Absence of Teamwork

Nurses Relations


  • Specializes in CCU, SICU, CVSICU, Precepting & Teaching.

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393 Posts

Specializes in ICU.


Not all units are every-woman-for-herself. I am fortunate to work on a unit that still practices teamwork, although not team nursing in the strictest sense. We will answer each other's lights, fix each other's pumps, pass each other's meds if needed. Anyone who is caught up will go around and ask the other nurses if they need help. I work days and nights. Night shift is responsible for 95% of the complete baths, including all vents and the confused pts. We usually bathe anybody who is incontinent too. We team up - both aides, and 2-3 nurses all go in and whip out the baths. We can easily do 4-5 complete/vent baths in the first 4 hours. If you aren't in bathing, you help out with the lights since the aides are busy.

I work in a small, midwestern city. I suspect that has something to do with it. I think the values of courtesy, teamwork, and gratitude of which you spoke, are more prevalent in small-town and rural areas than in the big cities.

I should add, also, that about 2/3rds of my unit consists of very experienced RN's - 20-40 years experience each.


Specializes in Hospital, med-surg, hospice.

A lot of that sounds sooo familiar, some nurses go off the unit and you find yourself alone or with one other staff running around answering call lights etc..some people have no concern about others seeing them checking their facebook or e-mail while we are running around like crazy...:nono:


2 Posts

I take great offense to the 20 something comment. I work my tail off to 'prove' myself to senior RNs who haven't done education in years and because of their senority gives them the right to sit in the nursing station and talk about the good old days.

I do think team nursing was a great concept and at some point will return, I think when I am sitting at the nursing station having a full patient load and doing charge and there are the 40-50 somethings talking to god knows who on the phone and their call bells ring no I am no going to answer their bells.

I know every unit is different, but I hate when it's generalized by age group. Do I check my emails or text occassionally at work, yes but that same technology gives me answers to questions in seconds, therefore making my care/support more efficient.

I constantly envy my husband he works as a policemen, and it's like a brotherhood everyone has each others backs. I just wish there was more Sisterhood type activity in nursing.

Poi Dog

1,134 Posts

I am a CNA and just today, two CNAs on the floor with me were called to a meeting, which left me alone to care for 36+ residents. Soon enough I had 6 call lights going off and the nurse I was with was ignoring them. I politely pointed out to her that I was the only CNA on the floor and could she please answer some lights. She told me to do my best and then continued to read the local newspaper.

Thanks, nurse. Thanks for playing on the "team". Most of all thanks for showing me your true colors. This saddens me :(

allnurses Guide


7,071 Posts

Specializes in Peds/outpatient FP,derm,allergy/private duty.

My first hospital had gone to the "primary care nurse" model in '76-'77, but even so, I felt we had "teamwork" without the structural "team nursing". With the right mix of people, you have teamwork, and you feel supported. The Nurse Manager was all-important to us, because she kept her eyes on the "flow" and would actually come in and help herself or ask someone else to pitch in if they weren't busy.

That was essential with primary nursing - some (like me) were shy about asking for help, and others just were understandably not aware of the other nurse's patients. I remember when we got a new secondary Nurse Manager. She liked to gab with the doctors and never mussed up her perfect manicure. She rarely glanced in a patient room. Sure, work gone done with her there, too. But the day just went faster, and so much more pleasant with YMRN there.

gonzo1, ASN, RN

1,739 Posts

Specializes in ED, ICU, PSYCH, PP, CEN.

Ruby Vee, I couldn't agree with you more. You summed it all up. I rotate day/night. Day shift all works together, helping each other. Night shift, it is every man for himself. If you need help, then you are a loser. Sad, but true.

Needless to say I like to work days. I feel that no one should sit, until everyone can sit. But sadly there are always the few that spend a great deal of time surfing the web.

By the way, I think I worked with your "special" charge a time or two.

Specializes in Psych/CD/Medical/Emp Hlth/Staff ED.

It seems to vary widely by unit and even by shift in a particular unit. In my experience on my unit, night shifts seem to work better as a team than days, which might be due to the support available at night vs the day. This seems to be because the night nurses have to depend on each other more and it's easier to be aware of what's going on on the floor with a less hectic environment. Units with heavy patients but bad ratios seem to have more difficulty working as a team, which has always seemed odd to me since you'd think that those would be the nurses that would learn to depend on each other, but instead they seem to go into a "survivalist" mode of nursing where it's everybody for themselves.

