesley; 1984. Weller J, Boyd M, Cumin D. Teams and teamwork in healthcare. Anaesthesia. 2014. Weaver SJ, Dy SM, Rosen MA. Team training in healthcare. BMJ Qual Saf 2014. Additional Declarations Competing interest reported. At the time the study was conducted (2024), the corresponding author served as Chair of the Institutional Ethics Review Board of Pamantasan ng Lungsod ng Marikina. Due to this role, the corresponding author declared a conflict of interest and recused himself from the ethical review and approval process of the study. The protocol was reviewed and approved independently by other members of the ethics committee in accordance with institutional procedures. The corresponding author is no longer affiliated with the institution and currently holds no position in the ethics review board. The authors declare that they have no other competing interests. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 29 Mar, 2026 Editor assigned by journal 26 Mar, 2026 Submission checks completed at journal 26 Mar, 2026 First submitted to journal 14 Mar, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9122922","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":606101802,"identity":"605b1c36-6d63-4bbb-8ba3-5f999faf775a","order_by":0,"name":"Ma. 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At the time the study was conducted (2024), the corresponding author served as Chair of the Institutional Ethics Review Board of Pamantasan ng Lungsod ng Marikina. Due to this role, the corresponding author declared a conflict of interest and recused himself from the ethical review and approval process of the study. The protocol was reviewed and approved independently by other members of the ethics committee in accordance with institutional procedures. The corresponding author is no longer affiliated with the institution and currently holds no position in the ethics review board. The authors declare that they have no other competing interests.","formattedTitle":"Nurse–nurse collaboration among millennial emergency room nurses in government hospitals in Metro Manila, Philippines: a cross-sectional study","fulltext":[{"header":"Background","content":"\u003cp\u003eEffective collaboration among healthcare professionals is essential for ensuring safe and high-quality patient care. Poor communication and ineffective teamwork have been consistently identified as major contributors to adverse events in healthcare settings [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. In high-acuity environments such as emergency departments, where rapid decision-making and coordinated clinical actions are required, collaboration among nurses is particularly critical for maintaining patient safety and efficient care delivery [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eNurse\u0026ndash;nurse collaboration refers to the cooperative interaction between nurses working together toward shared clinical goals, characterized by effective communication, mutual respect, shared decision-making, and professional autonomy [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Previous research has demonstrated that collaborative nursing environments are associated with improved patient outcomes, higher job satisfaction, and reduced burnout among nurses [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Conversely, poor collaboration among nurses may lead to workplace conflict, decreased morale, and compromised quality of care [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eHealthcare organizations today are increasingly characterized by generational diversity in the workforce. The nursing profession currently includes multiple generations, including Traditionalists, Baby Boomers, Generation X, Millennials, and Generation Z [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Among these groups, Millennials\u0026mdash;individuals born between 1981 and 1996\u0026mdash;represent a growing proportion of the global nursing workforce [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Millennial nurses are often described as technologically adept, collaborative in their approach to work, and motivated by opportunities for professional development and supportive work environments [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDespite these positive attributes, generational differences may also create challenges in workplace communication and teamwork. Studies have suggested that variations in work values, communication styles, and expectations between generations can influence collaboration within healthcare teams [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Understanding how millennial nurses interact and collaborate with their colleagues is therefore essential for creating supportive and effective clinical environments.\u003c/p\u003e \u003cp\u003eEmergency departments present unique challenges for teamwork and collaboration. Nurses working in emergency settings must manage unpredictable workloads, critically ill patients, and complex clinical situations that require rapid interdisciplinary coordination [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. In such contexts, effective nurse\u0026ndash;nurse collaboration plays a crucial role in ensuring timely interventions and maintaining patient safety [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe present study is guided by Social Learning Theory, which proposes that human behavior develops through interactions between personal experiences, environmental influences, and observed behaviors [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Within healthcare organizations, nurses may develop collaborative practices by observing colleagues, learning from shared experiences, and adapting to the norms of the workplace environment.