1 Katarina Husarek*
1 Valentino Loborec*
1 Matija Čunović*
1 Petra Ilić*
1 Jana Krajačić*
1 Martina Smrekar
* Student at the University of Applied Health Sciences, Mlinarska 38, 10 000 Zagreb, Croatia
1 University of Applied Health Sciences, Mlinarska 38, 10 000 Zagreb, Croatia
Author for correspondence:
Martina Smrekar
University of Applied Health Sciences, Mlinarska 38, 10 000 Zagreb, Croatia
E-mail: martina.smrekar@zvu.hr
https://doi.org/10.24141/2/8/1/6
Keywords: teamwork, effective teamwork, nursing, factors
Methods. A narrative review of articles regarding the factors which influence effective teamwork in nursing was carried out between December 2023 and January 2024. An electronic search of the Pub- Med database was applied to select relevant articles using the keywords teamwork among nurses, effec- tive teamwork, and nursing.
The nursing workforce is the largest group of profes- sionals in healthcare worldwide (1). According to the International Council of Nurses, “Nursing encompass- es autonomous and collaborative care of individuals of all ages, families, groups and communities, sick or well and in all settings” (2). Today, modern healthcare is complex and rapidly changing and it is therefore im- portant for nursing staff to work together as a team to secure quality of care (3). A nursing team is defined by authors Kalisch, Weaver, and Salas (2009) as “two or more members of nursing staff who work together to provide care and administrative tasks for a group of patients” (4). The importance of nurses’ teamwork in healthcare has gained increased attention in re- cent years due to the complexity of the healthcare delivery system, and a shortage of nurses, which has increased workloads which may result in work errors, thus impacting patient, nurse, and organiza- tional outcomes (5). The literature states that team- work plays a crucial role in addressing the shortage of nurses (3). Organizations such as the World Health Organization and the Institute of Medicine have identified teamwork and team-based care as the key contributors to patient safety (3). Recent evidence from the literature stated that the nursing care team plays a pivotal role in patient and staff outcomes and proficient teamwork is identified as one of the premises of a healthy work environment in nursing
(3). Effective teams are those in which both lead-
ers and members make a conscious effort to unify a group of people into a well-functioning work unit (6). Thus, effective teamwork has a positive effect on job satisfaction, staffing efficiencies, retention, and care
delivery (7). It supports the optimal use of the knowl- edge and skills of nurses and their co-workers and reflects an individual’s sense of belonging to a team and their willingness to work in a team (8). It has been identified as one of the cornerstones of nursing education. Evidence from the literature stated that having a supportive and trustworthy nursing team is a key factor in fostering effective teamwork and that healthcare organizations should recognize the value of teamwork and emphasize approaches which maintain and improve teamwork for the benefit of their patients (8,9). Therefore, understanding which factors foster effective teamwork ensures teamwork qualities (10,11).
This review examines current research on teamwork in nursing with a focus on factors related to effective teamwork performance.
A narrative review of articles regarding the factors influencing effective teamwork in nursing was car- ried out.
We included full-text articles which focused on fac- tors contributing to effective teamwork performance in nursing. Studies conducted only among nurses were included. The inclusion criteria were also the articles written in the English language. There were no restrictions regarding the publication date.
Exclusion criteria were studies without analysis of teamwork-related factors or studies not written in English. Studies conducted among other healthcare professionals were excluded. Articles not available in full-text (i.e. title or abstracts only) were excluded.
A literature search was carried out between Decem- ber 2023 and January 2024. An electronic search of the PubMed database was applied to select relevant articles using the keywords teamwork among nurses, effective teamwork, and nursing. Two reviewers in- dependently screened titles and abstracts from arti- cles yielded in the search. Afterward, full texts of all relevant articles were obtained and screened by the same two reviewers. Full-text articles were retrieved when both reviewers agreed that inclusion criteria were met.
The online search resulted in 854 articles. Twenty- one articles were then selected for a full-text review. Five articles met the inclusion criteria. Table 1 de- scribes the selected articles.
