Critical Care Nurse Teamwork Essay

Introduction The American Association of Critical Care Nurses (AACN) has made an active commitment to promote the creation of healthy work environments that support excellence in patient care. There is a plethora of evidence supporting the notion that unhealthy work environments contribute to many other serious problems in healthcare such as medical errors, patient readmission, and nurse turnover. Therefore, the AACN has put forth six essential standards for the establishing and sustaining of healthy work environments. These standards are evidenced-based and relationship-centered, and they include: skilled communication, true collaboration, effective decision making, appropriate staffing, meaningful recognition, and authentic leadership (“AACN
Standards,” 2005). This paper will focus primarily on the standard of true collaboration, also known as teamwork. However, it is important to recognize that without the other five standards, true and effective collaboration can never be achieved.
Teamwork, as defined by the American Heritage Dictionary, is “a cooperative effort by members of a group or team to achieve a common goal” (Thomas, Sexton & Helmreich, 2003, p. 2). According to one source, the use of effective teamwork has been associated with higher job satisfaction, higher quality of patient care, increase in patient safety and patient satisfaction, increase in productivity, and decrease of stress (Kalisch, Curley, & Stefanov, 2007). Another source states that higher levels of teamwork lead to lower burnout scores, less nurse vacancy, confidence in patients after discharge, and perceived quality improvement (Rafferty, Ball, & Aiken, 2001). Consequently, it is quite evident that the use of effective teamwork is vital to the well-being of the patient and the success of the healthcare organization.
The topic of this paper stems from the recognized importance of collaboration among nursing staff, and the creation of a quality improvement project geared towards enhancing teamwork in critical care areas. When patient acuity is high, it is important that staff are constantly supporting one another and helping out in any way possible. The primary focus should be on the patient and doing what is best to promote the optimal health and well-being of that patient; this cannot be achieved without the help and commitment of the entire healthcare team. It is vital to understand that teamwork is a crucial element in providing exceptional care for critically ill patients.
This quality improvement project is targeted toward critical care units; however, it can be easily generalized and implemented in any acute care unit. This project was presented to the Transplant ICU at the University of Kansas Medical Center. The implementation of such a project will positively impact nursing care, patient satisfaction, and overall safety in the many ways as stated previously. The use of teamwork will result in an increase in the quality of patient care and the achievement of optimal patient outcomes because nursing staff will accomplish more tasks by working together. It will also increase patient satisfaction and safety because staff will be more willing to help patients in need, whether or not they were assigned to them. Lastly, the use of teamwork can help decrease an individual’s workload and stress, allowing him or her to be more productive. This will also help the staff enjoy being at work, resulting in improved job satisfaction and decreased turnover or vacancy.
Review of Literature The role teamwork plays in developing and sustaining a healthy work environment has been recognized by key stakeholders in healthcare. The Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) is a strong proponent of teamwork with a focus on the coordination of care and support of healthcare professionals. According to JCAHO, “teams whose members have experienced working together know each other 's strengths and weaknesses, can better support each other and compensate for each other, even under extreme stress and fatigue conditions" (Thomas et al., 2003, p. 4). Also, JCAHO believes that “teamwork is essential for optimizing quality and safety in the care of hospitalized patients” (Thomas et. al, 2003, p. 4). The Institute for Healthcare Improvement also recognizes the importance of teamwork. In their book, Crossing the Quality Chasm: A New Health System for the 21st Century, teamwork is cited as essential in caring for patients with complex problems. They strongly conclude that "effective working teams must be created and maintained” (Thomas et. al, 2003, p. 4). If teams are not maintained and supported by management and staff, then they will provide little to no benefit to the unit or organization.
There are several well-established and trusted hospitals that have already implemented systems focusing on teamwork.
The Burn Center at Grady Memorial Hospital in Atlanta understands that it takes more than just skills, technology, and compassion to care for patients; teamwork is essential (Raines, 2010). This unit, in particular, improves teamwork by focusing on education, sending staff members to conferences, and team-building classes. A Wall of Recognition displays patient thank-you notes and performance goals met to affirm the value of a dedicated team. Teamwork has also helped the cardiovascular-thoracic critical care unit at Emory University Hospital earn the Beacon Designation, awarded to outstanding critical care units by the AACN. This unit has a unique approach to teamwork in that every nurse has a specialty, such as infection control or skin care. It is then their job to gather resources, learn about new products, and share that information with all members of the team so that they can address particular problems together (Raines,
2010). The topic of teamwork has been vastly researched in today’s literature. It is clear that teamwork is vital to success in many dimensions. Many of the articles specific to teamwork in the healthcare field pertain explicitly to multidisciplinary teamwork. Very few articles specifically discuss the issue of teamwork among the nursing unit staff or the effects of specific interventions on improving teamwork on the unit. A review of literature concluded that effective teamwork is crucial in providing optimal patient care in intensive care units. Team leadership should guide the way that ICU team members interact and coordinate with one another (Reader, Flin, Mearns, & Cuthbertson, 2009).