In terms of age I've never really noticed any theme. I've seen plenty of older nurses suddenly disappear when help is needed and I've seen young nurses do the same, I've always seen it as an issue of personality more than age.

eriksoln, BSN, RN

2 Articles; 2,636 Posts

Specializes in M/S, Travel Nursing, Pulmonary.
nursing has changed a lot in the past thirty years, but when i reflect upon it, it isn't so much the technology, although that is definitely a factor. it's more about the nontangible things -- ethics, the courtesy and gratitude of patients and their families, and the teamwork of the staff. if i had to put one of those above the rest, it would be the lack of courtesy and gratitude. but a close second would be the absence of teamwork.

team nursing was still the unit structure when i started nursing. primary nursing had just come into vogue, but it hadn't yet filtered down to the small midwestern community hospital where i was working. we worked in teams. thirty beds, fifteen to a hall. two teams led by an rn and staffed by a combination of one or two of the following: a less senior, less experienced rn, a lpn and /or an aide -- because that's what we called them then. the assignment was a shared one: the two of us or the three of us were responsible for our 15 patients. the team leader passed scheduled meds, called the doctors, took off the orders, etc. the lpn or junior rn did prn meds and treatements. and the team member or members were responsible for adls and toileting. we all worked together.

i remember working with an na and cranking out 15 baths and linen changes together in a morning. we'd go into a room together and work together until that room was finished and move on to the next one. if someone's patient was incontinent anyone who was free changed him and everyone who was free helped. the closest person answered a call light. there was camaraderie. we worked together. there was none of this sitting at the nurse's station while everyone else was busy running around. either we were all working or we were all sitting.

these days, or maybe it's just this unit, we don't work together. we can all work in one big room, six patients. one nurse is running her posterior off while a second sits on hers and looks at facebook and the third does chart audits and bugs the first nurse about missing admission documentation rather than offering to help with the hourly glucose checks, taking a line out or pushing a wheelchair down to the step-down unit. the 20-somethings are all friends, which is great. they'll help their friends out if needed, but they won't help anyone else unless asked directly and even then sometimes they won't. i remember trying to make a patient comfortable a few weeks ago -- you may remember that vent -- and the 20-something guy i asked to help me came into the room, helped me boost my patient and then went back to his facebook page while i was still asking the patient if he was comfortable yet or if he wanted to be turned some more. the charge nurses will sit at the desk and read your computer charting in between bids on ebay and call you to come out to the desk and explain why you haven't gotten the hourly glucose for 80 minutes rather than getting up and coming to help you out or at least to investigate. did you fall asleep in your room? are you wrestling with a sundowner? did you have a syncopal episode? did your computer crash the minute you finished your charting but before you signed it? or are you too freaking busy to get to the glucose and thus possibly too busy to come out to the desk and explain why you didn't?

years ago, i was involved in a sentinel event. among many other factors was the fact that instead of helping me with an overwhelming assignment that included one patient crashing while an inept resident attempted to do a procedure on her while the other (stable) patient screamed continually for ice and her family kept pushing the curtains back to threaten me with legal action or bodily harm because i was "ignoring sister because she's black," the charge nurse was sitting at the desk reading my computer charting and commenting to all of the other nurses on shift who were sitting at the nurse's station about what i was doing wrong. how would she know? she never even popped her head into the room to look? nor did anyone else who was listening avidly to lab values that charge was reading out: glucose of 22, hemoglobin of 5.9.

i'm not saying all nurses are like that, or even all of the nurses where i work. but it's an alarming majority.

i miss the gratitude and courtesy of patients and their families. but i sure miss the teamwork, too.

i was thinking about this today myself. it seems people have taken on a competitive nature in nursing. better to let someone sink and be fired than work as a team and leave management with the impression that all the nurses are equal.......seems to be the attitude lately.

our nurses "work" together, they don't function as a team though. for me, teamwork goes beyond simple things like helping someone pull a pt. up in bed or doing a couple chart checks here and there. everyone is an island upon themselves and has their own idea of how much they have to do to avoid being accused of "not helping". they do just enough to be able to claim being a team member, and stop.

good example of what i am talking about:

middle aged nurse, more computer savy than a good many of her fellow nurses was orienting me when i got my current job. she was leaving the unit, and i was put with her because the other nurses on that night were all new grads. she was very nice and helpful to me. she showed me a way to do chart checks so that all the info. i needed to see (to make sure orders were actually put in) was on one screen right in front of me. none of the other nurses on the unit had any idea of how to do this.

this nurse eventually left the unit. one day, i was doing chart checks and another nurse who had been there 20 years asked me "why do you use that screen for chart checks?" i showed her how every order, from meds to pt. care to labs......could all be verified from that one spot. she was amazed at the simplicity of the chart checks after trying it out herself.

