Close Server: KOPWWW05 | Not logged in

Team Building Essentials

Learn how to build an effective clinical team.

To view the Course Outline and take the test online, click here.

For a printer-friendly version of the exam you can print out, complete and mail in to ADVANCE click here.
This continuing education offering is sponsored by an educational grant from MJHS.

Learning Scope #358
1 contact hour
Expires May 2, 2013

The goal of this CE offering is to review the essentials of team building. After reading this article, you will be able to:
1. Explain why team building is important in nursing, and how the organizational culture and a shared frame of reference support team development.
2. Describe the stages of team development and the transitions between stages that must be accomplished to prepare the team to engage in the task at hand.
3. Identify three characteristics of team leaders who build teams that work together effectively.

It is 7 a.m. and dayshift staff members are gathering to listen to report. As you expected, the regular charge nurse is away and you will be in charge today.

You take a look at the staffing sheet. You recognize most of the names and are relieved to see a few of your strongest nurses and nursing assistants - people on whom you can always rely - will be working with you today. There also are two people you know well, but are not looking forward to working with. One is a nurse who frequently complains when other people and other departments do not do what is expected of them; the other is a nursing assistant who lacks initiative and often has to be told what to do.

You see two people you do not know are assigned to your unit. One is a nurse from a staffing agency; the other is a per diem nurse who usually works on another unit. As you think about what your unit will need to accomplish today, you are conscious that your first task is to organize your team.

Nurses Work in Teams

Whether the work setting is an inpatient unit or an outpatient clinic, nurses generally work as members of multidisciplinary teams. This is true whether the unit uses a team nursing or primary nursing practice model. These teams often include both licensed and unlicensed clinical staff, as well as non-clinical staff, such as unit secretaries and housekeepers. Some staff, such as discharge planners, respiratory therapists, physical therapists and others, may spend part of their day working alongside staff members who are assigned to the patient care unit.

Team building is a daily activity in nursing. On any given day, the patient care team may include per diem staff, staff who float from other units or other shifts, and staff from outside agencies. These individuals may or may not be familiar with the work setting, and they may or may not be known to other members of the team. In practice, it is frequently necessary to form a new team at the start of each shift.

Because clinical teams work within a larger organizational context, much of the work of team building has been done before the team members even assemble. Healthcare organizations have regulations, policies and procedures that explicitly define formal aspects of organizational culture, including the roles and functions of specific types of teams, and the roles, qualifications and competencies of team members. For example, the number and responsibilities of nurses, nursing assistants and housekeepers are defined before any individuals are assigned to fill those roles. Team members may be new to this shift or this unit, but most of them will have worked many times on other shifts or other units. Because the team is embedded in the organizational culture, teams know they can rely on the organization's logistical and moral support.

Equally important, the organizational culture provides a shared frame of reference that enables everyone to understand the purpose of the team and the roles of its members before the team is even assembled. Individuals with a shared frame of reference approach a particular situation with a common orientation and set of values. They have a shared understanding of the actions that must be taken, and of the role played by each person who takes action in that situation.

Team Development

We can think of the process of team building as happening in stages: individuals assemble; the individuals join together as a team; and the team engages in the task at hand.

It begins with a collection of individuals who are assembled, ready to begin a new shift. They are available, but in a sense, they are not yet committed to the team, and they are not yet engaged in the task at hand.

For team building to be successful, two transitions have to be achieved. First, the individuals must join together to become members of a team. This requires agreement on shared goals and a process to achieve those goals. When this happens, they become committed to one another and to the team effort. Second, the team members must become engaged in the task at hand (see Figure).

In a classic work on team development, Bruce Tuckman described this process as forming, storming, norming and performing.1 In Tuckman's model, forming occurs when individuals assemble and become oriented to the task at hand. Storming describes the initial resistance to group influence and task requirements that often occurs as the group transitions to norming, the development of group cohesiveness, the adoption of group standards and the assumption of individual roles. This process enables the individuals to join together as team that is ready to engage in the task at hand. Individual concerns have been resolved and the group is ready to work together by performing constructively.

Effective Team Building

The team leader has primary responsibility for team development. Teams are most effective when one person is designated as the formal leader to whom everyone on the team is accountable. Qualified leadership requires definition of the leader's role and assignment of a particular individual to fill that role. The team leader may be designated by a job title, such as charge nurse. Alternatively, the leadership role may be defined generically. For example, more than one individual may be called upon at times to function in the role of charge nurse. By means of policies and procedures, the organizational culture provides a mechanism for defining the leadership role and filling it.

Being an effective team leader is not the same as being a competent nurse. As nurses, we are educated to provide clinical care within our scope of practice. Through experience, we develop our skills and competence. For most nurses, being able to provide excellent care to our patients is a source of great personal and professional satisfaction. Although team leaders often find opportunities to apply their clinical expertise to direct patient care, their primary responsibility is to facilitate the patient care delivered by members of their team.

Competent team leaders are able to look at the big picture. Nurses who assume a leadership role must be able to understand and prioritize the work of the unit as a whole. They must understand the flow of patients from and to other departments, such as the emergency department or the operating room, and how the clinical unit interacts with ancillary departments, such as imaging or discharge planning. To make assignments and plan effectively, team leaders must understand the work and scope of practice of each member of the team.

