Good teamwork is as essential to a high-functioning nursing unit as the nurses themselves. Even the best nurses can’t operate in a silo–patient care takes a comprehensive and cohesive approach where nurses know what to do, know what everyone else does, and each nurse supports the rest of the team.
Despite being a fundamental nursing practice, teamwork can be challenging. Some teams don’t work well and don’t know what’s wrong, or they know what’s wrong and don’t implement solutions that work.
So what’s the key to good teamwork?
It’s all about communication.
“This applies to all professions–communication is key,” says Dr. Margarita David, DNP, MSN, BSN, BA, RN, PCCN, CSN, founder and CEO of Dr. Registered Nurse Success Academy, LLC. But fine-tuning communication skills sometimes gets pushed aside for the immediacy of nursing duties. “Many nurses get overwhelmed with doing what the job requires and what needs to be completed. There’s not enough time.” The dangers of an ineffective team are many; the worst outcome is when it causes patient or nurse harm. For example, patients who leave the hospital without a clear plan or a plan they need help understanding are more likely to be readmitted within 30 days. “That also affects a hospital’s numbers,” she says. “It’s a domino effect.”
Developing Skills and Practice for Effective Work
Teamwork can be guided, but it can only succeed with flexibility. What works for one team may not hold for how another team operates. So constantly reassessing how a team works–its strengths and weaknesses–is necessary. “In nursing, everything changes every single day,” says David.
Building teamwork skills often starts when nurses are still in school, says Dr. Shelley Johnson, EdD, MSN, MBA, RN, NE-BC, CNE, dean and professor at Florida Agricultural and Mechanical University’s School of Nursing. “In nursing education, there’s a lot of content delivery, and we ask students to work on communicating with each other for support and to talk through difficult concepts,” she says, noting that a tried-and-true method that nurses can use throughout an entire career span is the SBAR method. Presenting problems and solutions with the SBAR method helps nurses identify issues and background, assess, and then recommend how to solve things; it’s a method that can be used in many situations. “They can use the SBAR format if they are going to a faculty member with an issue, or they can use it in a presentation to advocate for themselves, others, or as a leader.”
According to David, nurses should seek opportunities to intentionally put themselves in positions to grow confident speaking up because that’s what it takes to be an effective team member and leader. “Get involved in a research council or on practice committees,” she says. “Get involved, and then put yourself out there.” Because so much of nursing is focused on direct patient care, nurses have fewer chances to speak in front of others or to gain the confidence that comes from that experience. Nurses can also actively practice at conferences and meetings where they learn to communicate what they want.
Johnson says that when nurses grasp the skills that will strengthen their team, standardizing the language and process makes a difference. “You want it to mean the same thing when there’s an emergency,” says Johnson, “so no one is confused.”
And if tension does develop, team members need to recognize the problem, reassess the approach, and address it. Take a step back and wait for things to deescalate, says Johnson, and then come from a place of humility. Have patience, she says, and evaluate what happened, what went wrong, and how to fix it. In interdisciplinary teams or even working with patients, the chance for miscommunication is elevated, and sometimes an apology is necessary and the right thing to do. “Own your mistakes,” Johnson says. “You don’t want to break a relationship to the point where progress fails, you can’t work together, or someone doesn’t want you as a nurse.”
Recognize the cultural communication component for each team you work on, says Johnson. “Think of how others are receiving your messaging,” she says. Nurses can also look for subtle signals in their teammates to know when the teamwork isn’t optimal. Look for body language and facial expressions, and listen to the responses from team members. “We must be proactive with talking and practice active listening,” says Johnson. “That active listening is important for gathering information, managing teams, and being team members,” she says. The skill is important enough that practicing it with role-playing is valuable.
Everett Moss II, BSN, RN, EMT-P, and a nurse anesthesia DNP candidate at the Nell Hodgson Woodruff School of Nursing at Emory University, has worked as a flight medic and nurse and as a firefighter before beginning his path to his DNP. So he understands how teamwork flows from one unit to the next in the patient’s journey. “The continuum of care is only effective with communication,” he says.
Every person’s role is important when a patient is moved from the ER to a trauma unit or the ICU and then is moved to discharge. “We saw that especially during COVID,” he says. Healthcare industry workers who aren’t in direct contact with patients still have a significant impact on nurses’ ability to care for patients effectively, he says. And nurses routinely communicate with pharmacies, labs, other teams, and family members or caregivers, so each step extends the team working on a patient. “In nursing, you’re forced into an environment where you have to learn teamwork or suffer the consequences of not,” he says. “And in our profession, if we suffer the consequences of not, our patients do too. I don’t believe an area of nursing survives without teamwork.”
Advanced practice degrees also provide communication skills that help nurses with teamwork, whether they remain bedside nurses or expand into other roles. As nurses progress to team leaders, David says they must understand how to lead effectively. “Understanding your style is vital in making sure you lead others,” she says, noting that she found her style and works with it. “I have a democratic approach. I tell them my expectations, but then I ask about their expectations of me. I let them know if you come to me with a concern, I want to hear a potential solution.” Building rapport strengthens trust so that each nurse can work for the betterment of the whole team. “It has to be 100 percent of the people working together,” says David.
Moss likens teamwork’s effectiveness to how sports teams operate. “Until you establish who does what, everyone may not know their role,” he says. “They may think, ‘I don’t know what you’re expecting from me, and I don’t know what to expect from you.’”
Johnson agrees. “None of us can do this alone,” she says. “The moment we do, we all fail.”