As it pertains to multidisciplinary teamwork, Thomas et al. (2003) found that critical care physicians and nurses have discrepant attitudes about the teamwork that they experience with each other. Overall, this study discovered that physicians perceive the quality of collaboration as being much higher than nurses do. This finding demonstrates that different occupations may have varying perceptions of teamwork, which may be related to a hierarchal structure within an organization (Thomas et al., 2003). Le Blanc, Schaufeli, Salanova, Llorens, and Nap (2012) investigated whether intensive care nurses’ efficacy beliefs predict future collaborative practice, and tested the potential mediating role of team commitment in this relationship. The results of this study showed that the relationship between efficacy beliefs and collaborative practice is mediated by team commitment and that efficacy beliefs, team commitment and collaborative practice were reciprocally related (Le Blanc et al., 2010).
When considering the relationship between interdisciplinary teamwork and nurse autonomy, Rafferty et al. (2001) concluded that nursing autonomy was positively correlated with better perceptions of the quality of care delivered and the level of job satisfaction. Those that perceived higher levels of teamwork also had higher levels of autonomy and were more involved in the decision making process. Therefore, this article suggests that organizations may promote nurse autonomy as a way to enhance nursing teamwork rather than undermine it (Rafferty et al., 2001). Amos, Hu, and Herrick (2005) completed a series of team-building activities on a medical-surgical unit, and observed the impact on staff communication and job satisfaction. It was discovered that such interventions improved communication and interpersonal relationships on the unit so the staff could function as a more cohesive group (Amos, Hu & Herrick, 2005).
Beatrice Kalisch is one author that has completed extensive research on the topic of nursing unit teamwork. She has discovered factors that directly influence teamwork on the unit, implemented and evaluated an intervention used to enhance nursing staff teamwork, and even developed and tested a tool to evaluate the nursing staff’s perception of teamwork. One of the first studies conducted by Kalisch and Begeny (2005) looked at possible barriers to achieving a high level of teamwork on the nursing unit. Such barriers include: large team size, lack of familiarity, instability of the work force and assignment, absence of a common purpose and destiny, and inhibiting physical environment (Kalisch & Begeny, 2005). Kalisch and Lee (2005) found a relationship between selected staff characteristics, work schedules, staffing, and teamwork. Similarly, another study by Kalish, Lee, and Rochman (2010a) explored the influence of unit characteristics, staff characteristics and teamwork on job satisfaction. The results showed that a higher level of teamwork and perceptions of adequate staffing lead to greater job satisfaction with one’s current position and occupation (Kalisch et al., 2010a).
Kalisch (2007) constructed an intervention to enhance teamwork and staff engagement on a medical unit in an acute care hospital. The intervention included: involvement of the entire unit staff in the development of values and goals for guidance of the project; a teamwork training needs assessment; training in teamwork knowledge, skills, and attitudes specific to the unit; the selection of a guiding team who engaged in the generation, testing, and implementation of creative ideas for change; a comprehensive communication strategy to keep the unit staff informed and involved with the project; and follow-up after training by managers and the guiding team members to reinforce the new behaviors and change of culture on the unit to one that both supports and expects teamwork. The results of this study showed that the intervention resulted in significantly lower patient fall rates, staff ratings of improved teamwork on the unit, and lower staff turnover and vacancy rates. Patient satisfaction ratings improved but did not reach statistical significance, perhaps because the sample size was small (Kalisch et al., 2007). After the completion of the intervention, Kalisch, Lee, and Salas (2010b) found the need for an acceptable, reliable, and valid instrument to study the status and characteristics of nursing teamwork and to test the effectiveness of teamwork-enhancing interventions. Therefore, they developed and tested a tool known as the Nursing Teamwork Survey (NTS), which was designed to measure nursing teamwork in acute care settings at the patient unit level. The NTS was tested on 38 acute care units, with 1,758 participants. This tool consists of 33 questions using a five-point Likert-type scale with five subscales including: trust, team orientation, backup, shared mental model, and team leadership (Kalisch et al., 2010b). The literature clearly shows the importance of teamwork in providing exceptional patient care. Therefore, healthcare organizations should aim to create working environments that provide intensive care unit nurses with sufficient resources to perform their job well. Further research regarding specific ways to design and evaluate interventions that directly influence collaborative practice in intensive care units would only enhance current knowledge of this topic.
