Are teamwork and professional autonomy compatible, and do they result in improved hospital care?

Abstract

A postal questionnaire survey of 10 022 staff nurses in 32 hospitals in England was undertaken to explore the relationship between interdisciplinary teamwork and nurse autonomy on patient and nurse outcomes and nurse assessed quality of care. The key variables of nursing autonomy, control over resources, relationship with doctors, emotional exhaustion, and decision making were found to correlate with one another as well as having a relationship with nurse assessed quality of care and nurse satisfaction. Nursing autonomy was positively correlated with better perceptions of the quality of care delivered and higher levels of job satisfaction. Analysis of team working by job characteristics showed a small but significant difference in the level of teamwork between full time and part time nurses. No significant differences were found by type of contract (permanent v short term), speciality of ward/unit, shift length, or job title. Nurses with higher teamwork scores were significantly more likely to be satisfied with their jobs, planned to stay in them, and had lower burnout scores. Higher teamwork scores were associated with higher levels of nurse assessed quality of care, perceived quality improvement over the last year, and confidence that patients could manage their care when discharged. Nurses with higher teamwork scores also exhibited higher levels of autonomy and were more involved in decision making. A strong association was found between teamwork and autonomy; this interaction suggests synergy rather than conflict. Organisations should therefore be encouraged to promote nurse autonomy without fearing that it might undermine teamwork.

Interprofessional collaboration may pay off: introducing a collaborative approach in an orthopaedic ward

“…The checklist may have created a higher degree of certainty in the team and increased the team's capacity for decision-making regarding their health services. Through the intervention the members of the team may have changed their attitude from a wait-and-see attitude to being pro-active as described by (Rafferty, Ball, & Aiken, 2001), who found teamwork and professional autonomy to be compatible, promoting synergy and thereby improving hospital care. Furthermore, it is possible that the previous hierarchy between the healthcare professions with the surgeon making all the decisions independently was more balanced by the use of interprofessional meetings with joint decisions.…”

Knowledge translation and interprofessional collaboration: Where the rubber of evidence-based care hits the road of teamwork

“…9,10 Explanations for poor interprofessional relationships include the lack of explicit, appropriate task and role definitions; the absence of clear leadership; insufficient time for team building; the "us-and-them" effects of professional socialization; frustration created by power and status differentials; and the vertical management structures for each profession. [11][12][13][14] As this evidence of error and quality problems accumulates, it is accompanied by a growing belief among policymakers that interprofessional relationships are important and must be improved. For reasons that remain unclear, policymakers are choosing to intervene in this relationship using one of two generic approaches.…”

Nurse Autonomy in Cancer Care

“…Oncology primary nurses also linked autonomy with job satisfaction, a sentiment echoed in previous studies examining nurse work environments. 16,22,39,40,42,44 Findings from Magnet hospital studies revealed that RNs experience greater job satisfaction in circumstances characterized by positive nurse-physician relationships, autonomy in clinical decision making, and control over their work. 16,22,39,40,42,44 Other studies that examined nursing work environments in non-Magnet hospitals also supported the relationship between nurse autonomy and job satisfaction.…”

“…10,24Y26,28 Professional nurse autonomy has been identified as a key indicator of quality healthcare environments. 12,22 Studies have shown that perceived autonomy is a strong predictor of nurse job satisfaction 7,10,22,34,39,41 and that autonomy and job satisfaction are linked to job retention. 39,40,43 In the present study, oncology primary nurses shared how they would be less likely to stay on the job if they did not have job satisfaction.…”