Factors related to effective teamwork performance in different domains have been identified and de- scribed in the present research. Those factors are: trust among team members, team motivation, effec- tive working environment, effective communication, effective team management, education about team- work, measurement of teamwork, knowledge sharing among team members, and interventions for enhanc- ing nurses’ teamwork (Table 1).
Effective nursing teamwork is vital for the provision of high-quality healthcare (16). The current study’s findings suggest the following factors which are related to effective teamwork performance: trust among team members, team motivation, effective working environment, effective communication, ef- fective team management, education about team- work, measurement of teamwork, knowledge sharing
among team members, and interventions for enhanc- ing nurses’ teamwork.
A trusting atmosphere in nursing teamwork can en- hance job satisfaction, productivity of the employees, organizational commitment, cooperation, and effec- tive communication. Trust is a positive expectation resulting from roles, relationships, experiences, and interdependence with others (13). A study which in- vestigated the impact of organizational justice, trust, and identification and their impact on nurses gave us positive examples from practice. The results of the study showed that the maximization of organization- al justice, trust, and identification by hospital manag- ers positively changes the attitude of nurses toward work, but also improves the quality of work. Nurses were motivated to provide feedback to the attention and care provided by the hospital management, fa- cilitating teamwork among colleagues, boosting the morale of the nursing faculty, and reducing resigna- tions and career changes. Trust in the team also af- fects the members’ satisfaction with the team (17). Evidence from the literature stated that when team members feel valued, it will help them overcome their fear associated with taking interpersonal risks, making them feel safe to speak openly and overall to engage in their work. Feeling trusted by the team leader facilitates a sense of psychological safety, but their absence can cause team members to relapse to natural behavior patterns (18).
Motivation is an extremely relevant factor which af- fects the quality and content of work outcomes in healthcare (19). In general, motivation can be extrin- sic or intrinsic. The quality and quantity of work is better when employees are highly motivated. The ability to motivate employees to not only meet their individual goals, but also achieve organizational goals is an important leadership skill. Team mem- bers do not have to be motivated only by money and rewards, but it would be good if they are highly in- trinsically motivated and if their motives are in line with the motives of the organization (20). These in- dividuals tend to perform well without the need for constant supervision and can even motivate other employees to work harder.
Table 1. Overview of the studies finally included | ||
Authors/year of publication | Findings about factors influencing effective teamwork in nursing | Recommendations |
Baek H, Han K, Cho H, Ju J. (2023) (12) |
| Enhancing nurses’ teamwork can serve as an effective strategy for promoting patient- centered care. Education through awareness and knowledge starting from the undergraduate level (e.g., TeamSTEPPS) will provide basic skills for better teamwork, as well as organizational training such as virtual simulation and train- the-trainer interventions aimed at improving teamwork skills (12). |
Chen SY, Wu WC, Chang CS, Lin CT, Kung JY, Weng HC, Lin YT, Lee SI. (2015) (13) |
| Organizations must actively seek an improved understanding of trust and must implement measures to increase the trust of their employees (13). |
Farley, MJ (1991) (14) |
| Development of a team does not take place automatically and inevitably. It is a result of the efforts of the team leader and the team members (14). |
Anselmann V, Brouwer J, Mulder RH. (2023) (8) |
| In order to improve team performance, team leaders and managers in nursing need to foster the engagement of both individual and team learning activities by providing opportunities for these activities. Team leaders should pay attention to team members’ work preferences, psychological empowerment, and the team’s overall boundedness (8). |
Mabona JF, van Rooyen D, Ten Ham- Baloyi W. (2022) (15) |
| Nurse leaders play a significant role in facilitating effective or authentic leadership through effective communication, Also, nurse leaders play a significant role in enhancing teamwork by staying in tune with the needs of the team, as well as promoting autonomy of nurses in their team, establishing trust between team members (15). |
A healthy nurse work environment is a workplace which is satisfying, safe, and empowering (21). The results of previous studies demonstrated that a sup- portive environment for the nurses, motivation from the management, opportunities for professional de-
velopment, education about communication skills and ways of improving professional relationships and resolving conflict, as well as smaller unit sizes, are all ways to improve nurses’ working environment (22, 23). Likewise, a good organization of the work en- vironment contributes to job satisfaction and better patient care (23).
