Teamwork and Collaboration Nursing CE Course

workplace to create an environment where all levels of staff work together and respect one other's opinions (AHRQ, 2023b; Rodziewicz et al., 2024).

Nurses must communicate effectively with a diverse group of professionals and unlicensed personnel when caring for patients. Health care delivery to patients suffers when health care team members communicate ineffectively. This finding has prompted several health care organizations, including the IOM and the AHRQ, to call for an improvement in communication skills among HCPs (AHRQ, 2023c; Rodziewicz et al., 2024).

The Joint Commission (TJC) also addressed communication in its 2025 National Patient Safety Goals for Hospitals. The second goal is to "improve the effectiveness of communication among caregivers" (TJC, 2025). This goal explicitly addresses the need to report critical results of tests and diagnostic procedures promptly to the correct individual. Critical results of tests and diagnostic procedures fall significantly outside the normal range and may indicate a life-threatening situation. The objective is to provide the responsible licensed caregiver with these results within an established time frame so the patient can be promptly treated. Institutions should develop written procedures for managing critical results of tests and diagnostic procedures by identifying the definition of critical results of tests and diagnostic procedures, by whom and to whom critical results are reported, and the acceptable length of time between the availability and reporting of critical results (TJC, 2025).

One of the essential elements of human interaction is the ability to communicate. Communication, particularly in high-intensity environments such as health care settings, is not merely the transaction of words. Effective communication requires an understanding of the underlying context of the situation, an appreciation for the tone and emotions of a conversation, and accurate information. The consistent implementation of effective communication principles can bridge gaps between departments and staff, ensuring reliable and dynamic information and feedback exchange. Recently studied and found successful, the Sunnybrook framework for healthy interprofessional team collaboration includes communication as the first key principle (Table 1; McLaney et al., 2022).

 

Table 1

Sunnybrook Core Competency: Communication

Definition

Interdisciplinary teams seek to achieve common understanding when communicating across roles and professions. They are attentive to actively providing information to and seeking information from team members and other teams to ensure a thorough understanding of the situation. They create specific processes and tools and select varied media/approaches to enhance the exchange of information within and across teams.

Associated behaviors

The team develops specific processes for exchanging information in a specific and timely manner—within and across teams. The team explicitly considers which members need to be involved in giving and receiving which pieces of information. The team communicates using language that is common among roles and professions by avoiding jargon and acronyms, providing explanations and checking for understanding.

Professional Collaboration 

To illustrate a highly effective practice environment, the ANA included collaboration in their code of ethics in provision 8: "Nurses build collaborative relationships and networks with nurses, other health care and non-healthcare disciplines, and the public to achieve greater ends" (ANA, n.d., Provision 8, para. 1). The provision includes "networking, advocacy, leadership, and diplomacy" (ANA, n.d., Provision 8, para. 2). These principles guide all nurses in their synergistic role to create, enhance, and sustain collaborative relationships. When working relationships are strong and effective, nurses function as a team and can deliver on their shared goal of high-value care (ANA, n.d.).

In collaboration, there is no implied supervision or hierarchy; it is a two-way exchange of information. The power is shared and based on everyone’s knowledge and expertise in the setting, not their role or title. When there is true collaboration in the workplace, the responsibility for the patient is shared; the professionalism of all is strengthened when each group member has participated and obtained success. Each professional's unique perspective on a situation results in creative and practical solutions; in turn, the patient's well-being is the ultimate beneficiary. To practice effective communication in the workplace, everyone must be willing to participate equally. Collaboration is significantly more complex than simply working closely. It implies an interdependence and a degree of caring for one another. A collaborative relationship is not merely the sum of its parts but a synergistic alliance that maximizes each participant's contributions, which results in greater action than the sum of individual efforts (ANA, n.d.; O'Hara, 2024; McLaney et al., 2022). Refer to Table 2 for the elements of a healthy practice environment according to the American Organization for Nursing Leadership (AONL, n.d.).

Table 2

Elements of a Healthy Practice Environment

Element	Definition
Collaborative practice culture	Respectful collegial communication and behavior, team orientation, presence of trust, respect for diversity
Communication-rich culture	Clear and respectful, open and trusting
A culture of accountability	Role expectations are clearly defined, everyone is accountable
The presence of adequate numbers of qualified nurses	Ability to provide quality care to meet patient's needs, work/home life balance
The presence of expert, competent, credible, visible leadership	Serve as an advocate for nursing practice, support shared decision-making, allocate resources to support nursing
Shared decision-making at all levels	Nurses participate in system, organizational, and process decisions, formal structure exists to support shared decision making, nurses have control over their practice
The encouragement of professional practice and continued growth/development	Continuing education is supported/encouraged, participation in professional association encouraged, an Information rich environment is supported
Recognition of the value of nursing's contribution and by nurses for their meaningful contribution to practice	Reward and pay for performance, career mobility and expansion

