Teamwork Makes Every Nursing Team Better

Teamwork Makes Every Nursing Team Better

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

Dr. Margarita David is the founder and CEO of Dr. Registered Nurse Success Academey, LLC

Dr. Margarita David is the founder and CEO of Dr. Registered Nurse Success Academey, LLC

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.”

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Dr. Shelley Johnson is the dean and professor at Florida Agricultural and Mechanical University’s School of Nursing

According to David, nurses should seek opportunities to intentionally put themselves in positions to grow confident speaking up because thats 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.

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Everett Moss II is a nurse anesthesia DNP candidate at the Nell Hodgson Woodruff School of Nursing at Emory University

Every persons 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.”

The Importance of Soft Skills

The Importance of Soft Skills

The medical field relies upon teams of highly skilled workers. From clinical competency to medical administration, everyone who is a part of a patient’s care has to be well trained and able to carry out their particular role to a high standard. However, nurses in particular also need an array of soft skills to achieve their maximum potential in the medical field.

Soft skills are those skills that don’t necessarily require formal training and can be used in an array of situations. They are “core” skills and act like glue to help everything else work smoothly. In fact, 91% of organizations want more soft skills , cited as one of the four major trends transforming workplaces.

Here’s a quick breakdown of the most important soft skills for nurses.

Empathy

Nurses hear a lot about “empathy” and its importance. Simply put, being empathetic means that you can understand the feelings or emotions of other people and change your behavior to accommodate them. In health care, this ensures that every patient feels valued and heard.

For example, if you work in medical coding and billing, you must have the ability to empathize with the patient to reduce their stress around the financial strain that may be caused by chronic illnesses or expensive fees. You could do this by simply having an understanding conversation with the patient or could even rearrange their fees and payments to match the circumstances of that patient.

Most nurses understand the importance of showing empathy towards patients. However, sometimes we forget to empathize with our peers. This is an issue, as the medical field has faced a burnout problem for several years. While wider change is needed to combat burnout effectively, nurses can ease the burden on one another by actively empathizing with colleagues who are struggling or going through burnout.

Communication

Effective communication is vital in all health care settings — but unfortunately, only 5.9% of organizations communicate their goals on a daily basis. Medical practices are often fast-paced, high-pressure environments that require everyone to be on the same page. However, breakdowns in communication still occur and can have damaging effects on patients, physicians, nurses, and medical practices as a whole.

To overcome these issues, nurses can seek further training and should aim for a professional-but-friendly tone at all times. This shows the folks at your practice that they are valued, while you still ensure that important information is still communicated.

Strong communication skills also help nurses make a positive first impression. This is important, as patients find it difficult to trust medical professionals who they haven’t met before. But, by smiling, actively listening, and paying attention to non-verbal cues, nurses can ensure that they connect with a new patient within a matter of minutes. This will save time, money, and effort in the long run, as patients are far more likely to follow the advice of a medical professional that they trust.

Teamwork

Health care settings are filled with multi-talented professionals from an array of backgrounds and specialties. However, this melting pot of skills, experience, and specialisms can only work cohesively if everyone is invested in teamwork.

However, not everyone is a born “team player.” Left unchecked, this can cause disarray in a patient’s experience and serious friction in the hospital, clinic, or office. To overcome this, management must emphasize the importance of teamwork and can point towards research that shows that teamwork improves the quality of care that patients receive.

While team-building activities sound fun, you may not have the time or resources to engage in traditional bonding exercises like team Q and As or days out. Instead, you can forge strong bonds between your team members by teaching them about the other roles that surround them. This means that folks will understand the skills of those around them better, and will be more likely to work efficiently and in unison.

Time Management

Effective time management is the product of organization, forward-thinking, and clear communication. It’s a tough skill to develop but without it, patients are left waiting, and medical professionals can end up logging hours of avoidable overtime every week.

Developing effective time management requires a holistic approach to your work. You have to assess where you’re losing time and may need to suggest operational changes that are knocking you off course during your day. Alternatively, you might just need to organize your day a little more thoroughly or build in more slack time when possible.

The easiest way to further develop time management skills is to set pen to paper before and after each shift. Before your shift starts, you can plan out your day to see how long you have to complete each task or activity. Then, at the end of the day, return to the plan to see where you lost time or underestimated the difficulty of a task or activity. This will ensure you don’t overcommit your time and gives you a plan to follow throughout the day.

Conclusion

We all have “soft” skills that we picked up from our lives before working in the medical field, but few of us actively develop these skills when we land a job. However, paying attention to soft skills will pay dividends in the long run, as your improved ability to communicate, work with teams, empathize with patients, and manage your time will improve your “hard” skills and allow you to move through your day with greater efficiency.

