NUR 431 Module 4 Project One Team Analysis Example

Project One: Analyzing a Night Team That Never Stands in One Room

[Student Name]

Southern New Hampshire University

NUR 431: Leadership Practices for the Professional Nurse

Project One

[Instructor Name]

[Date]

The organization, setting and figures below are a composite written as a model document. No real employer, client, colleague or patient is described.

Project One: Analyzing a Night Team That Never Stands in One Room

Teams in textbooks meet around a table. The night team at Ridgeline Community Hospital, a composite 25-bed critical access hospital, almost never does. Its members are spread across two units, their homes and a physician's office in another city, and they come together only when a patient needs several of them at once. This Project One analysis examines that team using the stages of group development proposed by Tuckman (1965) and the teamwork framework proposed by Salas et al. (2005). It finds that the night team is capable and committed but stuck between forming and storming because its membership changes every shift, and that its weakest teamwork components are the ones that depend on shared understanding: closed-loop communication and a shared mental model of who is doing what.

The Team and Its Work

On a typical night the team includes the house supervisor, two registered nurses in the emergency department, a pair of RNs with one LPN and one aide covering inpatient and swing beds, a laboratory technician, an x-ray technologist and a respiratory therapist on call with a thirty-minute response time, and a hospitalist who covers admissions and inpatient concerns through a video cart. Two or three travelers are usually on the schedule. The team's shared tasks are to admit patients from the emergency department, respond to deterioration, stabilize patients who need transfer and keep the building safe overnight. Most nights are quiet until they are not: a trauma, a septic patient or two simultaneous admissions can require almost every member within an hour.

Stage of Development

Tuckman (1965) proposed that groups move through forming, when members orient and depend on the leader; storming, when conflict emerges over roles and tasks; norming, when shared expectations develop; and performing, the stage at which the team gets its work done with little wasted friction. The night team shows features of forming and storming. With rotating schedules and travelers, the same combination of people rarely works together twice in a month, so each night partly restarts the forming stage. Storming appears around roles, as in a recent disagreement over floating a traveler to the emergency department, and around expectations of the on-call staff, some of whom feel called in for tasks that could have waited. The team has pockets of norming among long-time staff, who know each other's habits, but newcomers do not share those norms. The model helps explain why the team can perform well in a crisis led by a strong supervisor and still struggle on ordinary nights.

The Big Five of Teamwork

Salas et al. (2005) argued that five behaviors sit at the core of effective teamwork: someone coordinating the effort, members keeping an eye on one another's work, members stepping in to help, the team adjusting when conditions change, and members putting team goals ahead of their own. Three mechanisms hold these together: a shared understanding of the situation, messages confirmed by the receiver, and trust. Table 1 applies each to the night team.

Table 1

Night Team Strengths and Gaps by Teamwork Component

Note. Composite team. Components and mechanisms follow Salas et al. (2005).

Interpreting the Pattern

The table shows a consistent pattern. The team's strengths rest on the experience and relationships of long-time staff, while its gaps affect the members who are new, remote or on call. Shared mental models and closed-loop communication, which Salas et al. (2005) describe as the mechanisms that allow the core components to work, are weakest at exactly the points where the team is most dispersed. A traveler may not know that the respiratory therapist has a thirty-minute response time. The hospitalist on video may not know which nurse is caring for which patient. Calls to the laboratory technician at home often end without confirmation of what was requested and when the technician will arrive.

What Teamwork Interventions Can and Cannot Do

Structured teamwork interventions are promising but not magic. O'Leary et al. (2015) implemented structured interdisciplinary rounds on five medical units and found that teamwork scores on a safety attitudes survey improved, driven mainly by nurses, but that the rate of adverse events did not change. The authors suggested that higher baseline teamwork and lower adverse event rates than in their earlier study may have limited the room for improvement. For Ridgeline, that finding sets expectations: changes that improve how the team works together are worth making, but the team should measure communication and coordination directly rather than expect an immediate drop in adverse events.

Recommendations

Three changes address the weakest mechanisms. First, a five-minute start-of-shift huddle, in person for those in the building and by phone for on-call staff who wish to join, to build a shared mental model: who is working where, which patients are at risk and who responds to what. Second, closed-loop communication for every call to on-call staff and the video hospitalist, in which the receiver repeats the request and states an arrival time or next step. Third, a brief night-team orientation for travelers covering on-call response times, the video cart and the surge plan. The supervisor would lead all three, and the team would track two measures for three months: the share of on-call calls with a confirmed arrival time and staff ratings of knowing who to call for what.

Conclusion

Ridgeline's night team is committed and capable, especially when an experienced supervisor takes charge in a crisis. Tuckman's stages explain why it keeps returning to forming and storming, and the Big Five framework shows that its gaps cluster around shared understanding and communication with members who are new, remote or on call. A huddle, closed-loop calls and a traveler orientation would strengthen the team where it is thinnest.

References

O'Leary, K. J., Creden, A. J., Slade, M. E., Landler, M. P., Kulkarni, N., Lee, J., Vozenilek, J. A., Pfeifer, P., Eller, S., Wayne, D. B., & Williams, M. V. (2015). Implementation of unit-based interventions to improve teamwork and patient safety on a medical service. American Journal of Medical Quality, 30(5), 409-416. https://doi.org/10.1177/1062860614538093

Salas, E., Sims, D. E., & Burke, C. S. (2005). Is there a "big five" in teamwork? Small Group Research, 36(5), 555-599. https://doi.org/10.1177/1046496405277134

Tuckman, B. W. (1965). Developmental sequence in small groups. Psychological Bulletin, 63(6), 384-399. https://doi.org/10.1037/h0022100