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Strategies to Foster Teamwork among Nurses



Strategies to Foster Teamwork among Nurses


The effectiveness and efficiency of health care providing services depend greatly on the quality of nursing work. Nurses represent special links between doctors and patients. They provide clock round observation of patients and evaluate their condition. Improvement of nursing work will lead to the improvement of patient care. This improvement can be obtained by the implementation of various strategies at fostering teamwork between nurses. This paper will describe and evaluate both theoretical and practical types of research regarding teamwork and various approaches utilized in effective team-building practices among nurses. Much attention will be paid to such aspects as leadership, communication and interaction, shared vision, creating a positive working environment within a team.

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Stakeholders and Performance Indicators

Nowadays much public attention is brought to the subject of understanding, evaluation, and improvement of the quality of health care providers in the USA. Various private groups, such as the National Quality Forum (NQF) and the Joint Commission on Accreditation of Health Care Organizations (JCAHO), evaluate current nursing activities and teamwork among nursing staff. These organizations use various indicators for collecting evidence about teamwork and thoroughly analyze this information (Savits, Jones, & Shukamit, 2005).

Maas, Johnson, and Morehead developed the concept of ‘nursing-sensitive indicators, which reflects outcomes in patient’s conditions as results from providing health care intervention (Maas, Johnson, & Moorehead, 1996). These indicators help to improve clinical practice in health care-providing institutions.

The work of nursing staff in health care institutions has been examined from the perspectives of various commissions and forums.

The need to embrace the idea of teamwork in nursing staff is supported by the Joint Commission on the Accreditation of Hospitals. In July 2004 a special research determined that about 75 % of hospitals have problems with staff communication and teamwork (Joint Commission on Accreditation of Healthcare Organizations, 2004). These problems were recognized as the main reasons for infant deaths. The Joint Commission on the Accreditation of Hospitals' recommendations was to improve teamwork performance in hospitals for increasing the quality of patient care.

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Special indicators were designed for controlling and improving teamwork performance in health care-providing institutions. In January 2004, the National Quality Forum determined and endorsed a set of national standards in nursing-sensitive care. These standards include a framework of nursing-sensitive practices, evidence-based performance measures, and appropriate recommendations for further research in the field. These measures of performance were determined through the National Quality Forum Consensus Development Process that brings together diverse healthcare stakeholders.

These multiply measures help to obtain a comprehensive vision of nursing activities and teamwork performance. The recommendations include the use of such indicators for measuring nursing teamwork performance as ‘PES-NWI Nurse and Physician Teamwork’, ‘PES-NWI Nurse and Physician Relations’, and ‘PES-NWI Collaboration’. These indicators were developed to determine the extent of cooperation between nurses and physicians, as well as the extent of interaction and collaboration between medical staff (The Joint Commission, 2009).

It should be noted that the National Quality Forum mostly considers nurses as a part of the whole staff and evaluates their performance in conjunction with their interaction with physicians, as well. Hence, nurses are seen as a part of the whole health care providing process, and not as a separate division on its own.

Background Information, Analysis, and Evaluation of the Research Problem

Various researchers emphasized the importance of teamwork collaboration of nursing staff in providing effective and efficient health care services. This subject is also very important to me.

This section will present the results of my online research on the problems that affect the patient’s safety in nursing practices. During the research of the relevant literature, I surfed the Internet to find the articles from professional nursing journals that share systematic reviews, as well as randomized controlled trials, cohort studies, case studies, and so forth, to produce reliable findings. My search was limited by such requests as “patient safety” and “nursing teamwork”. These requests were chosen because the patient’s care and safety are the top priorities in the work of a registered nurse. As I pursue my career in this field, the topic is of great importance. I need to know all possible challenges and threats that might hamper the performance of individual and teamwork operations and ways to mitigate these risks.

