Focus on…Quality and Patient Safety

Creating a nursing dream team

Teamwork is fundamental to successful nursing care. But many nursing teams struggle with poor communication, lack of confidence in fellow team members, lack of unity around shared goals, and disruptive behavior. The quality of professional relationships between nurses can affect the quality of patient care and healthcare outcomes, which makes teamwork an urgent topic for nurses in many practice settings. So how can you create a team that enhances the quality of care?

A framework for building a cohesive nursing unit

The concept of a transformational team provides a framework for improving cohesiveness among nursing colleagues and strengthening workplace effectiveness. Understanding and adopting the qualities of a transformational team can help a nursing unit improve quality of care and patient outcomes.

Both leaders and individual members have a role to play in creating a transformational team. A transformational leader influences individual members and the team as a whole to perform optimally, resulting in higher quality outcomes. Each team member within a transformational team has a positive influence on the team and other team members.

In this article, I discuss key factors in creating a transformational nursing team: resolving interpersonal conflict, involving all team members, and promoting and practicing informal leadership. (See Six paths to better teamwork.)

Resolving interpersonal conflict

Teamwork can be greatly enhanced by dealing effectively with conflicts between coworkers that inevitably occur, but it isn’t easy. As one nurse said to me, “I don’t want the drama. I don’t claim it’s the right thing to do, or the responsible thing to do, but naturally I just try to avoid conflict.”

Interpersonal conflict can be beneficial to humans in small doses. But avoiding conflict permits it to fester, just as a local disturbance slowly expands into systemic infection. Unresolved conflict can negatively affect the entire team and harm quality of care.


Seek to become more skilled at addressing conflict. Relying on management to handle conflict is usually not as effective as dealing with coworkers directly. Learn the rules of effective communication skills and practice them. Many resources are available both online and in print to help people communicate more effectively. For example, I recommend the book Crucial Conversations: Tools for Talking When Stakes Are High. Learning to handle conflict through professional dialog is a powerful way to become more effective within an organization.

Involving all team members

Your nursing team may include registered nurses, advanced practice nurses, and licensed practical or vocational nurses. It may also encompass unlicensed assistive personnel such as nursing assistants and even unit secretaries and medical assistants. Make sure to include all team members in initiatives to build teamwork, improve patient care, and achieve quality outcomes. This inclusion also enhances motivation to engage more fully in quality improvement initiatives.

One cultural model that provides a framework for creating a more inclusive environment is Relationship- Based Care. This model emphasizes the importance of self-knowledge, self-care, cultivating relationships with the healthcare team, and formingpositive relationships with patients and their families. The overarching goal is to improve relationships throughout the entire organization as a path toward improving patient outcomes and quality of care. One recent study showed evidence that Relationship-Based Care can help improve patient satisfaction and decrease length of stay and readmission rates. (See Relationship-Based Care and nursing practice.)

Principles discussed in the book The Six Secrets of Change: What the Best Leaders Do to Help Their Organizations Survive and Thrive offer another framework for building teamwork. In this book on organizational leadership, author Michael Fullan advocates purposeful peer interaction toward a common goal instead of leadership from the top down. He argues that purposeful peer interaction can create an atmosphere in which team members focus on achieving common organizational goals, such as improved patient safety and better quality outcomes.

Monitor the language you use in everyday conversation to help focus your team on a common purpose. For example, when communicating with nurses on your unit, use phrases such as “our unit’s patients” or “our hospital’s patients,” instead of saying “your assigned patients” or “my patients.” Likewise, encourage nurses to use expressions such as “our patients” in everyday speech.

Promoting informal leadership

Emphasize the opportunities for leadership in the jobs of all registered nurses, regardless of job description. Every nurse can assume a leadership role within his or her area of responsibility. Recognize that, regardless of your title, you are an important leader. Like every nurse, you can influence colleagues and patients and their families. Directed in a positive manner, your influence can help to resolve conflict and achieve excellence.

Remember that your work isn’t just about getting tasks done. It also includes leading others in the effort to achieve goals that will improve patient outcomes. Be committed to your team’s goals and your healthcare organization’s vision, and lead by example. Practice shared responsibility and consensus building. Invite other people on your unit such as PRN staff, faculty, and students to become a part of the team. Celebrate team successes and use failures as an opportunity to learn and make improvements.

Leaders alone don’t produce quality patient outcomes, rather, it’s the leader’s ability to influence the team to work in a cohesive manner toward a shared vision that produces high-quality outcomes. Finda mentor within your organization who excels at leadership, and learn from that individual how to refine your own leadership skills.

The bottom line is this: Nursing teamwork can have transformational power and positively affect patient outcomes. As one nurse said, “Teamwork alone doesn’t always necessarily lead to good outcomes, but when the team functions well, everything is better.”

Debbie Rahn is director of the Reading Hospital School of Health Sciences in West Reading, Pennsylvania.

Selected references

Cropley S. The relationship-based care model: Evaluation of the impact on patient satisfaction, length of stay, and readmission rates. J Nurs Adm. 2012;42(6):333-9.

Fullan M. The Six Secrets of Change: What the Best Leaders Do to Help Their Organizations Survive and Thrive. San Francisco, CA: John Wiley & Sons; 2008.

Koloroutis M, Manthey M, Felgen J, et al. Relationship-Based Care: A Model for Transforming Practice. Minneapolis, MN: Creative Health Care Management; 2012.

Patterson K, Grenny J, McMillan R, Switzler A. Crucial Conversations: Tools for Talking When Stakes Are High. New York, NY: Mc- Graw-Hill Education; 2012.

Rahn, D. Transformational teamwork: Exploring the impact of nursing teamwork on nurse-sensitive quality indicators. J Nurs Care Qual. 2016;31(3):262-8.

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