Elsevier

Nursing Outlook

Volume 58, Issue 5, September–October 2010, Pages 233-241
Nursing Outlook

Article
Practice
The impact of teamwork on missed nursing care

https://doi.org/10.1016/j.outlook.2010.06.004Get rights and content

Previous studies have shown that missed nursing care is a significant problem in acute care hospitals. Other studies have demonstrated that teamwork is a critical element in assuring patient safety and quality of care. The purpose of this study was to determine if the level of nursing teamwork impacts the extent and nature of missed nursing care. A sample of 2 216 nursing staff members on 50 acute care patient care units in 4 hospitals completed the Nursing Teamwork Survey and the MISSCARE Survey. The response rate was 59.7%. Controlling for occupation of staff members (eg, RN/LPN, NA) and staff characteristics (eg, education, shift worked, experience, etc), teamwork alone accounted for about 11% of missed nursing care. The results of this study show that the level of nursing teamwork impacts the nature and extent of missed nursing care. The study results point to a need to invest in methods of enhancing teamwork in these settings.

Section snippets

Missed Nursing Care

A detailed literature review suggests a lack of clarity regarding the degree to which nursing care is provided or not. Findings from completed studies, largely observational, have revealed aspects of nursing care not completed—namely ambulation, turning, nutrition, medications, patient teaching, hand washing, and intravenous site care.5, 6, 7, 8, 9, 10, 11, 12, 13

Ambulation standards for hospitalized patients indicate that patients should be progressively mobilized 3 times per day.13 However,

Conceptual Framework

The conceptual framework for this study is illustrated in Figure 1. This conceptual framework postulates that organizational and patient unit characteristics, along with the level of nursing teamwork, predict missed nursing care. The individual staff member demographic characteristics (ie, gender, age, education, and experience) along with their occupation or role (ie, RN, licensed practical nurse [LPN], NA), work schedules (full or part-time, shift worked), staffing adequacy, overtime, and

Research Questions

The aim of this study was to examine the effect of nursing teamwork on missed nursing care. The research questions are as follows:

  • How does the level of team work vary by unit type?

  • Does nursing teamwork predict missed nursing care after controlling for occupation of staff members (eg, RN/ LPN, NA), and staff characteristics (education, gender, age, experience, absenteeism, work schedules, and perceptions of staffing adequacy)?

Sample and Setting

The setting for this cross-sectional, descriptive study was 50 medical-surgical, intermediate, intensive care, and rehabilitation units in 4 hospitals located in the Midwest. As seen in Table 1, the sample was made up of 2 216 nursing staff members (1 719 staff nurses (RNs/LPNs) and 491 NAs). Licenses Practical Nurses accounted for only 1.3% (n = 29) of the sample and thus was too small for comparison purposes. Therefore, they were combined into a category for all nurses. Among a total of 2 216

Teamwork by Unit Type

Table 2 shows teamwork overall score was significantly different by type of unit (F = 29.14, P < .01). Post-hoc analysis revealed that intensive care units had a higher teamwork overall score than intermediate, medical-surgical, and rehabilitation units.

Teamwork and Missed Care

Table 3 presents Pearson correlations for all missed care and teamwork variables. The negative relationship between the missed care mean scores and teamwork overall scores (r = -.37, P < . 01) was supported. More missed care was also

Discussion

The results of this study show that the level of nursing teamwork on inpatient acute care hospital patient units impacts the process of nursing care. The process of nursing care in this study was measured by the nursing staff reports of care they did not complete (missed nursing care). When teamwork was stronger, less missed nursing care was reported. This relationship persists after adjustment for individual characteristics of subjects and clustering of data by nursing units and hospitals.

The

Implications

This study provides evidence as to the importance of nursing teamwork in the inpatient setting among staff who work together to provide nursing care to patients. It points to a need to invest in methods of enhancing teamwork in these settings such as teamwork training, staff engagement in dealing with teamwork problems as they emerge, mentoring staff on methods of dealing with teamwork problems, and re-engineering the compensation system to reward team (versus individual) outcomes. There are

Beatrice J. Kalisch, RN, PhD, FAAN, is Titus Distinguished Professor of Nursing and Director, Nursing Business and Health Systems, University of Michigan, School of Nursing, Ann Arbor, MI.

References (36)

  • N.C. Lee et al.

    A survey of patient education postdischarge

    J Nurs Care Qual

    (1998)
  • J.P. McWhirter et al.

    Incidence and recognition of malnutrition in hospital

    BMJ

    (1994)
  • D. Pittet et al.

    Compliance with handwashing in a teaching hospital. Infection Control Program

    Ann Intern Med

    (1999)
  • R.A. Timmerman

    A mobility protocol for critically ill adults

    Dimens Crit Care Nurs

    (2007)
  • B.J. Kalisch

    Missed nursing care: A qualitative study

    J Nurs Care Qual

    (2006)
  • J. Sochalski

    Is More Better?: The relationship between nurse staffing and the quality of nursing care in hospitals

    Med Care

    (2004)
  • M. Schubert et al.

    Rationing of nursing care and its relationship to patient outcomes: The Swiss extension of the International Hospital Outcomes Study

    Int J Qual Health Care

    (2008)
  • S.A. Wheelan et al.

    The link between teamwork and patients' outcomes in intensive care units

    Am J Crit Care

    (2003)
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    Beatrice J. Kalisch, RN, PhD, FAAN, is Titus Distinguished Professor of Nursing and Director, Nursing Business and Health Systems, University of Michigan, School of Nursing, Ann Arbor, MI.

    Kyung Hee Lee, RN, MPH, is a Research Assistant and PhD Candidate at University of Michigan, School of Nursing, Ann Arbor, MI.

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