During my research on the topic, I faced some difficulties. One of the major problems observed in this field is the lack of rigorous and reliable methodology to test and develop positive trends in the nursing environment. Kalisch, Hyunhwa, and Salas (2010) note that even though the nursing community is talking about the benefits of positive change in the working environment there is little understanding with regards to the substance of this change. Therefore, it is extremely crucial to implement strategies of increasing teamwork among nurses in real life. Nursing staff should see the real effects of these strategies and have enough motivation and incentives for further improvement in nursing teamwork.

Purdy, Laschinger, Finegan, Kerr, and Olivera (2010) found that nurses’ dissatisfaction about teamwork environments had a direct effect on their attention and quality of care service delivered. These outcomes had an immediate negative effect on reducing the patient’s safety. Therefore, special methodologies should be developed to decrease this dissatisfaction. People should share their visions considering factors that hurt the working environment and productivity of nursing staff. Strong communication will help in the determination of these factors, analyzing, and developing strategies and activities for decreasing these factors.

The study conducted by Sammer and James (2011) confirmed that a lack of empowerment and a rough climate in nursing teamwork adversely affect “patients safety culture”. Weinstein (2006) tested the application of proposed solutions to mitigate medical risk and increase a patient’s safety by including nurses in the management chain and strategic decision making. The study proved that nurses command the necessary knowledge and skills to participate in a wide range of leadership initiatives as response teams.

Shea-Lewis (2012) argued that background education is not sufficient to ensure nursing professionalism and competency. Improvement of teamwork by the implementation of various strategies can increase the sharing of information, knowledge, and education among nurses. Staff will boost their performance through improved interaction and communication within the team. Effective communication and knowledge management in a teamwork environment are important constituents to handle various issues in a medical environment. Therefore, continuous evaluation and training are necessary to secure a high level of quality care and patient safety.

The above articles confirmed that working in a team is a very challenging process. Nursing teamwork was not properly described and studied yet. I tried to find a particular example and strategies concerning interaction and communication between nurses. I have completed online research on the topic for articles of the best available evidence on the topic of efficient strategies and solutions to increase teamwork among nurses. I paid much attention to communication and leadership strategies because these features provide the most effective and efficient outcomes in improving the quality of health care provision.

During my research, I have located numerous sources on the topic. Most of them were concerned with my research indirectly. However, I have selected and retrieved only several articles from medical services scholarly journals. Below I will provide analysis and evaluation of official researches because I think that only reliable professional resources can provide valid information, which can serve as the basis for argumentative reasoning and study. I want to create an accurate and comprehensive vision of all existing challenges and opportunities that are related to communication, leadership, and teamwork among nursing staff. Correct understanding of the problem will provide an ability to perform effective analysis, create new solutions, and make valuable conclusions to be a positive leader in my career as a nurse.

Castner, Ceravolo, Foltz-Ramos, and Yow-Wu (2013) argued on the importance of leadership and empowerment for nursing staff as a key to the excellent performance and quality of the service delivered. Their study evaluated the correlation between “team structure, leadership, situation monitoring, mutual support, and communication”. It is noteworthy that perceived quality and satisfaction from care were high in those cases, where hospitals delegated maximum authority to nursing units in regulating their teamwork interaction.

Professor Garon (2012) noted that nurses are the main and permanent link between patients and doctors at the hospital. Therefore, the benefit from their ability to rationalize, critically evaluate their patients' conditions and respond to treatment, as well as transmit this valuable information through approved communication channels should not be underestimated. McIntyre and Foti (2013) insisted that hospital management should create conditions that would allow empowering nurses with leadership and communication opportunities.

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Their study showed that devotion and focus when working in teams generated performance and efficient decision-making in the process of care delivery. In self-sustained nursing teams (abiding by hospital policies and accurate rational models), nurses are capable of accepting each other as a leader and professional partners, sharing knowledge, and providing mutual help. Mok and Au-Yeung (2012) specified that such an approach to teamwork organization among nurses contributes to the creation of a rewarding hospital environment and boosts patients’ satisfaction in the course of their treatment.

