[petra]

Help - my staff is not a team and they really need to be. I manage a small facility of 10 beds and 13 staff members. What can I do to help them be a team? Any ideas?

[RN1989]

You really need to look at WHY they aren't a team. Get their input. Ask them what they feel are the barriers to team work and what they would like to see happen in a team. Then ask them for ideas on how they can improve things.

If you start trying to impose things like the buddy system, forced togetherness time, etc. you are sure to end up with a mess. Get them involved. One thing I have always done is refuse to allow official complaints about things unless they can come up with at least one possible solution. That solution could be totally ridiculous but it got them involved and engaged in the workings of their unit.

Prior to implementing this for the first time I would walk in the door every morning and have my entire office floor covered in complaints that had been slid under the door. It decreased drastically when I made them responsible for their own behaviors and reactions to things.

[nickjohn32202]

I am a staff nurse at a 25 bed peds hospital in pittsburgh, pa. We have an average census of 7 patients. We have nurses from all back grounds and ages working here. For some reason, it works. We have a fantastic team that works well together. It is a relaxed atmosphere and the team functions great. I believe it is a result of low nurseatient ration.

[PsychRNOhio]

I agree with RN1989. Enforced team activities are a debacle waiting to happen. Asking input is always good but don't expect it all to be positive. With this small a facility/staff/ it's bound to be a geographic area where every employee knoes whose grandpa had an affair with whose grandma.
Team nursing is nice but not only the only model yoou can use.
With this small census you could use primary nursing and encourage personal accounatbility.

[RNOCN2311]

I was promoted to Charge/Clinical Resource Nurse of a small outpatient oncology clinic 6 months ago. I'm working with my peers in a different role. They, to say the least, are good people with bad attitudes. Some like to tattle on eachother, feeling I'm not addressing situations as fast as they would like. Some like to hide in a corner, do what they want to do and not be help accountable. The previous person in my position was horrible, she randomly picked on people to the point of harrassment, handled situations with acting out and threats that got no where. I've tried to treat them as I'd like to be treated, focus on patient care and have given each of them their own areas to oversee.... one does new charts/chemo orders, one readies charts for the day, one handles all incoming consults, etc. This one thinks that one is not doing what they think they should or wants to boss the other's in my absence. I was forced to a 4-10 working shift so they have one day to man up and do their own things, but it turns into pushing eachother around or ganging up on one person. I truly feel like I'm babysitting!

I, of course, have my own boss who I have to get the OK to make any changes and don't have disaplinary ability at this point so pretty much my hands are tied. When one nurse in particular is having a bad day or a personal event she uses me as her scape goat to the other staff...... I'm not being nice to her, even though I'm not doing anything different. Another one is addicted to her cell phone and runs out of the clinic to chat all day long..... I've asked for a cell phone policy and been told there is one, but I can't enforce it till upper management addresses the issue first. I've been asked to oversee performance and charting (due to an audit a few years ago that showed the previous charge's poor charting) but when I give things back and say, don't forget your stop time/initials/etc. I get "everything I do she says is wrong", which is not the case...... I try to say, "oops, I forgot" when I make my own errors in charting so they see I know they are just forgetting and dont' make a big deal about it. I've asked that pre-charting stop (one nurses terrible habit) and that no one chart for someone else, but remind them to complete a chart.

It's maddening! The other day I had my evaluation, glowing, but the "how can we help them to be team players...... look inot what they expect of a charge person". I've rattled my brain all weekend (my days off) to find any way to change it. Outside of them realizing i'm not just "pe.. in the wind" when I say something, I have no clue. I'm overworked myself, but assist in clinic, answer questions, handle most of the patient phone calls, as well as charges, billing, assignements, difficult IV sticks, assist in all areas of our department. I bring atleast 2 hours of work home a night and go in early and stay late. I'm slowly feeling like no matter what I do, it's not right and trying hard not to give up and stop careing. I love what I do, I'm good at what I do, and if I left the place would fall apart (not arrogance, but the doctors have told me I'm the glue and complain when I have a day off). I have asked my boss for more staff/more enforcement of the rules/direction/assistance/etc....

Help!! I feel like I' banging my head against a brick wall.

[Katnip]

First, I would stop doing their work for them. As long as you do, they'll expect you to continue it and don't have any incentive to try to work together to streamline their day. You need to get your manager on board to come up with a disciplinary plan that you can implement when necessary.

I was lucky, for the most part I inherited a great team. Not always, but they do try to work together.

As far as getting people who have been on their own, it's very difficult if they've been without leadership and have always been a dysfunctional group.

Have you had staff meetings and spelled it all out for them? You may have to micro-manage them for a while. Make sure each has an assignment and that they do it. If you see one floundering, order someone else to help. Eventually they may see that it pays better to work together on their own rather than have you hovering over them all the time.

Whatever you do, don't make them take one of those team-building rope course things.

[RNOCN2311]

Hi Katnip ( a very cute name),

I'll give them a team building rope alright.... lol.

I will keep trying to let them be on their own. It's hard when the physicians look to me when there are errors, missed orders, etc.

My boss has actually started the write up process and given one of the nurses the "step up or step out" speech. This particular nurse admitted she has been not pulling her weight and relying on me to fix her mistakes and not functioning well. Now, I've heard it before..... but I'm always willing to give them a try.

It's just a tough spot to be in. I've distanced myself from the "personal" aspects of the day and tried to remain friendly and approachable.

I figure I have a bit more in me.... not ready to give up, but I'm getting close.

[RNOCN2311]

Oh and for some reason, the cell phone has disappeared!!! Maybe she just forgot it today, but she made not one call..... !!!

[Katnip]

Hang in there. It's a real tough spot to be in like you said, especially since you are responsible for her, but not doing the write ups.

Best of luck to you.

[RNOCN2311]

Well hello there again,

The nurse who was giving me problems must have heard something in her evaluation because she actually (just once though) gave me an update on a patient. I was almost shocked. I thanked her afraid that if I didn't she wouldn't feel it was worth it. Of course, she chose a time when I was in the middle of 3 things, so truth be told.... I can't recall what the update was.... but it was a step in the right direction.