Lack of teamwork & Poor patient satisfaction

A lack of teamwork is a problem in the nursing profession and in interdisciplinary teams.

A lack of teamwork causes poor patient satisfaction. Nurses are important to assess and identify
patient needs, coordinate care, facilitate communication and collaboration among health care
team members to provide the best available care and patient outcomes (Al Sayah, Szafran,
Robertson, Bell, & Williams, 2014). Expert nurses can guide new graduates to make critical care
decisions about patient situations that new graduate nurses have never encountered. When new
graduates begin as registered staff, they rely on the interdisciplinary team for support. There is a
growing complexity and multidimensionality of health problems, and increasing specialisation of
health care workers to ensure patient-centered care (Al Sayah et al., 2014).
A lack of teamwork causes poor patient satisfaction. Kalisch& Lee (2010) recognized
that teamwork among nurses is imperative to patient safety. Errors in nursing care occur as a
result of poor teamwork (Kalisch& Lee, 2010). When teamwork is strong, less nursing care is
missed (Kalisch& Lee, 2010). For example, a nurse must prioritize what needs to be done on the
unit based on the needs of patients; good teamwork will ensure that all priorities are met for all
patients (Kalisch& Lee, 2010). It is difficult for a new graduate nurse or any other
interdisciplinary team member to work as an effective team when the unit is understaffed
(Kalisch, Lee, &Rochman, 2010). Watson (2015) recognized workload as the primary cause of
poor teamwork. Increased staff improves teamwork and leads to safer and higher quality of care
(McCulloch, Rathbone, & Catchpole, 2011). Kalisch& Lee (2010) also found that nurses
reported poor teamwork when they worked longer shifts, worked many hours in a week, and
when absenteeism occurred. A supportive unit culture is also correlated with teamwork
(Kalischet al., 2010). It is difficult for organizations to retain nurses if the nurses do not feel like
an important and respected part of the team (Tyler & Parker, 2011). Communication failures

cause inadvertent patient harm (Kalisch, Lee, & Salas, 2010). Patient harm causes poor patient
satisfaction (McCulloch et al., 2011). It can be difficult to communicate with team members
because of nurse demographics (Kalisch& Lee, 2010). On the unit, nurses are often different
ages, genders, educational backgrounds, and experience levels. Demographics can become
communication barriers based on the attitudes and behaviours of a nurse (Kalisch& Lee, 2010).
It was also discovered that younger nurses had a difficult time communicating and feeling as part
of the team (Watson, 2015). It is imperative for managers to adjust their own behaviours and
attitudes to support teamwork (Tyler & Parker, 2011). All nurses should be modelling positive
cultural attitudes so that other team members will learn how to demonstrate these attitudes
(Powers, Normand, & Whitcomb, 2014). In order for teamwork to be successful, team structure,
leadership, mutual support, and communication need to be demonstrated (Castner, Ceravolo,
Foltz-Ramos, & Wu, 2013).
There are many strategies that can be used to correct a lack of teamwork on a nursing
unit. Two alternatives that have been successful in the literature are: virtual simulation and nurse
residency programs. Kalisch, Aebersold, McLaughlin, Tschannen, & Lane (2015) have
recognized that there is a need for teamwork training. Their strategy involves a theoretically
based model of teamwork to determine relevant team processes among nurses (Kalisch et al.,
2015). Kalisch et al. (2015) chose a virtual training environment because it had shown higher
levels of knowledge acquisition and knowledge application. The conceptual framework was
developed by Kalisch, Lee, & Salas (2010). The model specifies five core components: team
leadership, collective orientation, mutual performance monitoring, backup behaviour, and
adaptability (Kalisch et al., 2015). These relationships are fostered by three coordinating
mechanisms according to the framework: shared mental models, closed-loop communication,

and mutual trust (Kalisch et al., 2015). Nurses were given opportunities to practice skills related
to teamwork and deal with difficult situations. After each scenario presented in the virtual
training, nurses were asked to identify if this element of teamwork was present or not (Kalisch et
al., 2015). Hopkins & Bromley (2016) explored whether a residency program is efficient in
preparing nurses for teamwork. In this study, nurses were placed in a residency program. Then,
surveys were given to the nurses and their managers (Hopkins & Bromley, 2016). The survey
was a Nursing Practice Readiness Tool which outlined 36 competencies (Hopkins & Bromley,
2016). It was discovered in this study that a nurse residency program may ease transition to
practice (Hopkins & Bromley, 2016).
In order to put an end to a lack of teamwork among nurses on the unit, virtual education
should be implemented into the organization. The simulation would have to be developed by a
company or by the staff at the organization and implemented electronically. Then, the simulation
would need to be made available to all staff. Most hospitals already provide some training online
or have an intranet through which the simulations could be run. Kalisch et al. (2015) scheduled
the nursing staff in for the simulation during their work shifts and had their shift covered. Virtual
simulations are easy to use and all of the nurses in the study were able to participate with limited
training (Kalisch et al., 2015). Therefore, no training to use the simulation would be required and
the training would be relatively short. This approach allows for greater access and a safe
environment to practice non-technical skills like teamwork (Kalisch et al., 2015). There is no risk
of patient safety in virtual training. Furthermore, the virtual environment has potential to
disseminate information/evidence rapidly to participants, breaking down barriers to the
traditional classroom or training facility (Kalisch et al., 2015). Also, scenarios can be made
reflective of the teams learning needs. For example, an oncology unit registered nurse is

miscommunicating with an unregulated care provider (Kalisch et al., 2015). Kalisch et al. (2015)
found that their virtual environment was a great alternative to conventional education.
Evaluation of virtual education involves evaluations of learning. Kalisch et al. (2015)
administered pre- and post- test evaluations. These evaluations showed an improvement in scores
(Kalisch et al., 2015). The nurses were tested on various scenarios which included: a challenging
assignment requiring teamwork and delegation, over-delegation to a nursing assistant, and
miscommunication and follow up (Kalisch et al., 2015). The nursing teamwork was evaluated
with a 33-item questionnaire ranked from (1) rarely to (5) always and included five subscales:
trust, team orientation, backup, and shared mental model (Kalisch et al., 2015). Since this
evaluation worked, a similar evaluation could be made for any organization. Another test used in
the study was a teamwork knowledge test, which was eight items and was weighted by a percent
using a survey created by Castner et al. (2013). These tests could easily be reproduced and
distributed in organizations. They will provide considerable knowledge about the teamwork
abilities of any staff at any organization. By increasing teamwork on a nursing unit, patients will
become more satisfied with their level of care.

References
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