Sammer and James (2011) added that the “patients’ safety culture” is directly determined by the ability of nurses to communicate efficiently with each other, share knowledge, interact with hospital personnel, deliver important information related to treatment procedures, and exercise leadership in learning and making decisions in the process of every-day care delivery.

The above articles provide a mostly theoretical approach towards team working. Researchers analyzed and evaluated separate aspects of nursing activities. I made considerable efforts to find practical examples of the implementation of teamwork strategies into real life with the measurement of outcomes. Additionally, I wanted to receive valuable and accurate information considering the patient’s condition before the implementation of teamwork strategies and after it. I think figures will provide the most valuable vision of the benefits of increasing teamwork practices among nurses. Also, I wanted to receive an assessment of the nursing staff and their opinion towards implemented activities. I intended to determine professional visions regarding the implementation of teamwork strategies in the nursing working process.

I evaluated a lot of different researches and found a description of a team work-study, methodologies of improvement of the interaction of nursing staff, and evaluation of positive patient outcomes due to the improvement of nursing teamwork.

Beatrice J. Kalisch, in her work An Intervention to Enhance Nursing Staff Teamwork and Engagement, performed testing and evaluation of teamwork performance, based within a medical-oncology unit of a community hospital. 55 staff members worked in this unit: 32 registered nurses, 2 licensed practical nurses, 15 certified nurses, and 6 unit secretaries (Kalisch, 2007).

At the beginning of the researches, Beatrice J. Kalisch (2007) determined perceptions of the medical staff towards teamwork, existing barriers in effective and efficient communication and interaction of medical staff, and possible issues that enhance teamwork performance. The determination of these factors was aimed at understanding people’s attitudes towards working in teams and being part of the team.

All collected information was presented in the form of reports to the medical staff of the hospital. People were provided with clear and comprehensive evidence concerning work in teams. This presentation had an aim to convince people of the need to make changes in the existing working environment. The nursing staff demonstrated interest in improving communication and interaction among the team members.

Thereafter, the visions, goals, and values of all medical staff were established, including the development of strategies towards the improvement of the working environment and patients’ care. Each nurse could express her or his personal opinion and vision about the goals, values, and visions. Thus, staff members understand that their visions are valuable for the medical unit where they work.

People feel themselves not as isolated medical workers if they associate themselves with the team. Thus, they become significant contributors within the provision of the most effective and efficient health care services (while abiding with sets of stipulated procedures) (Ingersoll, Witzel, & Smith, 2005).

The next step of research performed by Beatrice J. Kalisch was staff training. Nurses received information concerning conflict management, effective and efficient interaction within their teams, as well as support in understanding how to share information among the team members. These pieces of training significantly improved teamwork, skills, and knowledge of the nursing staff.

Nursing teams have proved their ability to make changes in the working process of their unit. Team members proposed ‘to move staff to 12-hour shifts, with a mix of 8- and 12-hour shifts to decrease the number of handoffs between staff members and the number of different people they worked with’ (Kalisch, 2007). It should be noted that the implementation of these initiatives led to the improvement of health care services.

Much attention was paid to the importance of increasing communication and interaction between members of the nursing staff. Nurses openly stated their ideas and evaluated the ideas of others during dedicated meetings. They received e-mails from the nurse manager at the end of each meeting so they could keep track of the decisions of these meetings.

Managers performed continuous coaching of nursing staff. Reinforcement of knowledge and skills on the job leads to the strengthening of teamwork (The use of simulation for training teamwork skills in healthcare: how low can you go?). This research was evaluated by using various measurements, such as the amount of patients’ successful treatment/ falls and the level of patients’ satisfaction with nursing services.

After completion of the education program, the number of patients’ falls decreased about 2,5 times – from about 7,7 percent in 1,000 patient days to about 2,9 per 1,000 patient days (Kalisch, 2007).

