Teamwork in Acute Care: Perceptions of Essential but Unheard Assistive Personnel and the Counterpoint of Perceptions of Registered Nurses

Abstract

Teams of unlicensed personnel and registered nurses have provided hospital-based nursing care for decades. Although ineffective teamwork has been associated with poor patient outcomes, little is known of the perspectives of nursing assistive personnel (NAP). The purpose of this study was to gain insights into the perceptions of NAP and professional registered nurses (RNs) on teamwork in acute care. In a qualitative descriptive approach in a metropolitan hospital in the southeastern United States, 33 NAP participated in audio-recorded focus group sessions, and 18 RNs provided responses to open-ended electronic survey questions. Findings were examined in relation to previously identified coordinating mechanisms of teamwork: shared mental models, closed-loop communication, and mutual trust. None of the mechanisms was strongly represented in these data. In contrast to RNs' mental models, NAP perceptions of teamwork included the centrality of holistic caring to the NAP role, functional teams as NAP-only teams, NAPs and RNs working in parallel spheres rather than together, and team coordination in silos. Closed-loop communication was less common than one-way requests. Mutual trust was desired, but RNs' delegation of tasks conveyed to NAP a lack of value and respect for the NAP role, while RNs perceived a professional obligation to delegate care to ensure quality of care amid changing patient priorities. Further empirical research into NAP practice is needed to enhance understanding of teamwork issues and direct effective interventions to improve work environments and ultimately patient outcomes. © 2016 Wiley Periodicals, Inc.

Relationship between nurses' perceptions of nursing assistant roles and information‐sharing behaviors: A cross‐sectional study

“…Regarding asking behavior, nurses' perceptions of the NA roles of “caring for a range of patients using broad perspectives” and “facilitating co‐ordination and co‐operation among team members” were related to their frequency of asking NAs questions. A previous study on teamwork between nurses and NAs found that some nurses recognized NAs as critical team members in providing patient care and understood the importance of communication with NAs (Bellury et al, 2016). These nurses may regard information received from NAs more positively and incorporate it into patient care.…”

“…As noted, NAs provide patient care under the guidance of nurses but do not necessarily care for patients alongside nurses, often resulting in nurses and NAs caring for patients separately (Bellury, Hodges, Camp, & Aduddell, 2016). Collaboration between nurses and NAs is essential to achieve comprehensive and high‐quality nursing care (Kalisch, 2011; Kalisch & Lee, 2010; Wagner, 2018); information‐sharing between nurses and NAs is necessary to ensure high‐quality patient care.…”

Interventions to promote teamwork, delegation and communication among registered nurses and nursing assistants: An integrative review

“…To safely complete patient care, RNs and NAs must work as a holistic unit with great teamwork and strong communication skills. The importance of teamwork, communication and delegation between RNs and NAs has been the focus of some research studies in health care (Bellury, Hodges, Camp, & Aduddell, 2016; Kalisch, 2011). Knowing the evidence of these studies is a vital piece in the process of promoting collaborations between RNs and NAs.…”

Adding unregulated nursing support workers to ward staffing: Exploration of a natural experiment

“…However, it would appear that the situation is more complex than simply adding these staff to a ward. It is important to consider the possible unintended consequences of adding unlicensed staff to nursing wards/units, which may result from insufficient integration and acceptance of unlicensed staff (Bellury, Hodges, Camp, & Aduddell, ), problems with communication and delegation of tasks (Magnusson et al., ), a poorer skill mix and damage to morale over time (Aiken et al., ). It is important that we must also consider the implications of initially adding unlicensed staff to existing staffing (i.e., the complementary model ) but then not replacing RNs who subsequently leave (i.e., such that it ultimately becomes a replacement model ).…”

“…However, it would appear that the situation is more complex than simply adding these staff to a ward. It is important to consider the possible unintended consequences of adding unlicensed staff to nursing wards/units, which may result from insufficient integration and acceptance of unlicensed staff (Bellury, Hodges, Camp, & Aduddell, 2016), problems with communication and delegation of tasks (Magnusson et al, 2017), a poorer skill mix and damage to morale over time (Aiken et al, 2017).…”