Positive medical professional meeting in hospital
HealthSeptember 14, 2020

Examining a learning intervention to increase nurse team performance

By: Sarah Handzel, BSN, RN
According to the latest statistics from the Centers for Disease Control and Prevention, almost 85% of adults in the United States have at least one healthcare encounter every year1. The vast majority of these encounters involve a collaborative team effort to provide the best healthcare possible.

Teamwork can be defined as how each person in a group works with others in the same group to accomplish certain tasks. And effective teamwork boosts job satisfaction and may help reduce turnover among nursing staff.

However, knowledge, skills, and attitudes among staff members aren’t the only determinants of teamwork. The quality of teamwork is often impacted by several other factors, such as2:

  • External leadership and culture
  • Knowledge about effective teamwork process behaviors, such as rapid learning and adapting
  • Team composition and task interdependence
  • Understanding core competencies necessary for collaborative practice

Many strategies for improving teamwork among nurses have been already been examined. The use of checklists, goal sheets, and case analyses may work to improve communication among staff, thereby fostering teamwork. Leadership can help by creating and sustaining a culture of teamwork within the unit. And education, including teamwork training, may help change behaviors that hinder teamwork among nurses.

How teamwork affects patients and healthcare providers

In many cases, adverse patient outcomes, such as diagnostic errors, patient falls, and hospital-acquired infections result from a lack of teamwork among healthcare providers. Already, a large body of research shows that effective teamwork, especially among nurses, decreases rates of falls and mortality, lowers levels of postoperative pain, and reduces length of stay for many patients2.

But healthcare providers also benefit from improved teamwork. Research shows that effective teams create a more positive, engaging, and resilient workplace2. Healthcare centers with higher levels of teamwork often report lower rates of workplace injury or illness, workplace harassment or violence, and lower levels of staff turnover2.

Education to help nurses form high-performing teams

A recent study featured in Nursing Management examined an educational intervention predicted to improve teamwork among five low-performing nursing units in a university hospital. The intervention was compared to Kalisch’s teamwork model, which consists of five separate elements:

  1. Adaptability
  2. Backup behavior
  3. Collective orientation
  4. Mutual performance monitoring
  5. Team leadership

Three mechanisms, including closed loop communication, mutual trust, and shared mental models, are used to coordinate these five core behaviors. Researchers used the educational component of the teamwork model to inform nurse volunteers over a two-day training session. The goals of the project were to measure whether the sessions improved teamwork among nurses in the five lowest performing units.

The results showed that each one-hour training session didn’t statistically improve overall teamwork scores, which were measured using responses to pre- and post-intervention surveys sent to all participating staff members. However, many nurses did report making changes to their personal practice habits as a result of the educational sessions3:

  • 43% of nurses took steps to increase praise, gratitude, and recognition of teamwork
  • 35% of staff members expanded the use of the buddy system with more proactive back-up behaviors
  • 32% of nurses increased their use of direct, prompt, and respectful communication to help resolve conflicts
  • 30% of nurses intentionally focused on teamwork by incorporating more teamwork terminology into their daily work
  • 27% of participants began huddles by stating team goals
  • 24% of staff members increased the use of team member strengths during surges

While a single learning intervention wasn’t enough to substantially boost teamwork scores, it was sufficient to prompt change among individual nurses. Acknowledging these changes and taking steps to sustain them may be a good strategy for nurse leaders as they explore education and other techniques to improve teamwork on their units.

Sarah Handzel, BSN, RN
Freelance Health and Medical Content Writer, Wolters Kluwer Health
Sarah has over nine years’ experience in various clinical areas, including surgery, endocrinology, family practice, and pharmaceuticals. She began writing professionally in 2016 as a way to use her medical knowledge beyond the bedside to help educate and inform healthcare consumers and providers.


  1. Ambulatory Care Use and Physician Office Visits. Centers for Disease Control and Prevention. https://www.cdc.gov/nchs/fastats/physician-visits.htm
  2. Teamwork in Healthcare: Key Discoveries Enabling Safer, High-Quality Care. American Psychological Association. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6361117/
  3. Becoming a high-performing team. Nursing Management. https://www.nursingcenter.com/journalarticle?Article_ID=5646563&Journal_ID=54013&Issue_ID=5646503
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