ArticlePracticeThe impact of teamwork on missed nursing care
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:
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How does the level of team work vary by unit type?
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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.
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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.