Teamwork...in an Imperfect World.

[Anna Flaxis]

I recently took a new job where I was just amazed by the teamwork displayed by the entire staff. I was just in awe. But now, the honeymoon is over. I'm starting to see the chinks in the armor. Like Neo in "The Matrix", catching glimpses of the true reality, I am beginning to "wake up".

Don't get me wrong- the teamwork really is outstanding. Nobody ever utters the words "That's not my patient.", or when a physician asks who is taking care of Patient X, we might respond "Joe has been, but what can I help you with?". If there are orders to be transcribed, IVs to be started, meds to be given, EKG/Radiology/CT techs to be paged, whoever is not doing something at the moment just does it. Well, mostly.....

I work with one particular nurse who has....habits, shall we say...that I struggle with. It has made me see the value of zone nursing, where each nurse is assigned a set of rooms, or primary nursing, where each nurse has a set of patients, and those are their patients that they are responsible for. This is the background I come from, where I cut my teeth in ED nursing, and I have really enjoyed the team nursing approach in comparison. But, I've been seeing the value in zone or primary nursing lately.

What are these habits, you may ask?

Well, disappearing for one. Not just for a few minutes to go to the bathroom or something, but anywhere from 15 to 30 minutes, where I do not know where my partner in nursing is. I tell my partners where I'm going, even if I'm just going to the bathroom. That way they know, if something happens and they need me, where I am. Not this nurse. This nurse seems to feel it's okay to be gone without saying anything. To be fair, sometimes this nurse does tell me where they're going- for instance they will clock in and then tell me they need to go deliver a book they're lending to another nurse over in OB- and of course, they're gone for no less than 30 minutes.

Another thing is cherry picking. This is where the other nurse picks the patients they really want, sometimes even taking a patient right out from under me, and is conveniently busy when patients they don't want show up, leaving the other nurses to take them. This nurse tends to cherry pick the traumas and critically ill one on one patients, leaving the other nurses to manage the rest of the department.

Lastly, the "going the extra mile" thing. This is where the nurse will spend a good 30 to 45 minutes on the phone with a patient that was seen in our ED last week but still has some questions. This wonderful, caring nurse will spend as much time on the phone with the poor hapless soul as it takes to solve all their problems, while we're getting hammered with real patients who need real care in our ED right now.

I won't mention the personal phone calls. Oh, well I guess I just did.

So, what is my plan to address this, you may ask? Well, I considered talking to my supervisor. But this nurse has been around for a long time and has pretty close bonds with my supervisor. I don't want to have to watch my back. I was happy when I found this job and thought those days were over, and I want to maintain that illusion as long as possible.

So then I thought maybe whenever I work with this nurse, I'll just take care of my own patients and spend as much time in my patients' rooms as possible, sticking to a more primary or zone nursing model. But, this can be really inefficient, and not helpful to the patients.

Ah, I know what I must do. I must address these habits as they happen in the moment. I have to actually communicate with this other nurse about these habits. I'm not sure exactly how to do this- interpersonal communication is not my strong point, especially where conflict might be involved. It's something I work on regularly. Maybe that's what I'm supposed to gain from all of this- more practice in this area of weakness of mine. It's not really what I want. I'd rather practice difficult IV starts or hone my respiratory assessment skills.

Sometimes, however, getting outside of one's comfort zone, outside of that bubble of safety, is how we grow....and so, I will look at this as another one of those unsolicited opportunities for growth.

And maybe, just maybe, the teamwork will be enhanced as a result.

[thenightnurse456]

Lest my original post appear to be just a rant about a specific co-worker and not really an article about teamwork at all, I just want to say that even though I zeroed in on specific problem behaviors from one specific co-worker, the big picture context is that of how to promote better teamwork. In my experience, one person can bring teamwork to a screeching halt- it's like that saying, that a chain is only as strong as its weakest link.

So yes, I realize that my post may have come off as rant-y, but I ask the reader to put the specifics in the context of the bigger picture.

I think the poster who suggested leading by example hit the nail on the head. I think in this situation, where I am the newcomer and the person with the problem behaviors is well entrenched, direct confrontation may be counterproductive, and that the best way to perpetuate the great teamwork that made such an impression on me at the beginning, is to continue to behave as if that is the case and to set a good example by walking my talk.

Thoughts?

Team nursing is great... When you have good team members.

[Ava Z.]

The key to great teamwork is communication and making sure that everyone in the team is on the same page and has the same goals in mind. This creates honesty, trust, and a desire to see the team as a whole succeed.

[KatL.RN, ADN, RN]

I'm replying to a comment by 'lumbarpain'first:

I'm wondering what the affordable health care act has to do with nurses not doing their jobs or poor organization in the facility?

Now for both you and lumbarpain:

Those problems sound like they have been a part of the "culture" of that particular facility for a lot longer than the last year or two.

If they are really neglecting or endangering their patients you need to start documenting what you observe including dates names etc. Send a written memo to your immediate supervisor AFTER you speak with him/her in person to voice your observations and concerns. CYA! If things don't improve then it's your duty to report these issues to the State Surveyors, or JAHCO or whichever is responsible for oversight of these facilities in your state.

[KatL.RN, ADN, RN]

The situation you describe sounds like it's an entrenched part of the "culture" of the facility and not anything new. You might want to look for other employment. Whatever you do Document, document, document! Unfortunately it sounds like a CYA situation for you until you find a better position or the current one starts to improve.

*** sorry for what seems like a redundant post I'm writing from my phone and thought I'd "lost" my original comment until I posted this one an lo and behold there were two posts. :-(