A team is any group that works together toward a common goal.

Reaching the goal requires teamwork and a clear, shared vision of the future.

Team building isnt just magic, its just plain hard work. Challenge and Motivation

1. Mission The team must know the organization mission and then establish goals that contribute to that mission. And the team must be clear about its own mission.

2. Assessment The team must identify the criteria that ensure their effectiveness and assess how well they fulfill each of the criteria. Identifying strengths and weaknesses.

3. Goal Setting Team members must identify ways to improve team effectiveness, working together to develop common goals, learning the benefits of cooperation. 4. Communication The team must learn to communicate about ideas, problems, opportunities and concerns both within the group and up and down the organization.

5. Leadership Good teams need good leaders. And learning to share leadership can make theteam even more effective.

Predetermining a carefully detailed course of action that will enable the organization, unit, or individual to achieve specific objectives or goals. Requires ability to think, to analyze data, to envision alternatives and to make decisions. A decision making process.

Organizing the work of nursing care within each shift, between shifts, and between nurses and other health professionals throughout the health care deliver system.

A complementary function of direction. Effective delegation implies that a nurse shares a segment of corresponding authority, and demands accountability.

Is an inherent part of all organizations, units and work groups. Within a health care organization, conflict may result from divergence of opinion, incompatibility, transmission of erroneous information, or competition for scarce resources.

Nurses are employed in diverse settings: hospitals, community agencies, long term care, private practice, physician offices, faith communities and ambulatory clinics, which have an impact on the design of work groups.

In the hospital setting, it is assumed that the majority of all care must be performed by the employees. Anne Rowe She developed a workshop for self management of multidisciplinary primary health care teams. The theory and research on teamwork and adult learning principles and focuses on values, trust building and the equality of all to encourage interaction and risk taking.

Organization of the hospital and its larger system Cost of health services Nurse Characteristics

Bureaucratic structure shifted to a learning organization structure characterized by an integrated approach to organizational effectiveness, systems orientation, horizontal communications and professional growth and empowerment.

This trend has led to the fact that health professionals must be prepared to practice in settings that are more intensively managed and integrated.

The cost of hospital services is increasingly emphasized. Singleton and Nail explained hospital structure, organization, and relationships from a financial perspective. Doctor (responsible) nurse (implementing)-payers (government agencies) Patient (consumers)

Therefore, the quantity and quality of the services provided to patients is influenced and monitored by another body outside the hospital environment.

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Nurses sphere authority has not changed since World War II. Physicians work fewer hours and are available less for consultation in the hospital. Nurses are have not been recognized for their new level of clinical decision making.

4. The role of the nurse to synthesize and monitor multiple diagnostic and treatment regimens has not been recognized. 5. Nurses are the coordinators of all the support service involved with the care and safety of a patient, yet they have no authority to deploy or redirect these services to carry out responsibilities. 6. Nurses, mostly women who are now looking at many professional career options, do not find working conditions in hospitals professionally satisfying.

Magnet Hospitals Hospitals that were judged to have outstanding records of nurse recruitment and retention.

A visible, accessible, and participatory administration. Knowledgeable and strong leaders who support their work and care about their working conditions. A collaborative organizational structure with mutual goal setting Staffing patterns that recognize the need for adequate quantity, quality, and mix of expertise of staff.

Personnel programs and policies with flexible work schedules, competitive salaries, and benefits. Active recruitment and retention programs, Professional practice support nurse autonomy, constructive feedback on the quality of care, and knowledgeable nursing consultants available.

The Secretarys Commission on Nursing Report contained 8 of 16 recommendations addressing reorganization of the work place.

Health care delivery should preserve nurses time for direct patient care by providing adequate staffing levels for clinical and non-clinical support services. Innovative staffing patterns should use nurses different levels of education, competence, and experience. Automated information systems and other new labor saving technologies should be developed.

Methods for costing, budgeting and tracking nursing resource use should be developed. Involvement of nurses at all policy and decision making levels must occur The decision making level of the nurse in cooperation with medicine should be recognized. Positive and accurate images of nurses work should be promoted.

The effects of nurse compensation, staffing patterns, decision making authority and career development on nurse supply and demand and health care cost and quality should be researched.

Is used as an indicator of the hospitals and units status. (Alexander) voluntary turnover rate of 1,726 RN and licensed vocational nurses on 146 units within 17 hospitals. Correlated into 4 varialbles.

Staff integration Centralization Communication/coordination Evaluation

Defined as the ratio of RNs assigned to the unit to total patient care staff assigned to unit, extent of RN rotation and among shifts, and ratio of full-time staff to all staff.

Defined as RN influence in unit related decisions and decision-making authority of the head nurse.

Defined as the frequency of contact and communication among nurses during the shift, frequency of patient care conferences, explicitness of unit policies and procedures.

Defined as perceive accuracy of head nurse performance evaluation and the number of patients care hours performed by head nurse per week.

Yocom He conducted a test on 4,500 newly licensed nurses who responded to questions about nursing activities and client needs.

Nurses in medical/surgical clinical unit scored high in performing routine nursing measures, monitoring clients at risk, preparing clients for procedures, and controlling pain. low: emotional/behavioral needs, staff development, management, and collaboration and quality assurance and safety. Very low: parenting skills associated with teaching mothers and fathers how to care for new infant and immunizations.

The hay group conducted over 850 hospitals about nurses working on medical-surgical units. They found : 26% of RNs time = Professional Nursing 22% = Support Functions 52% = Housekeeping

The investigators reported the reason these nurses stayed or left an institution was based on reasons directly and indirectly related to environment, job, perceived opportunity for personal and professional growth.

Has been described using words such as knowing, caring, intuitive, the essence of nursing, or hidden work. The knowledgeable nurse and technically competent nurse distinguishes between what is nice and what is necessary for the clients care and not only cares about the assigned clients but also cares for them.

Platt says a team requires: A group of 2 or more A shared sense of purpose among the group members Interactions among the members that make them able to accomplish working individually toward the shared purpose.

Team building is an essential leadership competency and according to Schaffner and Berningham it is a method of participative management that encourages staff commitment to the unit and the organization.

The team or work group culture is an important ingredient when facilitating a team building. A group that knows what it stands for and where it wants to go is in a better position to move forward than a group that lacks an identity and is aimless.

Competing Values Model by Quinn This model appeared meaningful in understanding the complex and competing dynamics on a hospital. Quinn was concerned about how experts think about effective organizations and tried to understand underlying assumptions causing the behavior.

Vertical axis flexibility to control Horizontal axis internal to external focus Human relations internal focus with criteria as cohesion and morale, and values human resources training. Rational goal values output, productivity and efficiency with planning and goal setting. Open system provides an external orientation, values expansion and adaptation, readiness, growth, competition and resource acquisition.

Internal orientation is the internal process model that values continuity and consolidation with stability and control, information management, and communication. The model can be used to diagnose and intervene in actual organizations.

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