Model and Organizational Process The quality improvement model that best suits this topic is the Deming PDCA Model. This model, also known as the Shewhart Cycle, is especially useful in solving quality problems. Its cyclical shape denotes continuous improvement achieved through repetition. The first step of the model is Plan, which is the time when the data is gathered, the problem is analyzed, and the solution is planned. The second stage is Do, which is the step where the plan is carried out. Check is the third stage, when the change is observed and measured. Checking includes verifying the ability of the improvement to achieve the identified objectives. The last stage of the Deming PDCA Model is Act. During this stage, it is important to determine which practices have demonstrated the greatest potential for helping the organization achieve its desired performance levels. The proposed improvement must eventually become a natural part of the way that work is done and care is provided. Continued measurement is also important to ensure that the implemented practices are being followed and desire performance is sustained. The completion of each PDCA cycle leads directly into the start of the next cycle. The plan can be modified each cycle or as needed to create the desired amount of change (“Quality based,” 2003). The Deming PDCA Model was selected for this quality improvement topic because teamwork is an area where nursing units should be constantly looking for ways to improve. With each unit being unique and having very different needs, it is important that changes can be made during the Act stage to adjust to the varying goals and needs of each particular unit. This model is also very adaptable and allows for a maximum amount of change and growth. The cyclical direction of this model allows for continual growth of teamwork, because if interventions were completed only once rather than continued and adjusted, then the change achieved would be both brief and minimal. At the University of Kansas Medical Center, they use the Deming PDCA Model when implementing quality improvement measures. There is also an entire division focused specifically on quality improvement. Ideas for improvement can come from a variety of venues such as literature reviews, professional conferences, or brainstorming at the unit or division level. Usually, ideas are pilot tested on an individual unit or at the division level. Results of the pilot study are then evaluated and reported to either a divisional practice council or department of nursing practice council. Also, a problem may be discussed at the Department of Nursing coordinating council meeting and the members will determine how to move forward (Gartner, 2012). At the beginning of each fiscal year, each unit is charged with reviewing their unit’s data, which is provided to them on a rolling scorecard from the past twelve months. The scorecard consists of fifty quality indicators, and the indicators with the most opportunity for improvement are considered as the unit’s priority focus areas. Action plans are then designed to meet the improvement goals (Gartner, 2012).
The formal process for authorization and implementation of quality improvement projects includes the use of unit representatives known as QSI. These members focus directly on unit specific measures. Other projects can also begin with the bedside nurse and advance through the unit’s practice council and on to the Critical Care Practice Council. The quality improvement project will then eventually be brought before the Nursing Practice Council for approval (Gartner, 2012). Overall, the use of the PDCA Model is a critical component used to translate new knowledge into nursing practice.
Recommendations for Quality Improvement The need for teamwork on a critical care nursing unit is apparent. In order to enhance teamwork, it may be necessary to require team-building sessions and activities for the nursing staff while also having a designated committee that works primarily on promoting a team-like environment on the unit. This quality improvement project would consist of creating a teamwork committee that would serve as a liaison between the nursing staff and the nursing management. The committee will not only serve as a representative body, but they will create and implement ideas that can be used to foster teamwork on the unit. This quality improvement topic is supported by research that links team-building activities with improved staff communication and job satisfaction. Such strategies also assist the nurse manager in building an effective work team by strengthening communication and interpersonal relationships so that staff can function more cohesively (Amos et al., 2005).
The people that will be impacted by this quality improvement project include the nursing unit staff, the patients, and the hospital in general. The intent is that this initiative will be expanded even further to impact other nursing units and multidisciplinary practice. Implementation should occur as soon as the need for improvement of teamwork is discovered. Research has made it very evident that the use of teamwork on nursing units is absolutely vital to the happiness and success of the staff, as well as the well-being of the patients. Therefore, implementation of this project should occur immediately after approval through one of the many ways discussed previously. Staff may be skeptical of the need for this intervention and change, and that is why it is so important to create a sense of urgency at the beginning of the implementation process. If the staff is able to hear that others are concerned about the lack of teamwork on the unit and understand the crucial importance of teamwork in nursing, then they will be more willing to participate in the changes with a positive attitude. The committee will also serve as motivators for the other staff on the unit by continually encouraging them to help one another, maintaining an upbeat attitude, and participating in various activities with other staff. Initially, this project would be implemented on a single critical care unit and the outcomes would be evaluated. If the process needed to be changed slightly, then those adjustments would be made and the project would continue through another PDCA cycle. If this intervention proves to be effective, it will likely be expanded to other units.