\u003c/p\u003e \u003cp\u003eAlthough several studies have explored collaboration among nurses in various healthcare contexts, limited research has examined nurse\u0026ndash;nurse collaboration specifically among millennial emergency room nurses in the Philippine healthcare setting. Understanding collaborative dynamics within this population may provide valuable insights for nursing leaders, healthcare administrators, and policymakers seeking to strengthen teamwork and improve patient outcomes in emergency care environments.\u003c/p\u003e \u003cp\u003eTherefore, this study aimed to assess nurse\u0026ndash;nurse collaboration among millennial emergency room nurses in selected government hospitals in Metro Manila and determine whether demographic factors influence collaborative behaviors.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eStudy design\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study utilized a quantitative descriptive cross-sectional research design to assess nurse\u0026ndash;nurse collaboration among millennial emergency room nurses.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy setting\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was conducted in selected government hospitals located in Metro Manila, Philippines, where emergency departments provide acute and urgent healthcare services to a large and diverse patient population.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eParticipants and sampling\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants were millennial nurses aged 28\u0026ndash;43 years currently employed in emergency departments of government hospitals in Metro Manila and with at least six months of clinical experience.\u003c/p\u003e\n\u003cp\u003eSimple random sampling was used to select participants from the target population. A sample size of 173 respondents was determined using G*Power statistical software with the following parameters:\u003c/p\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003esignificance level (\u003cem\u003e\u0026alpha;\u003c/em\u003e) = 0.05\u003c/li\u003e\n \u003cli\u003eeffect size = 0.30 (medium)\u003c/li\u003e\n \u003cli\u003estatistical power = 0.95\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eThese parameters ensured adequate statistical power to detect potential relationships between demographic variables and nurse\u0026ndash;nurse collaboration.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInstrument\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData were collected using the Nurse\u0026ndash;Nurse Collaboration (NNC) Scale developed by Dougherty. The instrument consists of 22 items distributed across four domains:\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eConflict management\u003c/li\u003e\n \u003cli\u003eCommon goals\u003c/li\u003e\n \u003cli\u003eCommunication and coordination\u003c/li\u003e\n \u003cli\u003eProfessionalism and autonomy\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eResponses were measured using a five-point Likert scale ranging from \u0026ldquo;Always\u0026rdquo; to \u0026ldquo;Never.\u0026rdquo;\u003c/p\u003e\n\u003cp\u003eThe questionnaire included three sections:\u003c/p\u003e\n\u003col start=\"1\" type=\"1\"\u003e\n \u003cli\u003eInformed consent\u003c/li\u003e\n \u003cli\u003eDemographic profile (age, gender, length of experience)\u003c/li\u003e\n \u003cli\u003eNurse\u0026ndash;Nurse Collaboration Scale\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003e\u003cstrong\u003eValidity and reliability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eContent validity of the instrument was evaluated by three nursing experts. A pilot study was conducted to assess reliability. Cronbach\u0026rsquo;s alpha for the questionnaire was 0.749, indicating acceptable internal consistency.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData collection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData were collected between March and June 2024 using both face-to-face surveys and online questionnaires administered through Google Forms. Prior to data collection, permission was obtained from the Dean of the College of Health Sciences and ethical clearance was secured from the Institutional Ethics Review Board of Pamantasan ng Lungsod ng Marikina. Participants were provided with informed consent forms explaining the purpose of the study, potential benefits, and their right to withdraw at any time.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData were analyzed using the following statistical techniques:\u003c/p\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003eFrequency and percentage distribution for demographic variables\u003c/li\u003e\n \u003cli\u003eWeighted mean to assess levels of nurse\u0026ndash;nurse collaboration\u003c/li\u003e\n \u003cli\u003eFisher\u0026rsquo;s exact test to examine relationships between gender and collaboration\u003c/li\u003e\n \u003cli\u003ePearson correlation to examine relationships between age, length of experience, and collaboration\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eStatistical significance was set at \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.05.\u003cstrong\u003e\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical considerations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval was obtained from the Institutional Ethics Review Board of Pamantasan ng Lungsod ng Marikina. Participation in the study was voluntary, and informed consent was obtained from all participants. Confidentiality and anonymity of respondents were strictly maintained throughout the research process.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eDemographic characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 173 millennial emergency room nurses participated in the study. Most respondents were 30 years old and below (38.7%), female (68.8%), and had 2\u0026ndash;9 years of clinical experience (76.9%), indicating that the majority of participants were early-career nurses.