Nurse A: "We all have to share the knowledge. For example, in the last case, we needed to reinsert a guidewire and I grabbed the wrong wire and did not recognize it at first. And my circulating nurse said, "Sue, you grabbed the wrong wire." This shows how much different roles don't matter. We all have to know about everything. You have to work as a team.

Nurse B: "There is a painful process of finding out what didn't work and saying "We won't do that again." We are reactive. The nurses have to run off for stuff unexpectedly....If you observe something that might be a problem you are obligated to speak up, but you choose your time. I will work around [the surgeon]. I will go to his PA [physician's assistant] if there is a problem....If I see a [surgical] case on the list [for tomorrow] I think, "Oh! Do we really have to do it! Just get me a fresh blade so I can slash my wrists right now." (Johnson, 2009). Apply you knowledge of teams and team processes to explain possible causes for team members' experiences nursing metaparadigm articles. What interventions would you recommend to address the concerns expressed by Nurse B?

For Nurse A, her experience was a team effort. There may have been roles that they all played, but they worked together to get the job done. Everyone shares the same knowledge and they can all complete the same tasks with that knowledge. There is always some form of support coming from someone who works on the team. The staff never feels like they are alone and if there is a mistake that is being made, there is someone there to guide them in the right direction.

The staff had clear purpose and expectations of their roles. A study of the Queensland Children's Cancer Centre at the Royal Children's Hospital in Brisbane, Australia showed that when the team knew the clear purpose and expectations of their roles, that attention to the team's culture, vision and purpose, providing information and improving communication and relationships, when combined with a team's enthusiasm, will improve the team's growth, cooperation and work outcomes (Slater, 2011).

For Nurse B, there is absolutely no teamwork. It seems as if there are constant mistakes being made and no one there to guide them in the right direction. Nurse B feels as if her job is a painful situation. The team has no clear purpose of vision of what their roles are and the expectations that come along with those roles. She stated that the team is "reactive" in certain situations. By being reactive and in the moment, the team could cause a patient harm. There needs to be some kind of guidance on the team. The nurse feels like she can only go to the surgeon's PA when she has a problem, even though the surgeon is the team leader.

As the team leader, the surgeon needs to understand that mastering the art of team leadership can mean the difference between a medical career that is very satisfying and productive and one that is a tension-filled, frustrating series of interpersonal conflicts (Tiffan, 2011). The environment that his team is working in is full of tension and the team feels like they can't go to the surgeon if they feel that something is wrong. There needs to be a strong foundation for the team and at this point, the surgeon is not giving the team that foundation to stand on.

The first intervention that I would recommend to help Nurse B with her concerns is to identify the purpose of the team. Team identification is proposed as a mechanism of performance. Just because a team is created, this does not guarantee that the members will operate as a collective unit to accomplish tasks (Solansky, 2011). The person that puts the teams together needs to identify who works well with each other and who doesn't and if they can all work together as a team. If there is some conflict, there needs to be someone there who can mediate the problem and make sure that the team gets the job done.

The next intervention I would recommend for Nurse B is to go to the surgeon. After all, he is the team leader. If she feels that something is wrong, the surgeon should be the first person that she addresses her concerns with. As a member of the team, you have the freedom to voice your opinion when you see that something isn't being done in a proper manner or if you feel that there may be a way for the team's performance to improve and the team leader should be available to hear those concerns and ideas. If you feel that you can't talk to the team leader, I suggest that you try to find someone who is above him and express those concerns. As long as Nurse B keeps quiet and keeps everything to herself, things can only get worse. It's all about learning and growing and moving forward.

The final intervention that I would recommend for Nurse B is that she suggest some kind of formal training for all of the team members. If all of the team members share the same knowledge, there would always be someone around to help you if you need it. Nurse A, has the support of her other team members because they all have the same knowledge no matter what their roles are. They are all trained in every area that they need to be, so if something needs to be done in a specific role and the person who fills that role is unavailable, there is always someone on the team that can accomplish the task at hand. There is no shared knowledge on Nurse B's team and it is clear when mistakes are made, they just react. They need to have all around knowledge like Nurse A's team.


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