In today’s health care market, the practice of teamwork has gained in popularity. This is especially true for professional nurses. When nurses function as part of a unit, and when they act as part of a team, the job itself is easier and more efficient. Moreover, overall patient care is enhanced.
In nursing, when teamwork is emphasized and valued, every member works together to meet their patients’ needs; improved patient outcomes is their common goal. There are many relevant clinical examples of how teamwork improves patient care.
Every discipline is integral
First, consider teamwork in the case of hospitalized patients. The relationship between the nurse and the physician is paramount. The physician orders necessary intervention, and the nurse or therapist is responsible for carrying it out. Physical therapists, speech therapists and respiratory therapists all perform patient care. And, it is crucial that all team members work together and communicate effectively. Any changes in the patients’ status, whether deterioration or improvement, should be shared between team members. In some of these acute events, attention from a practitioner is warranted. In many instances, however, the attending physician might be at an off-site practice. Therefore, many acute care settings have implemented hospitalists into practice.
Hospitalists are on site at the hospital at all times, they are competent in their practice, and they can be the direct liaison between the nurse and the attending physician. When attending physicians, hospitalists, and nurses work with effective communication, teamwork is epitomized. One specific incidence in which hospitalists have proved to be beneficial in the treatment plan is the use of the Hospitalist/Orthopedics team at the Mayo Clinic. This team involves communication between hospitalists and orthopedic surgeons, and it has demonstrated improved efficiency and quality of care for those patients undergoing total joint replacements (J. Huddleston, unpublished data, 2003). In this scenario, hospitalists are readily accessible for the patient, and they are the direct line of communication to the attending physician.
Another example of the benefits of teamwork in patient care occurs when the respiratory therapist effectively works with the attending physician, and when she communicates with the patients’ assigned nurse. The respiratory therapist can make the appropriate recommendations for the ventilation settings and for weaning. Quantitative studies suggest that in the critical care setting, when these patients are managed by a multidisciplinary team that proactively oversees the weaning process using standardized protocols, they are consistently extubated in nearly two days less time as compared to the traditional process (Jeffrey R. Dichter, 2003). The decision to wean depends on effective communication between team members.
In health care, every care discipline is integral in patient care. If the patient needs respiratory care, the respiratory therapist implements an ordered treatment. The speech therapist carries out an ordered study; the physical therapist fulfills her duty. Each discipline plays a part; each care provider is part of a team. Achieving the desired patient outcome rests on teamwork and effective communication. In the contemporary acute care setting, many patients are over the age of sixty-five. For these patients, care has been markedly improved through the implementation of teams of professionals focused on their acute care needs. The patient might rely on the unlicensed staff to assist in turning, she might rely on the nutritionist for appropriate dietary recommendations, and she might rely on physical therapy for mobility. Each team member plays an important role, and overall care management rests on the communication between members. There are many other examples of the value of teamwork, but the underlying theme is that teamwork clearly strengthens the ability of nurses and other health care providers to provide higher quality, more efficient care.
For nurses and other care providers, it is crucial to note the value that the Joint Commission on the Accreditation of Healthcare Organizations places on teamwork. They are strong proponents of teamwork. Their focus is on coordination of care and the support of health care professionals for each other: "Teams whose members have experience working together know each other’s strengths and weaknesses, and can better support each other and compensate for each other—even under extreme stress and fatigue conditions." Furthermore, the Joint Commission on the Accreditation of Health care Organizations, suggests that, “… teamwork is essential for optimizing quality and safety in the care of hospitalized patients.”
A collaborative environment
The Institute for Health care Improvement also recognizes the importance of teamwork. In their book, "Crossing the Quality Chasm: A New Health System for the 21st Century," teamwork is cited as essential in caring for patients with complex problems. They strongly conclude that "effective working teams must be created and maintained." Based on these stakeholder recommendations, the hospital of the future will be more dependent than ever upon effective and efficient teamwork to coordinate care. In order for hospitals and primary care practices to survive, the culture of teamwork must be supported. The essence of this teamwork will be a collaborative environment in which advanced care practitioners, bedside nurses, and others work and share in the process and systems of care. There are numerous ways to support this concept; one such way has been the incorporation of the hospitalist into patient care.
First, consider the use of the hospitalist in the acute care setting. The hospitalist works on site and is involved in the day-to-day activities. Therefore, he or she gets to know the staff and can develop the kind of collegial relationships that lead to trust and respect for each and every member of the coordinating team of professionals.
Second, because the hospitalist spends so much time in the hospital, he or she understands the systems and protocols that support patient care activities within the hospital. Hospitalists also take a leadership role in the development of new and improved systems of patient care.
Finally, because hospitalists are constantly on site, they improve the team’s ability to respond rapidly to patient crises, thereby improving continuity of care and clinical outcomes. By being on site, by being an integral part of the hospital team, and by knowing and helping to improve the system, hospitalists are reviving the "collaborative" model of patient care. Although the concept of hospitalists may still be relatively new in some parts of the country, many of the nation’s leading academic and regional hospitals have embraced hospital medicine. (Jeffrey R. Dichter, 2003)
Among direct care staff, teamwork and communication are equally important. When changing shift, for instance, it is imperative that all relevant patient care information be shared with the oncoming nurse. Similarly, it is important for the licensed nurse and the unlicensed care staff to have an open line of communication. The nurse should be aware of what duties can be delegated; she should have an understanding of what falls under the scope of her nursing practice. She should communicate her needs with her co-assigned aid, and it is imperative that the two have a strong working relationship, whereby trust, appreciation, and teamwork are the underlying principles.
Teamwork is also emphasized in the concept of shared governance. Nursing is a profession that is recognized by a society as having a specialized body of knowledge and a commitment to a service ideal, as well as professional autonomy and accountability for their specialized practice. Nurses are in many aspects given the privilege of self-regulating or governing their profession. The concept of shared governance in nursing has been used over the past 20 years as a mechanism for health care organizations to empower nurses to participate in decision-making within an organization, particularly in regards to making decisions that affect nursing practice (Kalisch, 2005).
Nursing leadership rests on the premise of the shared governance model. This model incorporates a variety of hospital-wide and unit-based committees, whereby nurses have the authority to participate in decision-making affecting their practice (Kalisch, 2005). Within this shared governance structure, a variety of councils are employed. Examples of shared governance committees include, the “Falls Committee,” the “Patient Satisfaction Committee,” and the “Wound Care Committee". These councils are decision-making bodies in which nurses (and for some Councils, other professional disciplines), participate in determining goals and priorities. In some cases, members of these committees collectively make decisions affecting nursing practice and patient care or other aspects of professional practice. Members who get involved with shared governance initiatives report a sense of ownership over their practice. Similarly, individual patient care units also have the authority to establish unit-based councils that provide nurses with a decision-making mechanism. Unit Lead Teams are also used as a mechanism for decentralized decision-making; these teams empower nurses, and they extinguish some of the managers’ work load.
Teamwork is a key component of many professions; when employees feel as if they are part of a unit, relevant outcomes are improved. Nurses report enhanced job satisfaction and patient care outcomes are met. No longer can nurses function in isolation. Their profession mandates teamwork and effective communication.
About the author: Jennifer Ward, BSN, RN is a medical- surgical nurse also trained in Oncology and Long-Term Care. Jennifer is dedicated to evidence-based practice and shared governance. She especially enjoys wound care, falls prevention, patient satisfaction, and documentation initiatives.