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1. Demographic characteristics of respondents (n = 173)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"3\" cellpadding=\"0\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 204px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercentage\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 204px;\"\u003e\n \u003cp\u003eAge \u0026le;30 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e38.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 204px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e119\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e68.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 204px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e31.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 204px;\"\u003e\n \u003cp\u003e2\u0026ndash;9 years experience\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e133\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e76.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 204px;\"\u003e\n \u003cp\u003e\u0026ge;10 years experience\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e23.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003eNote: Percentages may not total 100 due to rounding.\u003c/em\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDegree of nurse\u0026ndash;nurse collaboration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eRespondents demonstrated a high level of collaboration across all four domains of the Nurse\u0026ndash;Nurse Collaboration Scale.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2. Level of nurse\u0026ndash;nurse collaboration among millennial ER nurses\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"3\" cellpadding=\"0\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 264px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDomain\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 264px;\"\u003e\n \u003cp\u003eConflict management\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e1.556\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 264px;\"\u003e\n \u003cp\u003eCommon goals\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e1.550\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 264px;\"\u003e\n \u003cp\u003eCommunication and coordination\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e1.633\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 264px;\"\u003e\n \u003cp\u003eProfessionalism and autonomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e1.586\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003eNote: Lower mean scores indicate stronger agreement with collaborative behaviors.\u0026nbsp;\u003cbr\u003e\u0026nbsp;All domains indicate high levels of collaboration.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRelationship between demographic variables and collaboration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePearson correlation analysis showed that length of clinical experience had a significant positive relationship with collaboration in terms of common goals and professionalism and autonomy. No significant relationships were observed between collaboration and age or gender.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3. Relationship between demographic variables and nurse\u0026ndash;nurse collaboration\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"3\" cellpadding=\"0\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDomain\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003er\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ep\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eInterpretation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003eLength of experience\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003eCommon goals\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003e.161\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e.034\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003eSignificant\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003eLength of experience\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003eProfessionalism \u0026amp; autonomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003e.178\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e.019\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003eSignificant\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003eAll domains\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e\u0026gt;.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003eNot significant\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003eAll domains\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e\u0026gt;.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003eNot significant\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003eNote: r = Pearson correlation coefficient; p \u0026lt; .05 indicates statistical significance.\u003c/em\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe findings of this study indicate that millennial emergency room nurses demonstrate a high level of nurse\u0026ndash;nurse collaboration across all measured domains, including conflict management, common goals, communication and coordination, and professionalism and autonomy. These findings highlight the importance of teamwork in emergency healthcare settings where coordinated actions and rapid communication are essential for safe patient care.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePrevious studies have similarly reported that effective collaboration among nurses contributes to improved patient outcomes and enhanced workplace satisfaction [5,15]. Collaborative nursing environments promote open communication, shared problem-solving, and mutual support among healthcare professionals, which are essential for maintaining high standards of patient care in complex clinical environments [16].