Successful teamwork is essential in high-risk environ- ments such as hospitals. Communication, along with effective teamwork, is necessary to achieve patient safety (14). Patient care is entrusted to different professions, so communication failures are almost inevitable. There are different communication styles used by different members of the team, which can occasionally lead to communication failures. In order to improve collaboration in a team, it is necessary to improve communication. Evidence from the literature states that in order to achieve effective teamwork, communication among team members must be open and honest (14). The findings from previous studies have shown that education is the key to improving team communication (24).
The ability of team leaders to develop others’ trust in them is critical to leadership effectiveness. An expe- rienced leader has to know the qualities and perfor- mances of their team members to encourage certain team members to achieve the best work outcome and, ultimately, better outcomes for the patient. The leader contributes to trust and security among team members by good examples of managing crises which is necessary for a sense of community. The findings from the previous studies have shown that emotional intelligence has made a significant contribution to ef- fective leadership, becoming one of the key character- istics of leaders. It is important for achieving effective leadership in healthcare organizations and it contrib- utes decisively to their good functioning and success- ful operation (15). As regards nurses, at every level, the above need is considered imperative because of the particular nature of the nursing profession, which places the healthy or weak person at its center. By implementing social and emotional learning programs, nurses can acquire knowledge, attitudes, and skills which are necessary for understanding and managing emotions, achieving positive goals, and maintaining positive relations and accountable decisions (25).
The findings from the previous studies have shown that education changes the culture, improves com- munication, increases professional understanding, and emphasizes the need to use effective communi- cation strategies and team-building techniques dur-
ing the formative period of professional learning (12, 14). Education through Team Strategies and Tools to Enhance Performance and Patient Safety program (TeamSTEPPS program), which is an evidenced-based communication-training toolkit created with the pur- pose of improving teamwork and communication, as well as various organizational trainings such as vir- tual simulation and train-the-trainer interventions aimed at improving teamwork skills are important for the acquisition of knowledge and skills for effective teamwork (12). Gillespie et al. (2010) suggested that education about teamwork should be included in the curriculum of undergraduate studies in medicine and nursing (26). van Diggele et al. (2020) suggested that effective team management is a complex and highly valued component of health education, increasingly recognized as essential to the delivery of high stand- ards of education, research, and clinical practice. In order to meet the healthcare needs of the twenty- first century, competent leaders will be increasingly important in all healthcare professions. Consequent- ly, the inclusion of leadership training and develop- ment should be part of all healthcare professionals’ curricula (27). Thus, it is critical to recognize that nurse leaders not only have the role and responsi- bility of leading teams, but they also must see to it that nursing staff receive the education and training needed for practicing effective teamwork (3).
The importance of teamwork measurement has grown significantly over the last few years. When research- ing the tools used to measure teamwork in nursing, we found Hackman’s model of team effectiveness, Sa- las’s “Big Five”, Nursing teamwork survey (NTS). The Nursing Teamwork Survey measures overall teamwork and five factors of teamwork: trust, team orientation, backup, shared mental models, and team leadership
(28). Different authors used the NTS survey where they showed that effective teamwork does not only improve efficiency but tends to lead to a healthier and happier workplace (29). Also, a higher level of team- work and adequate staffing tends to lead to greater job satisfaction with current position and occupation, resulting in better patient care (30). According to Cos- tello et al. (2021), introducing team-building strat- egies and acting on the results of NTS may provide effective support to help improve communication and teamwork which will ultimately improve the quality of nursing care and patient outcomes (29).
