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From Overwhelmed to Indivisible: How to Build a Team in an In-patient Hospital Unit

Cypress T. Kropko

School of Nursing, James Madison University

NSG 462: Issues in Contemporary Nursing Practice

Dr. Jill Delawder DNP, RN, ACCNS-AG, CCRN-CSC, FCCS

November 3, 2022
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From Overwhelmed to Indivisible: How to Build a Team in an In-patient Hospital Unit

The modern axiom “Teamwork makes the dream work” is of greater consequence when

what is at stake is not generic dreams but people’s careers and lives. This is why I believe it is of

vital importance to create and maintain a strong sense of team in healthcare settings. As a

registered nurse (RN) on an inpatient med-surg unit, my research and reflections will focus on

that area of practice. Miller and colleagues (2018) note that poor teamwork in healthcare settings

is associated with increased adverse patient events and rocketing healthcare delivery costs.

Subjectively, anemic teamwork on my unit has contributed to my own professional

dissatisfaction, concern about my ability to safely practice nursing, and decision to accept a job

in a different specialty. In this paper, I will reckon with the broad issue of developing effective

teams in hospital units, reflect on my own experience with teamwork shortcomings, and consider

how to contribute to a healthy and happy care team.

I selected this topic because as an in-patient med-surg nurse, I have witnessed the impact

of staff esprit de corps on staff satisfaction and staff performance. When I started work in my

current position, an experienced manager was the catalyst and fuel for a high-expectations, high-

support team. This meant that my manager held staff members to high performance standards

and provided the emotional and material support to enable us to meet those standards. This

created a team ethos where we demanded excellence of ourselves and helped one another to

achieve it by checking in with one another, offering task assistance, and mentoring each other. In

May, a new manager assumed leadership, and the decline in team morale has decreased staff

satisfaction and retention. Miller and colleagues (2018) noted that enhanced teamwork reduces

staff burnout, enhances patient outcomes, and increases staff satisfaction ratings. Therefore, both

anecdotally and according to research, effective and cohesive hospital teams are vital to optimal
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outcomes for patients and staff. For these reasons, in this paper I will explore generally how in-

patient unit teamwork can be improved and how this might be achieved in my med-surg unit.

Similar to how childhood influences make an enormous impact on an individual’s life,

new employee orientation is a critical window for instilling teamwork values and teaching each

person how to be a teammate. According to Adjei (2022), implementing the Team Strategies and

Tools to Enhance Performance and Patient Safety (TeamSTEPPS®) protocol in new hire

orientation with nurses and support staff improves staff and patient outcomes. This approach

entails teaching one Master Trainer who then trains fellow staff members via a 6-hour workshop

that includes case studies, information, and audiovisual interaction to determine how to integrate

communication, leadership, mutual support, and situation monitoring to enhance outcomes for

patients (Adjei, 2022). In Adjei’s (2022) study, three months after the TeamSTEPPS workshop,

outcomes included increased patient satisfaction, enhanced communication, and more robust

safety culture. While these results are encouraging, a few key shortcomings highlight other areas

for improvement: recruiting seasoned staff as well as new hire volunteer RNs and nurse aides,

and training other care team members including physicians, physical therapists, etc.

As previously mentioned, it is imperative to not only educate staff members early on in

their careers, but also to involve all members of the patient care team. This is crucial because if

not everyone is onboarded and invested in a team approach, there may be role confusions or

miscommunications that could corrode team spirit and, most importantly, endanger patient

outcomes. According to Kusi and colleagues (2019), when interviewed, many RNs, licensed

practical nurses (LPNs), and health care aides (HCAs) expressed confusion and/or consternation

with perceptions about their own or their teammates’ roles. Therefore, it is important for RNs,

LPNs, and HCAs (and ideally all members of the patient care team) to receive onboarding
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training about their scope of practice and appropriate delegation (Walker et al., 2021). As scope

of practice, staffing census, and patient needs change, it is also key that staff receive continuing

education on their roles and appropriate delegation (Walker et al., 2021).

According to Provision 3 in the ANA Code of Ethics (2015), part of a nurse’s

responsibility is to establish, maintain, assess, and optimize a culture of safety in the workplace.

In conducting research on how to establish and sustain a safe teamwork environment on an in-

patient hospital unit, I have learned that it is important to educate as many team members as

possible, emphasizing the employee orientation period. It is also critical to reinforce and update

team-building trainings via in-services and continuing education. Considering this in the context

of my current workplace, I realize that I received little if any formal instruction on the

importance of teamwork and specific recommendations on how to be a team player. I have not

received any team-specific continuing education since I was hired. While I am still employed

there, the ANA Code of Ethics (2015) makes it clear that I have a responsibility to do what I can

to enhance the culture of safety. To fulfill my ethical duty to my colleagues, patients, and the

profession, I will talk with my manager about current team-building initiatives and how they can

be optimized to maximize patient safety, staff satisfaction, and staff retention. With my enhanced

understanding of team building in healthcare settings, I intend to advocate for education to

improve teamwork on my current unit and in my next job.

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References

Adjei, N. B. (2022). Implementing TeamSTEPPS® Training: Using Evidence to Impact

Teamwork on a Medical-Surgical Unit. MEDSURG Nursing, 31(1), 9–12.

Kusi, A. E., Dahlke, S., Stahlke, S., & Hunter, K. F. (2019). Acute care nursing team members’

perceptions of roles: Their own and each other’s. Journal of Nursing Management (John

Wiley & Sons, Inc.), 27(8), 1784–1790. https://doi.org/10.1111/jonm.12877

Miller, C. J., Kim, B., Silverman, A., & Bauer, M. S. (2018). A systematic review of team-

building interventions in non-acute healthcare settings. BMC health services research,

18(1), 146. https://doi.org/10.1186/s12913-018-2961-9

Walker, F. A., Ball, M., Cleary, S., & Pisani, H. (2021). Transparent teamwork: The practice of

supervision and delegation within the multi‐tiered nursing team. Nursing Inquiry, 28(4),

1–10. https://doi.org/10.1111/nin.12413

Winland-Brown, J., Lachman, V.D., & O’Connor Swanson, E. (2015). The new code of ethics

for nurses with interpretive statements. (2015): Practical clinical application, Part I. Med-

Surg Nursing, 24(4).