Authentic Relationships 

Professional nurses cultivate caring relationships with their patients, supporting them to meet their physical, mental, and spiritual needs related to health. To bolster the profession and the quality of care patients receive, nurses must also build intentional professional relationships with one another. Nurses engage in the art and science of care; by their very nature, they thrive when they experience care from their colleagues. The principles of authentic relationships guide nurses to develop these interactions with colleagues and cultivate their sense of being cared for, promoting their ability to do the same for their patients. The ANA outlined this in the Code of Ethics, provision 5: "The nurse has moral duties to self as a person of inherent dignity and worth including an expectation of a safe place to work that fosters flourishing, authenticity of self at work, and self-respect through integrity and professional competence" (ANA, n.d., Provision 5, para. 1). Section 5.2 focuses on wholeness of character, stating that authenticity in nursing practice is key. Section 5.3 states that wholeness of character is based on personal integrity, which necessitates discernment and reflection (ANA, n.d.).

Establishing a Culture of Support

One of the first crucial steps is organizational commitment and willingness to address teamwork and collaboration. Leadership must demonstrate commitment, which reflects how an organization conducts its business. The focus should be on behavioral standards and their relationship to patient safety. Addressing dysfunction in communication that affects collaboration, information exchange, appreciation of roles and responsibilities, and direct accountability for patient care are vital components of any patient safety program. Clinical and administrative leaders must set the tone by establishing and adhering to behavioral standards that support the agreed-upon code of conduct practices backed by a nonpunitive reporting culture and zero-tolerance policy (AONL, n.d.; McLaney et al., 2022; O'Hara, 2024).

The next step in the process is recognition and self-awareness. Organizations must be able to assess the prevalence, context, and impact of behaviors to identify potential opportunities for improvement. Completing an internal assessment will help pinpoint issues and their severity and provide clues about which areas need to be addressed. Assessment information can be gained from formal methods such as incident reports, survey tools, gap analysis, focus groups, department meetings, task forces or committees, direct observation, and suggestion boxes. Informal methods such as casual meetings and conversations can also provide valuable preliminary information and should prompt further evaluation of the source, relevance, and significance of the data to determine the next steps (Adler, 2024; AHRQ, 2023a; Hut-Mossel et al., 2021; Martin & Bryant, 2023; Newera et al., 2024; Schnipper et al., 2021).

Creating formal and informal opportunities for different groups to gather is a highly effective strategy for enhancing collaboration and communication. Encouraging open dialogue, organizing collaborative rounds, implementing preoperative and postoperative team briefings, and creating interdisciplinary committees or task forces to discuss problem areas frequently provide an upfront solution that reduces the likelihood of disruptive events. When a disruptive event occurs, some organizations have implemented a time-out, code white, "speak up" or a "stop-the-line" policy that addresses the issue in real-time to prevent further serious consequences (AHRQ, 2023b, p. 25; Rickert et al., 2023; Rodziewicz et al., 2024, para. 32; Schnipper et al., 2021; Stephen et al., 2022).

Developing and implementing a standard set of behavior policies and procedures is vital. These policies need to be consistent and universally applied. There should not be a separate policy for any specific discipline or service. The policy should include a standardized protocol outlining expected standards and the process for addressing disruptive behavior issues, recommendations, follow-up plans, and actions to be taken if individuals resist or refuse to comply. Before implementation, employee education is needed to ensure all staff are familiar with the existence, purpose, and content of policies and procedures. The organization needs to encourage all employees to report disruptive behaviors so that the process can work successfully. They also need to address issues related to confidentiality, fear of retaliation, and the common sentiments that there is a double standard for specific disciplines and that nothing ever changes despite reporting incidents or speaking up. Reporting mechanisms should be user-friendly and supported by a nonpunitive environment. The ideal situation is to address the behavior in real-time, but concerns about position, appropriateness, receptiveness, fear, hostility, and retaliation are significant impediments. Appropriate avenues for reporting may include reporting the incident to a superior, filing an incident report, using a complaint or suggestion box, or reporting directly to a task force or interdisciplinary committee responsible for addressing these issues. Besides maintaining confidentiality and reducing the risk of retaliation, one of the most crucial aspects of the reporting system is recognizing and ensuring complaints will be addressed and corresponding actions are taken. Responses should be timely, appropriate, and consistent, while also providing necessary feedback and follow-up opportunities (AHRQ, 2023b; Ernstmeyer & Christman, 2024; Martin & Bryant, 2023; Newera et al., 2024).