Patients’ satisfaction from nursing work was evaluated by using such measures as nurses’ communication with patients and families, perceptions of nurses’ promptness in responding to calls, and total quality of nursing care. Obtained figures are presented in Table 1 (Kalisch, 2007).

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The patient’s recognition of considerable improvement in all aspects of nursing care provisions after the improvement of teamwork among nursing staff.

Nursing staff recognized the positive effect of improvement of interaction, communication, and improve teamwork, as well. Additionally performed survey showed that ‘84% of the nurses and 80% of the CNAs on days and 35% of the nurses and 60% of the CNAs on nights reported that teamwork had improved on the unit’ (Kalisch, 2007).

Intervention into nursing activities also effected vacancy and staff turnover rates. Staff turnover rate decreased by about 63 % (from 13,14 % to 8,05 %), when the vacancy rate decreased by 17 % (from 6,14 % to 5,23 %) (Kalisch, 2007).

Research performed by Beatrice J. Kalisch confirmed the positive effect of teamwork on nursing staff. Special strategies concerning increasing interaction and communication between nurses were accurately described in An Intervention to Enhance Nursing Staff Teamwork and Engagement. Nurses feel like a part of one team when working together. They clearly understood the necessity of interaction for the improvement of health care services.

Notably, positive changes were recognized by patients and medical staff. This understanding will lead to a further increase in interaction and improvement of teamwork among nursing staff.


I evaluated various articles concerning teamwork among nurses. Different researchers assumed that increasing communication and interaction between nursing staff and the implementation of various leadership strategies lead to considerable improvement of provided health care services. These assumptions were theoretically and practically supported by the relevant figures, which showed considerable positive results further to the implementation of increased teamwork strategies among nurses.

The benefits of the strategy revealed a considerable decrease in fall rate of patients in health care institutions, decrease in vacancy and staff turnover rates, increase in the level of patient's satisfaction from nursing work (nurses communication with patients and families, perceptions of nurses’ promptness in responding calls and total quality of nursing care).

At the beginning of my studies, I paid much attention to the role of leaders in nursing teams. However, at the end of my researches, I can assume that communication and interaction between nurses are also extremely important. These strategies provide the sharing of knowledge, skills, and visions among medical staff. Nurses perceive themselves not as isolated employees, but they become a part of one team. They understand that the effectiveness and efficiency of provided health care depend on the intentions of each staff member and the extent of cooperation between nurses.

Furthermore, nurses changed their working schedules for providing better services to patients. The above studies help me understand that teamwork leads to improvement in the whole working process. Thus, work in the team provides more abilities of significant positive changes than inputs of separate members of the staff.

Future Steps

The above-described strategies do not concern all aspects of nursing activities. Future researches and interventions should consider the further improvement of the quality of health care services by decreasing the time of patient’s stay in health care providing institutions, closer interaction between staff members, avoiding medical mistakes, and decreasing hospital-acquired conditions. Further researches considering leadership should be performed. Moreover, I recommend implementing proposed strategies into nursing practice while providing mechanisms for the evaluation of steps implemented in the figures.


I provided and analyzed various articles concerning the improvement of teamwork among nurses. Most of the existing strategies are based on the improvement of leadership, cooperation, and interaction between team members, along with creating a team-friendly environment. Strategies that promote the sharing of knowledge, skills, and experience among nursing staff are also very important. I evaluated different theoretical and practical approaches.

Improvement of teamwork leads to considerable positive effects that concern patients and nursing staff. These effects are evident thru decreased levels of patients’ falls and increased levels of patient’s satisfaction, as well as reducing vacancy and staff turnover rates reduction among nurses.

I recommend performing further researchers concerning the improvement of teamwork among nurses. These researches can include decreasing the time of patient’s stay in health care institutions, closer interaction between staff members, avoiding medical mistakes, and decreasing hospital-acquired conditions.

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