When it comes to nursing, learning, and knowledge are some of the most important aspects of good teamwork criteria. According to Anselmann et al. (2023), team learning activities, such as reflection and knowledge sharing, are cognitive intergroup processes which influence cognitive structures and thought patterns, affecting behavior (8). Also, knowl- edge sharing results in team members’ creativity
(31). Evidence from the literature on the importance of knowledge sharing shows that informal learning and individual learning activities do not show equally good results as knowledge sharing between team members. Having that in mind, one can’t go without the other, therefore individual, informal, and team learning contribute to the aspects of knowledge sharing, hence, to team effectiveness (8).
Evidence from the literature stated that in health- care settings, teams have become necessary to en- sure effective functioning within organizations (32) and interventions which improve teamwork improve clinical outcomes (33). The results of previous stud- ies emphasize several types of interventions such as individual-focused, structural or organizational, and combined interventions. Interventions focused on individuals encompass self-care workshops, stress management skill development, and com- munication skills training. Additional practices like yoga, massage, mindfulness, and meditation may be incorporated. Structural or organizational interven- tions involve workload or schedule rotation, stress management training programs delivered in group face-to-face sessions, teamwork/transitions, and the implementation of focus groups. Combined indi- vidual-focused and structural interventions include stress management and resilience training, stress management workshops, and improving interaction with colleagues through personal training. Training and follow-up are carried out face-to-face, by phone, e-mail, video, or online (34). Hughes et al. (2016) indicated that healthcare team training is effective because it surpasses employees’ pretraining utility, induces learning, transfers learned material to the job, and leads to improved organizational and patient results (32). According to Buljac-Samardzic (2020), key interventions for team improvement are train-
ing (principle-based, method-based, and general), tools (such as SBAR and (de)briefing checklists), or- ganizational (re)design, and programs. Crew resource management (CRM) training incorporates informa- tion, demonstration, and practice-based methods. Also, TeamSTEPPS emphasizes competencies and standardized tools across teamwork domains. Sim- ulation-based training enhances real patient experi- ences. Briefings and debriefings enable systematic communication, while organizational (re)design tar- gets structural enhancements. Programs are organ- ized in a manner which integrates learning sessions, simulation training, and structural interventions (35). According to Weaver et al. (2010), simulation and classroom-based team-training interventions can im- prove teamwork processes (e.g., communication, co- ordination, and cooperation), and implementation has been associated with improvements in patient safety outcomes (36).
Teamwork has always been important in nursing. It has been proven that effective teamwork is key to ensuring quality of care, better healthcare outcomes, and patient and health care worker safety. There- fore, facilitating and supporting effective teamwork should be one of the priorities of healthcare organi- zations. In order to achieve that, it is necessary to take into account the factors related to effective teamwork performance. The emphasis should be on strengthening the effective teamwork of nurses for the benefit of quality patient care and the creation of a healthy working environment, and therefore greater teamwork cohesion. The present research is intended for all nurses, at all levels of health care, to apply the mentioned factors in their daily work envi- ronment and thereby increase the functionality and management of the team.
World Health Organization. State of the World’s nur- sing 2020: investing in education, jobs and leadership. Geneva: World Health Organization; 2020. Available from: 9789240003279-eng.pdf (who.int) Accessed: 15.12.2023.
International Council of Nurses. Nursing definiti- ons. Available from: https://www.icn.ch/ Accessed: 12.01.2024.
Bragadóttir H, Kalisch BJ, Flygenring BG, Tryggvadóttir GB. The relationship of nursing teamwork and job satisfaction in hospitals. SAGE Open Nurs. 2023;9:23779608231175027. doi: 10.1177/23779608231175027.
Kalisch BJ, Weaver SJ, Salas E. What does nursing teamwork look like? A qualitative study. J Nu- rs Care Qual. 2009;24(4):298-307. doi: 10.1097/ NCQ.0b013e3181a001c0.
Kunaviktikul W, Wichaikhum O, Nantsupawat A, Nantsupawat R, Chontawan R, Klunklin A, et al. Nur- ses’ extended work hours: patient, nurse and organi- zational outcomes. Int Nurs Rev. 2015;62(3):386-93. doi: 10.1111/inr.12195.