Before implementation on a unit, the following considerations need to be taken into account; what does current teamwork look like on the unit? How long has the unit been in place and worked together? How experienced is the staff on the unit? How much of the staff works overtime? What is the nurse to patient ratio? What are the varying ages and genders of the staff on the unit? What are the different attitudes and personalities on the unit? What is the patient population that is cared for? What are the patient care needs? What is the unit’s needs for teamwork based on that patient population? What are the different shifts, and are their differences in teamwork among the varying shifts? Are there differences in perceptions of teamwork among the differing roles? What is the manager’s willingness to participate in this project? These are just some of the issues that need to be considered before the implementation of this quality improvement project. The use of team-building activities and a committee as ways to enhance teamwork on the unit are supported by a study discussed earlier that was done by Kalisch et al. (2007). In accordance with the initial step of the PDCA model, Plan, it is important to create multiple focus groups that include at least one person representing each occupation such as registered nurse, care assistant, and unit secretary. This will allow the members of the group to discuss their perceptions of current teamwork on the unit and issues that they believe inhibit or enhance teamwork. The use of focus groups can also reveal the staff’s educational needs. The data collected from the focus groups can then be complied and presented to the unit during a staff meeting. Sharing this information with the entire unit will aim to create a need for change, which is necessary for the quality improvement project to be effective. If people disagree on what they want to see happen, then nothing will change; everyone needs to feel a sense of urgency and desire for improvement. At the same staff meeting where the focus group information is shared, the members need to create vision and mission statements, goals, and critical success factors. The vision statement should reveal what the organization wants to accomplish, in a broad sense. The mission statement should explain what needs to be done to achieve the vision statement. Goals should include both short-term and long-term aims and reveal what the unit wants to accomplish. Critical success factors are elements that the unit is dependent on in order to achieve the vision and mission. Creating such statements will ensure that the entire unit has a common unified direction. All of these items can be completed during a staff meeting. However, there may need to be multiple staff meetings to accommodate the varying schedules on the unit. It would also be appropriate to allow members to set personal goals that address areas that they can work toward.. This may be best achieved by including a component that specifically addresses the area of teamwork on each of the unit staffs’ yearly evaluation forms. They would have the opportunity to write down goals that they would like to achieve over the next year and share those with the management staff. Then, after the year has passed, they would be able to evaluate if they achieved those goals or not and provide specific examples. Each year they would be asked to set new individual teamwork goals for the next year. Lastly, as a way of examining each member’s progress, the use of peer evaluations would allow for team members to provide feedback on one another’s team performance. It would be fitting for the individual being evaluated to see the responses so that they are able to understand areas of strength as well as areas for improvement. The next step of the model is the Do stage, when the plans to enhance teamwork are put into action. Many studies have shown team-building training programs to be successful at improving collaboration. Therefore, each staff member will be required to attend a day-long team training program. This will have to occur at multiple days and times so that everyone is able to be present despite their varying shifts and schedules. Attendance at this day will be compensated with pay, as well as continuing education hours. Various topics will be presented on during this training session with a focus on feedback, conflict management, listening, and understanding of team information processing styles. The information will be presented in various forms such as lectures, group discussions, and role play. The subject matter discussed may also be structured to fit particular needs and problem areas on the unit. Also, during this step, committee members should be selected. The committee will implement unit specific measures used to enhance teamwork. The committee should consist of managers, educators, nurses, care assistants, and unit secretaries. Staff with credible reputations and leadership qualities should be selected for representation on the committee. It would also be beneficial to select staff members that are not only passionate about improving teamwork, but who will also bring varyious backgrounds and ideas to the table. The committee will lead the unit in achieving the designated goals, while also serving as the main form of communication to the other members on the unit about what they are doing (Kalisch et al., 2007).