How Interprofessional Education is Transforming the Nursing Role

How Interprofessional Education is Transforming the Nursing Role

How nurses and other health care disciplines are being educated is starting to have a significant impact on the nursing role. A growing focus on interprofessional education (IPE) is shifting what we know about how the health care team can best work to improve patient lives. It is critical to understand what IPE is, why it is so important, and how nurses must leverage this knowledge to ride the wave that is transforming health care delivery.

What is IPE?

Since the 1970s, there has been growing attention on the quality of health care delivery. One thing has become clear: An increasing number of health care providers are interacting with patients, yet the delivery of this complex care often occurs in silos. One solution that has gained traction is IPE, which is now a requirement in most health care discipline programs. It is defined by the World Health Organization as learning from, about and with two or more disciplines, with a singular focus on the patients’ needs above all else. The idea is that if health care disciplines embrace collaborative learning from the beginning, then they will be prepared for collaborative practice once they graduate.

Why does IPE matter?

If you are reading this and have an RN past your name, you likely are able to think of more than one situation during which you have seen miscommunication and disconnected processes get in the way of patient care. Perhaps you have been at lunch only to learn that the physical therapist has come, ambulated your patient and wrote a report without your input. Or, was there a time when, during a patient admission, you learn they were recently seen by a provider and had tests run, but can’t tell you what the test results were or the name of the medication that was provided? Do you remember a time when a meal tray was delivered to a patient that you knew was having difficulty swallowing or had just started taking insulin? These disconnects are frighteningly common. IPE is one important intervention aimed at closing these gaps. By teaching future health care personnel how to work collaboratively through a team-based approach, we can minimize fragmentation of care delivery and reduce medical errors and adverse outcomes.

Riding the IPE wave

Like other aspects of nursing education, IPE teaches competencies that will lead to proficiency in a clinical skill. The skill, in this case, is working collaboratively to deliver coordinated care with other disciplines. Nurses who haven’t had the benefit of participating in IPE need to understand what these competencies are and how to best support them. This is not only important for the new nurses we will be orienting to the role, but also for those of us who need to embrace this new way of caring for our patients. The following four competencies have become the bedrock of IPE because they form the cornerstones of collaborative practice.

  • Communication: Interprofessional communication should be clear, problem-focused, and avoid discipline-specific terms and abbreviations.
  • Teams and Teamwork: Embracing relationship-building principles to develop effective team dynamics with other disciplines is the key to delivering safe, efficient, and effective patient care.
  • Roles and Responsibilities: As an interprofessional practitioner, you should have an understanding of your own role as well as how the role of other disciplines can help address the complex needs of patients.
  • Values and Ethics: Effective collaboration with other disciplines requires mutual respect and shared values for the skills and knowledge we each bring to the patient care team.

Are you ready to embrace this new way of delivering care? Our newest nurses are and will undoubtedly begin shifting the culture from distinct health care disciplines toward health care teams.

Yes, You Can Have It All

Yes, You Can Have It All

You can have it all. Decrease the stress in your life. Stop to smell the roses. Be in the moment. Great words of advice, but how does that happen? I don’t know about you, but I have found it almost impossible to accomplish! Almost.

I am the manager of a group of neonatal nurse practitioners in a level 3+ NICU of a large, urban Midwestern university hospital that provides care to an underserved population.  Yikes! Talk about stressors.

There are 18 women all ages, experiences, and personalities in our group. The question is: How do you create a cohesive, compassionate, supportive, and clinically excellent group of practitioners? Well, it took years of trial and error, strong faculty support, and the unexpected loss of our previous beloved manager—and then to find our feet again over the next three years. I hate it when people say “it’s a process.” Really? Of course it is, but it’s hard to see it in the beginning. We all want instant gratification, whether it’s from new sources, TV, retail, or work. I want it NOW! Yeah, well, that’s not going to happen.

First, you must have individuals of amazing talent, drive, personality, and intelligence. No short order for anyone. I’m not sure how we achieved this dynamic, but we did. Every person in our group is unique in their interests and skills. We foster and encourage the differences. We celebrate the differences. Thank goodness there are NNPs that are the ultimate in PICC insertion skills—not me! I will do anything for you if you get my line in—I will see all the other babies! (Just a note, my other procedural skills are awesome.) Thank goodness we have some young energetic women that love to go on transport. I am getting too old for climbing in and out of ambulances. [et_bloom_inline optin_id=optin_52]

Second, you must have the unwavering support of the faculty of neonatologists. Without the clear dedication of the physicians it’s like fighting upstream in the spring run off.  I’m not talking about money or time off or even the gift at Christmas. I’m talking about standing for you and beside you to the bureaucracy of administration. We all face shortages of staff, long hours, and extremely difficult patient care situations, but when you know that the medical staff is with you—and you with them—it means everything.