Mazzetti G, Schaufeli WB. The impact of engaging le- adership on employee engagement and team effec- tiveness: A longitudinal, multi-level study on the mediating role of personal- and team resources. PLoS One. 2022;17(6):e0269433. doi: 10.1371/journal.po- ne.0269433.
Kaiser JA, Westers JB. Nursing teamwork in a he- alth system: a multisite study. J Nurs Manag. 2018;26(5):555-562. doi: 10.1111/jonm.12582. Epub
2018 Jan 16. PMID: 29336502.
Anselmann V, Brouwer J, Mulder RH. The relationships between perceived individual and team characteristics, individual and team learning activities with effectivene- ss in nursing teams. Front Psychol. 2023;14:1163494. doi: 10.3389/fpsyg.2023.1163494.
Schmutz JB, Meier LL, Manser T. How effective is teamwork really? The relationship between teamwork and performance in healthcare teams: a systematic re- view and meta-analysis. BMJ Open. 2019;9(9):e028280. doi: 10.1136/bmjopen-2018-028280.
Polis S, Higgs M, Manning V, Netto G, Fernandez R. Factors contributing to nursing team work in an acute care tertiary hospital. Collegian. 2017;24(1):19-25. doi: 10.1016/j.colegn.2015.09.002.
Salcinovic B, Drew M, Dijkstra P, Waddington G, Ser- pell BG. Factors influencing team performance: what can support teams in high-performance sport learn from other industries? A Systematic Scoping Re- view. Sports Med Open. 2022;8(1):25. doi: 10.1186/ s40798-021-00406-7.
Baek J, Cho H, Han K, Lee H. Association between nu- rsing work environment and compassion satisfaction among clinical nurses. J Nurs Manag. 2020;28(2):368-
376. doi: 10.1111/jonm.12937.
Chen SY, Wu WC, Chang CS, Lin CT, Kung JY, Weng HC, Lin YT, Lee SI. Organizational justice, trust, and iden- tification and their effects on organizational commi- tment in hospital nursing staff. BMC Health Serv Res. 2015;15:363. doi: 10.1186/s12913-015-1016-8.
Farley MJ. Teamwork in perioperative nursing. Under- standing team development, effectiveness, evaluati- on. AORN J. 1991;53(3):730-8. doi: 10.1016/s0001- 2092(07)68947-9.
Mabona JF, van Rooyen D, Ten Ham-Baloyi W. Best practice recommendations for healthy work envi- ronments for nurses: An integrative literature re- view. Health SA. 2022;27:1788. doi: 10.4102/hsag. v27i0.1788.
Baek H, Han K, Cho H, Ju J. Nursing teamwork is essen- tial in promoting patient-centered care: a cross-secti- onal study. BMC Nurs. 2023;22(1):433. doi: 10.1186/ s12912-023-01592-3.
Liu HY. Inter-professional nursing education and the roles of swift trust, interaction behaviors, and crea- tivity: A cross-sectional questionnaire survey. Nu- rse Educ Today. 2020;95:104598. doi: 10.1016/j. nedt.2020.104598.
O’Donovan R, De Brún A, McAuliffe E. Healthcare pro- fessionals experience of psychological safety, voice, and silence. Front Psychol. 2021;12:626689. doi: 10.3389/fpsyg.2021.626689.
Toode K, Routasalo P, Suominen T. Work motivation of nu- rses: a literature review. Int J Nurs Stud. 2011;48(2):246-
57. doi: 10.1016/j.ijnurstu.2010.09.013.
Rajiah P, Bhargava P. Motivational leadership: tips from the business world. J Am Coll Radiol. 2016;13(5):585-
9. doi: 10.1016/j.jacr.2016.01.005.
Wei H, Sewell KA, Woody G, Rose MA. The state of the science of nurse work environments in the United Sta- tes: A systematic review. Int J Nurs Sci. 2018;5(3):287-
300. doi: 10.1016/j.ijnss.2018.04.010.