The committee will be the most valuable resource for the unit in that they will be role models for all other team members. It is important that they will continually be coming up with new and creative ways to enhance teamwork, which will hopefully keep up the momentum and excitement on the unit. The AACN Standards (2005) has recognized meaningful recognition as one of their six essential standards for a healthy work environment (p. 9). Therefore, it would be important for the committee to recognize those individuals that are standing out as team players on the unit. Having a bulletin board designated for this unique purpose would be appropriate. Staff members can then nominate a new person each month to be recognized for being a team player. Having another area in the lounge for staff to write thank you notes to one another would also be valuable. This would provide staff an opportunity to share their appreciation for one another. Volunteering experiences can also be used to boost teamwork. Having an opportunity for members on the unit to serve their community while also getting to know their co-workers outside of the work environment would be wonderful at improving teamwork. This would be an optional experience, and members would be encouraged to bring their families or loved ones along. Not only would this provide time to socialize and become better acquainted with one another, but it would allow members of the unit to share their time and talents with others in need. Members of the committee may feel as if it would also be beneficial to have activities at work to improve morale rather than demanding more time outside of work. Such activities could include making Valentine ’s Day boxes for members to distribute cards, having a mitten or mug exchange at Christmas time, or competing with the March Madness brackets. In critical care areas especially, the stress is very high and the outcomes may not always be positive. Therefore, it is important to find ways to make the work environment as upbeat and positive as possible. In turn, this will foster a healthy team atmosphere and boost job satisfaction. These are just a few of the ideas for what the team committee could do to on the unit to promote and enhance teamwork. However, it is important that the committee uses appropriate methods to fit the needs and desires of the individual unit. The overall goal of this quality improvement project is to enhance teamwork on nursing units and there is no simple way of doing that. Therefore, it may require different methods as well as various attempts to accomplish this objective.
Financial Concerns and Constraints
This quality improvement project will cost money to implement, but will create overall savings for the organization. The cost of implementation will include compensation for the staff during the training day and staff meeting, the speaker for the training sessions, and a budget for the committee to implement creative ideas on the unit. If there were forty staff members on the unit and each staff member made approximately twenty five dollars per hour, paying staff to attend a six hour long session would cost approximately $6,000 dollars. Also, the two hour long staff meeting would cost approximately $2,000 dollars for staff compensation. The speaker for the training sessions would charge approximately $600 dollars, and there would need to be at least two of these sessions to ensure that everyone could be in attendance. A budget of 500 dollars should be sufficient for the committee. Therefore, the anticipated cost of this quality improvement project would be $9,700 dollars.
However, the anticipated savings would outweigh the costs. According to Rafferty et al., such an intervention results in improved financial outcomes, reduced staff turnover and absenteeism, higher quality of care, increased staff motivation, reduced conflict, and better patient outcomes. Also, teamwork results in lower levels of stress and increased productivity for members of the team. (Rafferty et al., 2001). These will all result in significant financial savings for the organization. For instance, on average, nurse turnover costs hospitals at least $82,000 per staff member (Kalisch et al., 2010). Improving teamwork in these settings impacts staff satisfaction by decreasing the likelihood that staff will stay in their jobs to work unproductively or leave their position completely. If staff enjoy being at work, they will be less likely to miss work. This causes others to work on their days off or work overtime to cover for another member’s absence. In addition, increased teamwork leads to safer and higher quality of care. This decreases costs caused by medical errors and results in satisfied patients that are willing to return for future care. It is hard to put an exact number on the anticipated savings from this intervention, but it is quite obvious that the anticipated saving will far exceed the anticipated cost.
Evaluation Plan To determine the effectiveness of this quality improvement project, it is important to have outcome criteria that will be assessed before and after the project’s implementation. The third stage of the PDCA Model is Check. This is the time where change is observed and measured. The areas that will be observed and compared before and after the project include the number of patient falls, patient’s satisfaction with care, staff’s perception of teamwork, and the turnover or vacancy rates. These are areas that were monitored and assessed in a similar study done by Kalisch et al. (2007). Looking at these areas will help determine if the project was successful at enhancing teamwork. The number of patient falls is one way to determine whether or not the intervention is able to affect patient outcomes. Patient satisfaction scores will reveal if the intervention affects how patients perceive the care they receive. Staff perceptions of teamwork will show if the intervention has influenced relationships among staff members on the unit. If the intervention is successful, then less people will want to leave their job on the unit for reasons related to teamwork. This project should result in a decrease in the number of patient falls and the turnover rates for the unit and an increase in the staff’s perception of teamwork and patient satisfaction after the project’s implementation.
