Teamwork is Critical

     How important is teamwork within a facility?  Researchers have identified that facilities which have good teamwork have higher performance and have higher quality outcomes (1).  Culture change in nursing homes has focused on resident centered care which allows residents choice in their daily preferences and routines.  Part of the culture change that is less focused on is teamwork among the staff.  Teamwork among staff is a critical element of providing quality care to the residents.

     In a study done by Tyler and Parker (2010), researchers observed 20 different nursing homes to determine practices that increased teamwork within the facilities.  What they discovered was that facilities with a high level of teamwork had a positive work culture. This culture supported the positive values of the organization and a positive attitude about co-workers.  They also found that in high-teamwork facilities, teamwork was sustained by consistent modelling of positive attitudes and behaviors by supervisors and managers (2).

      Developing teamwork takes work and planning.  A leader should share stories that illustrate the values of the organization.  Create a picture for staff of what the team can achieve.  Set goals collaboratively with the staff, and let them know how the facility is doing in achieving the goal. Include staff in decision making processes and encourage creative solutions to problems.

     Leaders need to reflect on their own style and how it impacts teamwork within the facility.   When supervisors pitch in they teach teamwork, they "walk the talk".  Recently, a newly graduated nurse at my facility told me she was having problems with the cna staff.  She felt that they cnas did not respect her authority as the nurse.  She told me a story of how a resident fell and she was trying to do neurochecks, notify the family, and complete the incident report.  During this time a cna asked her to help turn a resident.  She had told the cna that she could not help, she had her own "nursing duties" to do.
     I shared with her my personal philosophy as a manager.  Every day, I feel pressure to get everything done.  I feel busy all the time.  However, if any team member asks for my help, I will not say no, or that I am too busy.  When you tell someone you are too busy to help with a resident, you are saying that the resident is not the most important thing, and that staff member's needs are not important.  That is the message.  The few minutes it takes to turn the resident will gain you the respect of your co-workers, and make your job easier in the long run.
      I asked her to try a different response next time, and that I would work with her on ways to become a team leader.  This problem was causing her so much stress that she started to cry and she thanked me over and over.  I realized that I need to do a better job supporting our newer nurses in team building skills.
     Supporting and developing your team as a nurse leader is a critical element of achieving positive outcomes and important part of culture change.  Building teamwork should be the first step in any quality improvement plan.

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Scott-Cawiezell, J., Main, D.S., Vojir, C.P., Moore, L., Nutting, P.A., …Pennington, K.   (2005).             Linking nursing home working conditions to organizational performance. Health Care Management Review,30(4), 372-380. 

Tyler, D. & Parker, V. (2011). Nursing home culture, teamwork, and culture change.  Journal of Nursing Research, 16(37), 37-49.