Copanitsanou P, Fotos N, Brokalaki H. Effects of work environment on patient and nurse outco- mes. Br J Nurs. 2017;26(3):172-6. doi: 10.12968/ bjon.2017.26.3.172.
Bradley DK, Griffin M. The Well Organised Working Environment: A mixed methods study. Int J Nurs Stud. 2016;55:26-38. doi: 10.1016/j.ijnurstu.2015.11.002.
Ghahramanian A, Rezaei T, Abdullahzadeh F, She- ikhalipour Z, Dianat I. Quality of healthcare services and its relationship with patient safety culture and nurse-physician professional communication. Health Promot Perspect. 2017;7(3):168-74. doi: 10.15171/ hpp.2017.30.
Prezerakos PE. Nurse Managers’ Emotional Intelli- gence and Effective Leadership: A Review of the
Current Evidence. Open Nurs J. 2018;12:86-92. doi: 10.2174/1874434601812010086.
Gillespie BM, Chaboyer W, Longbottom P, Wallis M. The impact of organisational and individual factors on team communication in surgery: a qualitative study. Int J Nurs Stud. 2010;47(6):732-41. doi: 10.1016/j.
ijnurstu.2009.11.001.
van Diggele C, Burgess A, Roberts C, Mellis C. Le- adership in healthcare education. BMC Med Educ. 2020;20(Suppl 2):456. doi: 10.1186/s12909-020-
02288-x.
Valentine MA, Nembhard IM, Edmondson AC. Measu- ring teamwork in health care settings: a review of sur- vey instruments. Med Care. 2015;53(4):e16-30. doi: 10.1097/MLR.0b013e31827feef6.
Costello M, Rusell K, Coventry T. Examining the avera- ge scores of nursing teamwork subscales in an acute private medical ward. BMC Nurs. 2021;20(1):84. doi: 10.1186/s12912-021-00609-z.
Kalisch BJ, Lee H, Rochman M. Nursing staff teamwork and job satisfaction. J Nurs Manag. 2010;18(8):938-
47. doi: 10.1111/j.1365-2834.2010.01153.x.
Mrayyan MT, Al-Shaikh Ali MH, Mrayan M. The percei- ved leaders’ authentic leadership, knowledge sharing within the team, and faculty members’ creativity: a cross-sectional online survey in nursing academia. J Prof Nurs. 2023;48:163-72. doi: 10.1016/j.profnu- rs.2023.07.008.
Hughes AM, Gregory ME, Joseph DL, Sonesh SC, Mar- low SL, Lacerenza CN, et al. Saving lives: A meta- analysis of team training in healthcare. J Appl Psychol. 2016;101(9):1266-304. doi: 10.1037/apl0000120.
McGuier EA, Kolko DJ, Stadnick NA, Brookman-Frazee L, Wolk CB, Yuan CT, et, al. Advancing research on teams and team effectiveness in implementation sci- ence: An application of the Exploration, Preparation, Implementation, Sustainment (EPIS) framework. Im- plement Res Pract. 2023;4:26334895231190855. doi: 10.1177/26334895231190855.
Zhang XJ, Song Y, Jiang T, Ding N, Shi TY. Interventions to reduce burnout of physicians and nurses: An over- view of systematic reviews and meta-analyses. Medi- cine (Baltimore). 2020;99(26):e20992. doi: 10.1097/ MD.0000000000020992.
Buljac-Samardzic M, Doekhie KD, van Wijngaarden JDH. Interventions to improve team effectiveness wit- hin health care: a systematic review of the past deca- de. Hum Resour Health. 2020;18(1):2. doi: 10.1186/ s12960-019-0411-3.
Weaver SJ, Dy SM, Rosen MA. Team-training in he- althcare: a narrative synthesis of the literature. BMJ Quality & Safety. 2014;23:359-72.
ljanje timom, edukacija o timskom radu, mjerenje tim-
skog rada, dijeljenje znanja među članovima tima i intervencije za poboljšanje timskog rada medicinskih
Ključne riječi: timski rad, učinkovit timski rad, sestrinstvo, faktori
sestara/tehničara.