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe absence of significant relationships between collaboration and demographic factors such as age and gender suggests that collaborative behaviors may be influenced more strongly by workplace culture, professional training, and organizational support than by individual characteristics. Similar findings have been reported in previous studies examining teamwork in healthcare settings, where organizational factors such as leadership support, communication systems, and workplace culture were identified as key determinants of collaborative practice [17].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe significant relationship observed between length of clinical experience and certain aspects of collaboration, particularly common goals and professionalism and autonomy, suggests that professional maturity and clinical exposure may strengthen collaborative competencies among nurses. Experienced nurses often develop greater confidence in clinical decision-making and stronger interpersonal communication skills, which may contribute to more effective teamwork in healthcare environments [18].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eEmergency departments require strong coordination and communication among healthcare professionals due to the unpredictable nature of patient care demands. Previous research has emphasized that effective teamwork among emergency nurses improves patient safety, enhances clinical efficiency, and reduces medical errors [19]. In such high-pressure environments, collaborative relationships among nurses play a critical role in ensuring timely and coordinated patient care.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe findings of this study highlight the importance of fostering collaborative workplace environments through mentorship programs, continuing professional development, and supportive leadership practices. Nursing leaders and healthcare administrators may play a vital role in promoting teamwork by encouraging open communication, conflict resolution skills, and shared decision-making within healthcare teams [20].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLimitations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study has several limitations. First, the cross-sectional research design limits the ability to establish causal relationships between demographic characteristics and nurse\u0026ndash;nurse collaboration. Second, the study was conducted only among selected government hospitals in Metro Manila, which may limit the generalizability of the findings to other healthcare settings or private institutions. Third, the study relied on self-reported responses, which may introduce response bias or social desirability bias. Future research may consider longitudinal designs and include a broader range of healthcare institutions to further explore collaborative behaviors among nurses.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eMillennial emergency room nurses in selected government hospitals in Metro Manila demonstrated a high level of nurse–nurse collaboration across all domains. While demographic factors such as age and gender were not significantly associated with collaboration, clinical experience showed positive relationships with collaboration in specific aspects of professional practice. Strengthening collaborative practices, mentorship programs, and professional development initiatives may further enhance teamwork and patient care outcomes in emergency departments.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval for this study was obtained from the Institutional Ethics Review Board of Pamantasan ng Lungsod ng Marikina. Written informed consent was obtained from all participants prior to participation in the study. At the time the study was conducted, the corresponding author served as Chair of the ethics committee but recused himself from the ethical review and approval process due to a declared conflict of interest. The protocol was reviewed and approved independently by other members of the committee.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and analyzed during the current study are available from the corresponding author on reasonable request.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAt the time the study was conducted (2024), the corresponding author served as Chair of the Institutional Ethics Review Board of Pamantasan ng Lungsod ng Marikina. Due to this role, the corresponding author declared a conflict of interest and recused himself from the ethical review, deliberation, and decision-making process for this study. The protocol was reviewed and approved independently by other members of the committee in accordance with institutional procedures. The corresponding author is no longer affiliated with the institution and currently holds no position in the ethics review board. The authors declare that they have no other competing interests.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors received no external funding for this study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors contributed to the conception, design, data collection, analysis, and preparation of the manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors thank the participating hospitals and nurses who contributed to this study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eWorld Health Organization. Patient safety: making health care safer. Geneva: WHO; 2017.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJoint Commission. Sentinel event data: root causes by event type. Oakbrook Terrace; 2018.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRosen MA, DiazGranados D, Dietz AS, et al. Teamwork in healthcare: key discoveries enabling safer care. Am Psychol. 2018;73:433\u0026ndash;50.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDougherty MB, Larson EL. The Nurse\u0026ndash;Nurse Collaboration Scale. J Nurs Adm. 2010;40(1):17\u0026ndash;25.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eReeves S, Pelone F, Harrison R, Goldman J, Zwarenstein M. Interprofessional collaboration to improve healthcare outcomes. Cochrane Database Syst Rev 2017;6:CD000072.