Team leaders must be able and willing to lead. In a very influential article, "Leadership: Good, Better, Best," Bernard M. Bass suggested there are three major leadership styles: laissez-faire, transactional and transformational. Laissez-faire leaders are passive. They show little interest in the work of the team and tend to act only when there is a problem. Transactional leaders actively set goals, monitor progress and reward successful performance. Transformational leaders go beyond that approach. They seek to inspire excellence and address the individual needs of team members to improve the performance of the team as a whole.2

These leadership styles have a real and significant effect on team performance. In a study of staff and patient satisfaction, and quality-of-life outcomes in mental health treatment programs, Patrick Corrigan and colleagues demonstrated that patients' ". satisfaction and quality of life were inversely associated with laissez-faire approaches to leadership and positively associated with both transformational and transactional leadership." They found staff ". who viewed their leaders as charismatic, inspirational and considerate of individuals worked in programs with [patients] who reported a relatively higher quality of life." The authors' conclusion is relevant for clinical teams in any setting: "Active leadership skills that inspire and intellectually stimulate appear to be an important element in programs that are satisfactory to consumers."3

Building Your Team

Instead of rushing to hear report and make assignments, take a few minutes to build your team. An article in Harvard Management Update describes specific techniques leaders can use to help a group of individuals join together as members of a team, quickly and effectively:

1. Share personal histories. Personal stories reveal competencies, generate respect and foster cooperation.

2. Ask: "What has worked for you in the past?" This signals that past experiences are valued as potential contributions.

3. Describe how the team will work together. Clearly state the vision, purpose and plan, and describe each person's role within the team.

4. Optimize individual team member's strengths. Make realistic assignments that take advantage of each team member's strengths.

5. Establish norms for making decisions. Let team members know what types of decisions they are expected to make on their own and what types of decisions will be made by the team leader.

6. Establish a process for giving and receiving feedback. This allows information to be exchanged quickly, easily and in all directions.4

At the start of a shift, it may seem as if there is not enough time to do all this. In practice, however, it takes only a few minutes, and it sets up the team for a productive and successful shift.

Putting It Together

Everyone is seated waiting for report. You greet them, introduce yourself and tell them a bit about your professional background.

You ask the team members to introduce themselves. As they give their names, you ask questions about prior experience on this and other units, and types of work each person has done. You casually elicit information about the nurse from the staffing agency and the per diem nurse who usually works on another unit. You acknowledge prior acquaintance with your regular team members and tell a few anecdotes of experiences you have shared in the past.

You give the team a brief overview of the plan for the day and describe any issues you anticipate, such as special procedures or difficult clinical problems. You ask if they have any preferences regarding procedures and routines. After each person has been heard from, you make the assignments and outline your expectations of the team. You conclude by saying how much you are looking forward to working with this particular team.

The whole process has taken less than 10 minutes. What you have done is create in your team members' minds the thought, "I want to be part of this team. This team is likely to be successful, and these are people with whom I will enjoy working." You also find that you feel the same way.

Tips for Team Leaders

• Clinical teams have three goals: 1) provide good clinical care; 2) provide good service to patients and their families; and 3) use resources wisely. Your most valuable resource is your team.

• Patient care is provided by teams. The quality of care provided by a clinical team depends on how well the team members work together. Team leaders can make it happen.

• Everyone who works on your unit is part of the patient care team. By including the nursing assistants, the housekeepers, the unit secretary and others in your planning, decision-making and team recognition, you increase the capacity of your team to achieve successful patient care outcomes.

• Work with the team you have. Ignoring new team members or complaining about being stuck with particular individuals is insulting, rarely changes anything and does not lead to successful results.

• Diversity is not only a policy; it is a fact of life. If you find ways to use people's strengths, you will spend less time trying to cope with their weaknesses.

• Address the needs and concerns of your team members. If you do this, they will be more interested in addressing your needs and concerns.

1. Tuckman, B. (1965). Developmental sequence in small groups. Psychological Bulletin, 63(6), 384-99.
2. Bass, B.M. (1985). Leadership: Good, better, best. Organizational Dynamics, 13(3), 26-40.
3. Corrigan, P.W., Lickey, S.E., Campion, J., et al. (2000). Mental health team leadership and consumers' satisfaction and quality of life. Psychiatric Services, 51(6), 781-785.
4. Garfield, J., & Stanton, K. (2005). Building effective teams in real time. Harvard Management Update, 10(11), 1-3.

To view the Course Outline and take the test online, click here.

For a printer-friendly version of the exam you can print out, complete and mail in to ADVANCE click here.

Ken Stanton is a staff nurse at Alta Bates-Summit Medical Center in Berkeley, CA. Jerry Garfield is an executive coach and change management consultant at Garfield Leadership & Management Development Services. The authors have completed disclosure forms and report no relationships relevant to the content of this article.

Sponsored by MJHS

View the Latest from ADVANCE


Back to Top

© 2017 Merion Matters

660 American Avenue Suite 300, King of Prussia PA 19406