Third, and most important, you need to see the problems that cause discord, anxiety, and anger within the group. In my first ten years here, the NNP group was growing in numbers and responsibilities, especially when we moved into our new, larger NICU. Often when a need arose in the unit the response was ”the practitioners can do it.” Sound familiar? Five years ago we unexpectedly lost our manager. This was a stunning blow to our group and unit. The next two and half years were a struggle as the section and department leadership changed, thus leaving the NNPs in limbo for their own leadership. In many ways the group was rudderless. We had no goal or focus. We reacted to the needs of the unit without any professional growth for any of us.

Last, you must have a manager/leader who believes. Believes in themselves, the members of the group, the faculty, the staff nurses, and staff support members. I know it sounds hokey, but it is absolutely essential. When I became the manager, I held a dinner at my home so we could come together as individuals to talk, laugh, cry, and plan.  I met with every practitioner to discuss their goals, aspirations, and what they wanted from me as the manager. Since we cover the unit 24/7/365, the NNPs are never all together at an event. I insisted that the NNP group have an annual retreat so that we could all be together to continue the discussion for our group. With a facilitator, we identified several issues that had been troubling us for many months. We designed a plan to address these issues. We also affirmed our commitment to each other as colleagues and friends.

We continue the “process” to grow and change. But it is not all the big stuff, the retreats and meetings. It is the seemingly small things, like making our collective office a little more cozy, posting funny and inspiring quotes, putting a seasonal wreath on the office door for all to enjoy, and remembering that this is our job, not our life. We are not always perfect, but we strive to be. You can have it all — just not all the time.

 

 

Communicating with Ease

Communicating with Ease

Communication: We do it hundreds of times per shift, over and over again, both professionally and personally. We do it electronically, over the phone, in person, verbally, and with our body language. And it is absolutely crucial to patient safety. 

At its most basic, communication is simply information passing between two people. But the sharing of information, especially in the medical field, is anything but simple. In fact, communication has often been identified as the most preventable way to avoid medical errors. Communication is absolutely paramount to patient safety, and was identified as one of the Joint Commission’s National Patient Safety Goals for the last several years. Root cause analysis of sentinel events often reveals that communication errors are a source of errors.

You can probably think back to a patient experience in your own practice that was affected by a miscommunication or a breakdown in information sharing. Have you ever had a patient tell you one thing, but tell the physician another story altogether? Have you ever received report on a patient who did not present at all as described by the off-going nurse? Have you ever been involved in a situation that arose because of a breakdown in communication between team members? Patient care teams are increasingly interdisciplinary, and communication is even more important when there are multiple providers caring for a patient. Complex relationships and dynamic care teams can present a challenge to even the best of communicators. [et_bloom_inline optin_id=optin_20]

Communication and information sharing is vital to safe patient care. What can you do as a nurse to improve your own communication skills? Below are some tips for avoiding errors and miscommunication in your practice.

1. Build relationships for effective teamwork.

Try to be an active team player on your unit and foster relationships between your colleagues, your management, and your physicians. Friendly encounters help foster mutual respect, which can help when two people communicate together.

2. Think of communication as a clinical skill.

It may seem that communication is a social skill, but if you look at it as a clinical skill, you may be able to step outside the dynamics of interpersonal relationships to effectively communicate.   

3. Use a systematic approach, such as SBAR.

SBAR, or Situation, Background, Assessment, and Recommendation, is a standardized communication tool that aims to present information in a logical, concise way for providers. It is a way of organizing information when providing handoff to another provider or calling a physician about a mutual patient. The use of SBAR can decrease miscommunication and errors, leading to safer patient care. You can read more about using SBAR at the Institute for Healthcare Improvement’s website

4. Close the loop.

Closed-loop communication, or “check back communication,” is when someone says something out loud, the responder repeats what they heard, and the original speaker confirms the understanding with a “yes.” This type of communication is specifically designed to reduce miscommunications. In patient codes or critical care, closing the communication loop can increase patient safety and leads to positive patient outcomes.

5. Clarify.

Trust your gut. If for any reason an order or directive seems strange for a patient, ask for clarification.

6. Report intimidating, rude, or unacceptable behaviors to supervisors.

If a member of your care team is rude to you, report this behavior to management. All care team members should be treated with respect. Mutual respect helps foster effective care relationships, and other behaviors can adversely affect patient care.

6. Be a good listener.

So much of good communication is not what you’re saying, but what you’re hearing. Remember that being a good communicator means that you are an excellent listener, both to what is being said but also to what is not said.  

7. Provide a strong hand-off report.

At change of shift, you are the expert on a particular patient’s plan of care, and you are handing over the patient to someone who has (usually) never seen the person before. Everything you say is important. Do your absolute best to give an organized, thorough report.