the nurse who had shown me did not get along with others on the unit, didn't feel like she was a member of the team, and never pointed it out to anyone. shame, chart checks used to be such a hassle for some of the nurses on the unit until they started using her system. how appreciated would she have been for pitching in and showing them all the better way? it didn't happen though, and it was not entirely her fault. she felt like an island, was in many instances treated like one, and everyone's experience suffered because of it.

i'll also say, being a part of a team requires a focus on how to ask for help, and i find that lacking these days. when i was a cna at a very busy nursing home many years ago......the rule was, you don't ask someone to come in and help pull a pt. up in bed until they are ready to be pulled up. on this unit i am on now, they will grab you, ask for your help, then as you are standing there waiting to pull the pt. up......gather meds to give the pt and fill out hourly rounding sheets or flush jps. ignorant. they don't even know to gather supplies when they need help cleaning up a pt. before asking for help. they'll grab me, interupt my documentation or chart checks, and leave me standing in the room while they gather bed linen and other supplies.

its not only the desire to be a team member that lacks today, its the knowledge/skill of how to do so efficiently that is gone.

allnurses Guide

NurseCard, ADN

2 Articles; 2,847 Posts

Specializes in Med/Surge, Psych, LTC, Home Health.

I hear ya, sister. The first hospital that I worked, doing Med/Surge.. generally, if one nurse's patients were doing okay and her work was finished, that nurse would sit at the nurses station on her butt, while the other nurse, or nurses, drowned. That was the atmosphere of the two Med/Surge units of that hospital. Not sure what the other units were really like.

My second Med/Surge experience was much, much different... much more of a sense of teamwork throughout that whole hospital... on the floor that I worked, each nurse had her own patient assignments, but all the other nurses pitched in to help out if a nurse was drowning, or just simply had a task that they were having difficulty completing. I was always just a so-so IV starter, and always had plenty of help if I had patients that I just couldn't stick.

I work psych now and most likely will never go back to Med/Surge, or for that matter any other type of floor in a major medical hospital. In psych, teamwork is CRUCIAL.


180 Posts

It's random. Wouldn't it be nice if there was a way to figure out the formula of a unit that works well? It doesn't matter what shift it is. It doesn't matter whether it's team or primary care. It doesn't matter the ages of the nurses. Sometimes there is a unique spirit among the group that makes for a sharing of the work and satisfaction of a job well done. I've been agency and traveled. Every so often I've worked on highly functional units.

diane227, LPN, RN

1,941 Posts

Specializes in Management, Emergency, Psych, Med Surg.

I LOVED team nursing. You get a good CNA and you were off to a great start. You could whip out your baths and bed changes real quick and they all got done. Are you seeing now that some patients on your units do not get baths as often as they used to? I think the CNA's enjoyed it too. When I worked as a CNA when I was in nursing school, by teaming up with the nurse I learned a lot and she taught me things that I never would have learned in nursing school. Now it seems like all we do is chart, give meds and chart some more. I am sick of filling out forms. I nurse the chart more that I nurse a patient.


1,753 Posts

Specializes in Surgical, quality,management.

A good team is essential! In our ward we are often hectic as we are a colorectal speciality/ trauma ward where in other hospitals the pt would be in HDU.

We are busy and have no nursing assistants and 4 pt each. Each shift has at least one Grad (usually 2) on and bank (pool) nurse 2 senior nurses and the Charge.........so it is crazy! But we help each other out if someone sees the hoist rolling down the hall they call out and see do I need a hand. If I know that there is a full spinal precautions pt on the ward I tell that nurse to sing out for me when she needs to do a log roll and collar care.

Our charge always lets us know if one of the grads has a sick patient or the bank nurse has one that is going downhill so that we keep an ear out and have a look at them if needed. The other day a grad came to me and was concerned about her post op pt who was hypotensive.............went in looked at him and saw a GTN patch. Poor grad was so busy looking at the numbers and panicking she missed the patch which had been put on in recovery and NOT handed over.

We also bounce ideas off each other all the time why is this happening?? what is the rationale? how can we fix it? I'm a good stick for bloods, another girl always seems to know where there is some IV paracetamol (which pharmacy only gives us in tiny amounts!) one of the guys has a "source" on the oncology ward for information, another is a genius with fixing beeping VAC machines!

Alot of us have worked in the UK and Ireland and know how lucky we are with 4 pt. so can zip around faster than the "locals" who have only ever had 4 pt!

I bake a lot and supply the ward with goodies, another is a cook and will bring in a home-made quiche or pie and we all share it and have chat!

Also there was a random "strip show" last week when we were trying on new uniform samples in the break room! Those of us who have worked in other places where we had communal changing rooms had no hangups about dropping pants in front of each other and trying the clothes on! So funny about the ones that had never worked anywhere where they had a communal changing room...... they went quite while we were chatting and stripping off!

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