My first experience as a nurse was as a student, training to be an adult general nurse. In those days about 75% of the training was spent in a variety of clinical placements, spending about 8 weeks with different clinical teams. After qualifying I trained as a mental health nurse, again spending time in an array of mental health settings. I then worked as a staff nurse on a number of wards and as a community psychiatric nurse before moving into nurse education. It is only now when I reflect back on those working experiences, that I realise the importance of the ethos of being part of a team. It was such a natural part of nursing that I don't think I understood how valuable and central it was to the nursing profession. Take a few moments to reflect on your own career in terms of the place that team-working has had on the way that you developed and currently function as a nurse.
Is working in a group the same as working in a team?
There are a number of jobs, occupations and professions that involve a group of people working together. In these groups there is often a named ‘team leader’, but such groups can lack the quality of ‘team spirit’ that is so often found in nursing. What is it about nursing that makes that team-working so important? Now reflect on your own experiences of working in nursing teams and try to identify some of the factors influencing team work.
What factors influence team working in nursing?
There are many factors that affect team working in nursing. These include:
- Nurses predominantly work in a way that covers patients 24 hours a day, 7 days a week, 52 weeks a year: this can only be achieved by an efficient team approach
- Although nurses are accountable for their actions, they are not independent practitioners in the same way that medical doctors, midwives and other allied health care workers are. Nursing care and treatments are usually determined by protocols, group decisions and directions from other independent practitioners
- Nursing teams usually consist of a group of staff with varying degrees of experience and specialist knowledge. Sometimes these will be obvious and definable skills, such administration of IVs, or independent prescribing. It may be that there are members in the team who are more skilled in caring for a confused patient, or who are better at mentoring junior staff or good are planning the ‘off duty’ rota. The skills required in any nursing area are both wide and deep and no single nurse working in isolation will be competent in all of those areas; therefore, a team approach is needed
- Nursing is an emotional experience. Nurses can be caring for patients who are ill, vulnerable, or dying while working 12-hour shifts, juggling night duty, and balancing home care responsibilities of elderly parents or young children. Sometimes nurses are seen as angels and other times they are sworn at or attacked by drunken or confused patients or relatives. To some extent only another nurse can identify with the highs and lows of the job. When a colleague offers care and support, then you know the power of team working.
- Professional development for any nurse can be an ongoing life-long journey. While nurses may arrive at a competent and even excellent stage of practice, they are always dependent on the skills and support of others for both practical and psychological support.
While nursing is not unique as a team profession, these are my thoughts and reflections on why nursing is special. How did your reflections compare with mine? What other factors have you identified that makes team working in nursing so important?
What happens when nursing teams go wrong?
If I again reflect back on the various nursing teams I've worked in over the years, I would estimate that about 60% of them have been very positive experiences, which I have been sad to leave. About 30% of them have been OK, people have worked together well, but there was no positive team spirit. However 10%, and I can remember those two areas vividly, were horrible places to work. Both occurred when I was a junior student and involved a very dominant leader, overt favouritism of certain staff members, belittling of others and a squashing of any questioning. A positive working team environment is not automatic, neither is it the sole responsibility of the person leading the team.
This series will explore various aspects of team-working as they specifically apply to clinical nursing. Each of the subsequent articles will explore a particular aspect of team-working, encouraging you to reflect and analyse what is happening in your own team and also identify and review alternative ways of thinking and working. Nursing is a team profession; most of us will spend the majority of our working lives in various nursing teams, let's make it a positive experience both for ourselves, our colleagues and our patients.