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLabrague LJ, McEnroe-Petitte D, Tsaras K. Predictors of nurse burnout. J Nurs Manag. 2019.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlmost J. Conflict within nursing work environments. J Adv Nurs 2010.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStanley D. Multigenerational workforce issues in nursing. J Nurs Manag. 2010.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSmola KW, Sutton CD. Generational differences in work values. J Organ Behav 2002.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTwenge JM. Generational differences in work values. J Manage 2010.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHendricks JM, Cope VC. Generational diversity in nursing. J Adv Nurs 2013.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eConsidine J, Shaban RZ et al. Emergency nursing workforce issues. Australas Emerg Care. 2015.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eManser T. Teamwork and patient safety in healthcare. Acta Anaesthesiol Scand 2009.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBandura A. Social learning theory. Englewood Cliffs: Prentice-Hall; 1977.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKalisch BJ, Lee H. Nurse staffing and teamwork. Nurs Outlook. 2010.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSalas E, Sims DE, Burke CS. Is there a big five in teamwork? Small Group Res 2005.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlmost J, Wolff AC, Stewart-Pyne A. Managing conflict in healthcare teams. J Adv Nurs 2016.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBenner P. From novice to expert. Addison-Wesley; 1984.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWeller J, Boyd M, Cumin D. Teams and teamwork in healthcare. Anaesthesia. 2014.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWeaver SJ, Dy SM, Rosen MA. Team training in healthcare. BMJ Qual Saf 2014.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"nurse–nurse collaboration, millennial nurses, emergency nursing, teamwork, nursing workforce, Philippines","lastPublishedDoi":"10.21203/rs.3.rs-9122922/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9122922/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground:\u003c/h2\u003e \u003cp\u003eEffective collaboration among nurses is essential for delivering safe and high-quality patient care, particularly in high-acuity environments such as emergency departments. Ineffective collaboration may lead to poor communication, mistrust among team members, and an increased risk of medical errors. Millennials currently comprise a substantial proportion of the global nursing workforce and bring unique communication styles, work values, and career expectations into clinical practice. However, limited evidence exists regarding nurse\u0026ndash;nurse collaboration among millennial emergency room nurses in the Philippine healthcare setting.\u003c/p\u003e\u003ch2\u003eMethods:\u003c/h2\u003e \u003cp\u003eA quantitative descriptive cross-sectional study was conducted among millennial emergency room nurses working in selected government hospitals in Metro Manila, Philippines. A total of 173 respondents were selected through simple random sampling. Data were collected using the Nurse\u0026ndash;Nurse Collaboration (NNC) Scale, a validated 22-item instrument measuring four domains: conflict management, common goals, communication and coordination, and professionalism and autonomy. Descriptive statistics, weighted mean, Fisher\u0026rsquo;s exact test, and Pearson correlation were used to analyze the data.\u003c/p\u003e\u003ch2\u003eResults:\u003c/h2\u003e \u003cp\u003eMost respondents were 30 years old and below (38.7%), female (68.8%), and had 2\u0026ndash;9 years of clinical experience (76.9%). Respondents reported a high degree of collaboration in all domains including conflict management (M\u0026thinsp;=\u0026thinsp;1.556), common goals (M\u0026thinsp;=\u0026thinsp;1.550), communication and coordination (M\u0026thinsp;=\u0026thinsp;1.633), and professionalism and autonomy (M\u0026thinsp;=\u0026thinsp;1.586). No significant relationship was found between collaboration and demographic factors such as age and gender (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). However, length of experience showed a significant relationship with collaboration in terms of common goals (r = .161, p = .034) and professionalism and autonomy (r = .178, p = .019).\u003c/p\u003e\u003ch2\u003eConclusions:\u003c/h2\u003e \u003cp\u003eMillennial emergency room nurses demonstrated a high level of nurse\u0026ndash;nurse collaboration across all domains. While age and gender were not significantly associated with collaboration, clinical experience was positively related to collaboration in specific aspects of professional practice. Strengthening professional development and collaborative workplace cultures may further enhance teamwork and patient care outcomes in emergency departments.\u003c/p\u003e","manuscriptTitle":"Nurse–nurse collaboration among millennial emergency room nurses in government hospitals in Metro Manila, Philippines: a cross-sectional study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-17 08:08:15","doi":"10.21203/rs.3.rs-9122922/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-03-29T08:47:04+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-26T16:10:43+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-26T16:10:11+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Nursing","date":"2026-03-14T13:32:35+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"eede4448-d60a-48d9-8002-879839342c82","owner":[],"postedDate":"March 17th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-18T11:08:47+00:00","versionOfRecord":[],"versionCreatedAt":"2026-03-17 08:08:15","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9122922","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9122922","identity":"rs-9122922","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}