The next step is taking action through appropriate intervention strategies. Interprofessional educational programs can provide education on collaboration and essential communication skills. Relevant topics include sessions on roles and responsibilities, values and ethics, communication, teamwork, and any other courses necessary to foster more effective team functionality and communication. Another essential strategy is promoting and providing competency training to all health care team members. The Veterans Health Administration (VA) has successfully used interprofessional collaborative education over the past decade, demonstrating how to effectively educate among diverse roles. Notably, the VA has proven that ambitious, interdisciplinary education initiatives can be expanded and implemented through a large health care organization. Focused team training programs have also been of significant value. Having a clinical champion or an early adopter who actively promotes the importance of appropriate behavior, communication, and team collaboration can be an extremely valuable asset. Champions can come from the executive ranks or other staff, if members express voluntary interest and enthusiasm. Co-champions may even be more effective. Some organizations have reported that having a nurse and physician (or another HCP) complete a joint training program helps foster cooperation and collaboration between different disciplines. Follow-up and feedback bring closure to the process. Participants must know that their input is welcomed, follow-up actions will be taken, and appropriate feedback will be provided (AHRQ, 2023b; Ernstmeyer & Christman, 2024; Liao et al., 2024; Martin & Bryant, 2023; Mohammed et al., 2021).

Mutual Respect 

Mutual respect is vitally important among all health care team members and must be valued by everyone to create a healthy, collaborative environment. Hierarchy is a barrier to communication. All hierarchies must be eliminated, if possible, to encourage collaborative practice. For example, some physicians with years of experience may expect nurses to be subservient and make fewer contributions on a professional level (AHRQ, 2023b; Ernstmeyer & Christman, 2024). 

According to Grenny and colleagues (2021), writing in Crucial Conversations: Tools for Talking When Stakes Are High, mutual respect is the continued condition of dialogue. People cannot stay in a conversation if they do not have mutual respect. If people perceive that others do not respect them, the conversation immediately comes to a halt. Respect is like air. If you take it away, it's all people can think about. The instant people perceive disrespect in a conversation, the interaction is no longer about the original purpose; it is now about defending dignity (Grenny et al., 2021).

Teamwork

Effective teams are characterized by shared purpose and intent, trust, respect, and collaboration. Team members value familiarity over formality and watch out for each other to ensure mistakes are not made. Health care teams that do not trust, respect, and collaborate are more likely to make a mistake that negatively impacts the safety of patients (Adler, 2025; AONL, n.d.).

In a 2002 work entitled The Five Dysfunctions of a Team, Patrick Lencioni points to five dysfunctions that create obstacles for even the best teams. He outlines a model with actionable steps that can be used to overcome these common hurdles and build cohesive, effective teams. Recent research has built on his model and added another category. Lencioni and contemporary colleagues identify the following dysfunctions and positive characteristics that may overcome each dysfunction. For Leoncioni's original framework, refer to Figure 1 (Aggarwal, 2023).

• Absence of Trust: Trust is confidence among team members that their peers' intentions are good and that there is no reason to be protective or careful around the group. Members of trusting teams:

• admit weaknesses and mistakes
• ask for help
• accept questions and input about their area of responsibility
• give one another the benefit of the doubt before arriving at a negative attribute
• take a risk in offering feedback and assistance
• appreciate and tap into each other's skills and experiences
• focus time and energy on important issues, not politics
• offer and accept apologies without hesitation
• look forward to meetings and opportunities to work as a group

• Fear of Conflict: It is crucial to distinguish productive ideological conflict from destructive fighting and interpersonal politics. The purpose is to produce the best possible solution in the shortest period. Teams that engage in healthy conflict:

• have lively, interesting meetings
• extract and employ the ideas of all team members
• solve real problems quickly
• minimize politics
• put critical topics on the table for discussion

• Lack of Functional Expertise: The revised model suggests that when expertise is lacking in the functional areas needed by a member of the group, other group members have difficulty trusting that all members will make valuable contributions to the group. Teams that have functional expertise:

• have valuable contributions from all members
• have trust among team members regarding competency and knowledge
• demonstrate high commitment and accountability

• Lack of Commitment: In the context of teams, commitment is a function of clarity and buy-in. Great teams make clear and timely decisions and move forward with complete buy-in from every team member, even those who voted against the decision. The most significant causes of a lack of commitment are the desire for consensus and the need for certainty. A team that commits:

• creates clarity around directions and priorities
• aligns the entire team around common objectives
• develops an ability to learn from mistakes
• takes advantage of opportunities before competitors do
• moves forward without hesitation
• changes direction without hesitation or guilt

• Avoidance of Accountability: In the context of teamwork, accountability refers specifically to the willingness of team members to point out performance or behaviors that might hurt the team. A team that holds one another accountable:

• ensures that poor performers feel the pressure to improve
• identifies potential problems quickly by questioning one another's approaches without hesitation
• establishes respect among team members who are held to the same high standards
• avoids excessive bureaucracy around performance management and corrective action

• Inattention to Results: A team's ultimate dysfunction is tendency of members to care about something other than the group's collective goals. An unrelenting focus on specific objectives and clearly defined outcomes are required for any team that judges itself on performance. A team that focuses on collective results:

• retains achievement-oriented employees
• minimizes individualistic behavior
• enjoys success and suffers failure acutely
• benefits from individuals who subjugate their own goals/interests for the good of the team
• avoids distractions

Strategies to Improve Interdisciplinary Collaboration

Updated in 2023, the AHRQ originally collaborated with the US Department of Defense in 2005 to develop the Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS). This evidence-based patient safety toolkit addresses the leading causes of medical errors. It helps organizations and HCPs improve health care delivery quality, safety, and efficiency through effective communication and teamwork skills. Many hospitals and care systems use the TeamSTEPPS framework to improve their culture and patient safety. One study showed an increase in positive staff perceptions of teamwork (13%) and communication (20%) when implementing TeamSTEPPS. TeamSTEPPS training has driven measurable quality improvement in various delivery areas using a framework of four core teachable-learnable skills, or competencies (refer to Table 3; AHRQ, 2023b, 2023c; Haugstetter et al., 2024):

Table 3

TeamSTEPPS Framework

1.	At the center are safe, efficient, and patient-centered care teams.
2.	This is based on four teachable-learnable skills: Team leadership: direct and coordinate, assign tasks, motivate team members, and facilitate optimal performance Situation monitoring: develop shared understandings of the team environment, apply strategies to monitor team members' performance, and maintain a shared mental model Mutual support: anticipate other team members' needs through accurate knowledge and shift workloads to achieve balance during periods of high workload or stress Communication: effectively exchange information among team members, regardless of how it is communicated
3.	The skills are connected and contribute to: Knowledge: shared mental model Attitudes: mutual trust, team orientation Performance: adaptability, accuracy, productivity, efficiency, safety, high reliability Sustainability: enduring culture of safety

(AHRQ, 2023b)

There are five phases of TeamSTEPPS implementation for the intervention to be effective:

• Readiness assessment: This is the first step that should be taken prior to implementation. It helps determine if there are issues or obstacles that need to be worked through before implementation can be successful.
• Measurement: Specific goals should direct measurement at the start to help gather baseline information and determine the extent of issues.
• Implementation planning: Planning occurs before implementation to ensure that activities are aligned with goals.
• Coaching: This is done with TeamSTEPPS tools until the implementation is fully incorporated into workflows and by personnel. The focus is on personal and team behavior change, which in turn creates organizational change.
• Change management: This is a high-level focus on safety and patient needs at organizational culture levels (AHRQ, 2023a).

Various other teamwork tools can be implemented to enhance patient safety (refer to Table 4).

Table 4 

Teamwork Tools 

(AHRQ, 2023b)

Although many communication tools are available, the SBAR tool (refer to Table 4) was initially implemented in the health care environment to facilitate better communication between nurses and providers. The SBAR is the gold standard for handoff reporting within health care, as many HCPs say that it leads to a more precise and thorough handoff. A 2019 pilot study determined that 72.2% of HCPs found the tool helpful to clarify information regarding the situation and request. Multiple studies have demonstrated significant benefits of using the SBAR tool, one of which found a reduction in mortality (11%), adverse events (65%), cardiac arrest (8%), and methicillin-resistant Staphylococcus aureus bacteremia (83%; Rholetter, 2024; Toumi et al., 2024).

Nurse-Provider Collaboration

Maximizing the effectiveness of nurse-provider communication is essential for creating interdisciplinary collaboration and more satisfying work roles. Nurse-provider collaboration can improve patient outcomes, lower health care costs, and maintain patient safety. Numerous studies have shown that when communication between nurses and providers is unprofessional or inadequate, conflict often arises and leads to poor patient outcomes and medical errors. It has also been found that poor communication between providers and nurses negatively influences nurse retention rates, resulting in staffing shortages. This is often the case when providers maintain a hierarchical relationship with nurses and view them as assistants instead of partners in the delivery of patient care (Al-Bustanji et al., 2024; AONL, n.d.).

 

Conclusion 

Effective clinical practice must not only focus on technological system issues but also the human factor. Strong communication encourages collaboration and helps prevent errors. Health care organizations must assess possible setups for poor communication and be diligent about offering programs and outlets to help foster team collaboration. By working to improve communication and collaboration, health care organizations have an opportunity to enhance their clinical outcomes significantly (Schnipper et al., 2021).

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