NURSING TEAMS: WHAT IS A TEAM

 

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Team nursing and nursing teams are not the same thing.  Are either of them really a team?  What is a team?  For purposes of this blog I am using the team definition from The Five Behaviors of a Cohesive Team by Wiley:

A team is a relatively small number of people (from three to twelve) who meet on a regular basis and are collectively responsible for results. The team members share common goals as well as the rewards and responsibilities for achieving them. Not every group is a team.

(The Five Behaviors of a Cohesive Team™ Facilitator’s Guide, 2014, John Wiley & Sons, Inc.)

 

If you look at the above definition I guess, we could call team nursing a true team.  After all, it is a small number of people, who might meet on a regular basis (depending on work schedules), and the ‘team’ is collectively responsible for results (the safe care of a specific group of patients).

 

Now let’s tackle a nursing team, the group who work the same shift, with the same leader on a regular basis.  Of course there is always the casual staff, who may or may not be considered part of the team.  Again, a small number of people, who meet on a regular basis.  But, are they collectively responsible for results?  Each RN has his or her own patient assignment, as does each LPN, or nursing assistant.  As a ‘team’ are they all responsible for the safe care of all the patients on the unit?  Do they even know the answer to that question or know what is expected?  The charge nurse is certainly responsible for all the patients, and is the leader of the team.  That kind of makes one think that everyone is responsible for all the patients.  Wow!  That could shed a whole different light on how the ‘team’ works together.

 

Let’s look at Patrick Lencioni’s (2002) list of the dysfunctions of a team

  1. Absence of trust
  2. Fear of conflict
  3. Lack of commitment
  4. Avoidance of accountability
  5. Inattention to results

(Lencioni, P. (2002). The Five Dysfunctions of a Team. Jossey Bass, San Francisco)

 

Consider the above dysfunctions: how does your team rate?

 

When I look back on my rather long career as an RN I remember variations of how many of the dysfunctions were present.  Of course some colleagues were trusted, others weren’t; with some conflict was definitely feared, but not with everyone; accountability was definitely individually based, and there was great variability.  As for results, I think everyone was working toward the same goal; keeping all patients alive and safe.  However, I am not sure everyone cared about every patient on the unit; if the patient was not assigned to you then that patient was not your responsibility.

 

It was my first solo shift in a new ICU and I had been scheduled for the first break.  Shortly after I should have left for that break the nurse with whom I was covering came and asked “are you ready to go for your break.  “No not yet”, I replied.  She responded with “If you don’t get away on time for this break, then I don’t get away on time, and all our breaks for the rest of the day will be messed up”.  I was so afraid of her that of course I skipped my break so she could go on her break and keep us on schedule.  I certainly didn’t want to ruffle any feathers, or ask for help so that I could get going.  There might have been a little absence of trust at this point too.  I continued to work with that RN for most of my career and once I got to know her, I became comfortable asking for help.

 

I think nursing teams would be much happier and work much more efficiently and effectively if they were true teams.  Of course that is not easy to accomplish.  First the leader must buy in and that goes beyond the charge nurse to the unit manager.  Think about it?  A healthy work environment where there is trust, no fear of conflict, commitment, accountability, and attention to results sounds like a place I might want to work.  Of course this wouldn’t be on just some shifts, depending who was on; but, on every shift.

 

I recall one ‘team’ I worked with, again in an ICU (different hospital).  I arrived for my night shift and one of my colleagues told me that I couldn’t care for the patient I had been assigned because she wanted that patient, and I didn’t have enough experience.  I went along with this, as I didn’t really care and she was much more experienced than I was, so fine.  One of the other nurses came to me later suggesting that I had been bullied and not treated with respect.  I had not thought of this myself, but when mentioned, she was right.  I guess I had let myself get into a mode of just thinking that is the way things are, so accept it.  Maybe she could have stood up for me at the time, seeing as I hadn’t stood up for myself.  But, all around a good lesson.

 

I encourage everyone to read Patrick Lencioni’s book, The Five Dysfunctions of a Team; it is a good story laid out in the form of a fable.  I also encourage all nurses to urge their charge nurses and unit managers to take the steps to develop a cohesive team.  I am positive that the results of having a cohesive team will be rewarding.