During the Act stage of the PDCA Model, the results of those areas will be analyzed and changes will be made before the completion of another PDCA cycle. This will allow specific changes to be made to affect a certain area that may need more improvement. This step of the Model also allows the quality improvement project to meet changing needs and desires of a particular unit. If outcome criteria are not met, changes will be made in the plan and the PDCA cycle will continue. The evaluation phase of the project will use data collected before the implementation of this quality improvement project, and data collected six months after the intervention implementation. However, teamwork is an ongoing process and will need to be continually evaluated so that changes can be made as needed to achieve the desired results.
This quality improvement project may face barriers. For instance, management and those who oversee the implementation of quality improvement projects may be hesitant to implement a project regarding teamwork. Teamwork is something that a unit is assumed to have. Therefore, the topic is not usually discussed as something that needs to be addressed and improved. This barrier will be overcome by educating those individuals involved about how crucial teamwork is for nursing units. It would also be important to show that teamwork is lacking on some units. The data collected from the focus groups may want to be completed prior to this time, so that it can be shared with those that may be hesitant on approving this type of project.
Another barrier to this project is the cost of implementation. There is very little research done on exact methods and ways to improve teamwork; therefore, there may be reluctance to support this project financially when the exact details of this plan are not well supported yet. Only a few studies have examined the use of similar projects, but those that were done were found to be effective. To overcome this barrier, it will be important to further educate people about the benefits of teamwork in nursing. Also, education will need to be done on those studies that have been done and shown to be effective.
A third barrier to the success of this project would be the attitudes of the unit staff and their readiness to change. It is not uncommon for teams to deny that they have problems working together effectively. If the staff members on the unit either do not think that this project is important or they are not ready to change, then nothing productive will be accomplished. The entire unit will need to be in agreement for this project to be effective and cause positive change. As discussed earlier, creating a sense of urgency is absolutely crucial in order to overcome this barrier. Therefore, using the data from the focus groups such as exact quotations from staff members, patients, and even physicians will help to compel the staff members toward acceptance of the change and mitigate their tendencies to discount reality.
Manager Recommendations The quality improvement project was presented to Adam Olberding, the Nurse Manager on the Medical Transplant ICU (MTICU) at the University of Kansas Medical Center. Many aspects of this project are already being implemented on this unit. Some of these include: volunteering opportunities for the unit to participate in together, individual goal-setting on the staff members’ yearly evaluations, and teamwork assessment on the unit every year using a tool know as the National Database of Nursing Quality Indicators (NDNQI) (Olberding, 2012). The purpose of NDNQI is to aid the registered nurse in patient safety and quality improvement efforts by providing research-based national comparative data on nursing care and the relationship to patient outcomes. This allows the hospital to compare unit-level performance with state, national, and regional percentile distributions. Some of the NDNQI indictors are measures that are relevant to the quality improvement project of enhancing teamwork; these include patient falls and pressure ulcers, nurse job satisfaction, and nurse turnover (“National database of,” 2012). Therefore, this could be a very valuable tool to evaluate the effectiveness of this intervention because data could be trended and compared with past data and national data. According to Adam, the 2011 NDNQI data for the MTICU ranked it as one of the highest units nationally in both areas of teamwork and nurse to nurse interactions. The staff on the MTICU also ranked job satisfaction as very high (Olberding, 2012). This data shows the MTICU values the importance of teamwork and has already been taking measures to foster a team-building environment. Adam supported the idea of having mandatory team-training days. He felt that this was an inexpensive and successful way to improve teamwork on a unit. At the University of Kansas Medical Center, there are many internal people that could be used to facilitate and lead the team-training day, which would he said could minimize the cost associated to paying for a speaker. Overall, Adam was very impressed with this quality improvement project and did not recommend any changes to be made (Olberding, 2012).
Conclusion
Enhancing teamwork is a very large issue that is influenced by many factors. This quality improvement project recognizes the importance of teamwork among nursing staff, especially in areas such a critical care where stress and patient acuity are both high. The implementation of a training program for the entire unit and the use of a committee focused on teamwork are just a few ways of the many ways to improve teamwork. Building a successful team is essential in creating a positive work environment. Promoting activities that increase teamwork and strengthen cohesiveness among members of the team will improve staff satisfaction, which will lead to decreased nurse turnover or vacancy. It will also improve patient satisfaction and, ultimately, patient outcomes. Taking measures to enhance teamwork will positively impact the way that nursing care is done and will make significant differences in the lives of both patients and nursing staff.

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