team work is lacking - what to do?

[purseOnalityRN]

Hey fellow nurses!

I have a long standing issue with my unit and I'm looking for advice on how to handle it constructively.

I work in neurosciences and our unit is full of total care pts. We only have one nursing attendent and 4 lpn/rn mix for 4-5 pt assignments each. Our unit has received team awards for the past few years. We used to be a great team and now it seems everytime I come home from work my back is in major pain and I'm frustrated as hell.

I cannot tolerate a few nurses on my unit who are great people out of work but have poor team skills. For example, charting at 830am (which I thought was looked down upon) without asking others if they need help. Or sitting down and chatting when you know your pt is on the call bell and needs to go to the bathroom or back to bed. (our pts are usually acute cva's thus they are all very heavy transfers)... Another example is a nurse chatting away & wasting time through the morning and then complaining that she can't finish off her meds or am care - then asks someone else to do it for her.

I am not perfect but I do strive to stay on task and help other team members before I sit down to relax or chart. When I know a pt is going for a test I finish off what I'm doing and go help with the transfer. If I'm done all my morning care I ask others if they want help with theirs. If I'm in charge and the desk is not busy I ask the nurses on the floor what I can do to help them. I feel the shift goes a lot better when nurses help each other - afterall we are working collectively to maintain pt care..

Our unit has a very high acuity with lots of backbreaking work. I feel like when I get home I'm so tired of taking care of my pts plus picking up slack due to either unawareness or just plain lazyness of a few staff members. It only takes one team member to be on with you to = a heavy stressful day.

I need some feedback. How do you constructively say to someone that their organization skills or team skills are lacking? I am not the only one on my unit that feels this way. And it's not just one particular nurse that is slacking.. t's a few.. Do you suggest bringing it up at a staff meeting? talking to the unit manager? talking directly to individuals? How do nurse managers respond to this? or am I just burnt out?? :uhoh21:

[1Tulip]

That's a tough one. I don't think there's any simple, good solution. What comes to mind is a lot of little things that might help.

First of all, you don't want to say to anyone that they have "poor team-working skills". That's a conlusion you've come to based on what sounds like adequate observations, but it's still your conclusion. You're better off dealing with specifics, i.e., a nurse squanders a couple of hours and then needs help to get work done in a timely way.

Second, you can't really do anything about a slacker if it's the first or second time it happens. Everyone can have a bad day... or two. You can only deal with it if it's really chronic and consistent.

Third, you have to bend over backwards to walk the walk before you talk the talk. Sounds like you are already doing that, but you have to be way above reproach, I think, before you start offering critiques of others.

Fourth, whatever you do don't act like a martyr.

Fifth, you don't talk to nurse B about nurse A's behavior. No talking behind the backs of others, no lobbying in advance to get people on "your side."

Sixth, if you're going to talk to someone about being a slacker, or being disorganized, or not being considerate of others on the team, do it in private.

But even with all that, I don't know how I would address the issue. Maybe someone with good conflict resolution skills can weigh in on this. But... trying to put myself in your shoes, I'd probably take her aside and say something along the line of:

You know, Mary... I don't mind helping you at all, 'cause I know you'd do the same for me if I asked you... (giving the benefit of the doubt here)... But maybe tomorrow you could kinda anticipate the rush. If you need help to stay ahead of the curve, let me know then and that way neither of us will get in a time crunch.

Then if I saw Mary sitting on her butt in the nursing station the next day, I'd ask her if she needed any help. Three hours later when she's got her back against the wall, she'll realize you already offered to help keep her from getting in dire straights. Maybe she'll feel chagrined at how she got in that position.

Hey, if you find something that works, let us know because I'll bet this has happened to a lot of people.

[P_RN, ADN, RN]

how many beds on your unit? how are the teams arranged? who is on the team?

imagine a 33 bed unit....14 rooms on the south and 26 rooms on the north. some semiprivates only had one bed but a room stretcher was not out of the realm of possibility in high census.

count from 1-11---that is always team one

12-14 and 24ab 25ab 26ab 27ab 28 are team 3

15, 16, 17ab, 18, 19, 20. 21 22 and 23are team 2

a team is rn+lpn+cna you stay with the same team all the days you work. if you are off you may or may not get the same team but then you stay til your next day off.

now this is important you have the whole team, so does the lpn and so does the cna. the tasks are split rn does the assessments while the lpn starts the med pass. they confer, pass on info as needed. they include the pct in decisions about when blood draws, bath preferences and transport are due. they all sit in report from the previous shift.

that's a team. since all have total responsibility for the same patients no one has time to sit back and not be busy.

a team is a valuable commodity. you can't do it willy-nilly and you can't slack off because the other two will remind you softly or loudly to get off the tracks and back on the team.

[purseOnalityRN]

1tulip : Thanks for the advice.. And no - unfortunately it's not the first or second time my shifts with them were like this.. I really wish it could be a "bad day for them" scenario. Ya it's a touchy subject and I agree - I'm not so sure there is a good way of bringing it up.