Nursing teamwork in general ward settings: A mixed‐methods exploratory study among enrolled and registered nurses

Aim To examine the perceived level of nursing teamwork and factors influencing teamwork among enrolled nurses (ENs) and registered nurses (RNs) in general ward settings. Background The nursing care delivery model includes RNs, ENs and others who work as a team to deliver patient care. The potential impact of teamwork on nursing care highlights the need to explore the work of nursing teams. Design A mixed‐methods exploratory study. Method Quantitative and qualitative data were collected concurrently from ENs and RNs in 2018. Two hundred and forty‐eight (n = 248) nurses completed the Nursing Teamwork Survey. Sixteen nurses participated in focus group discussions. Qualitative data were reported following COREQ guidelines, while quantitative data followed the STROBE guidelines. Results Both ENs and RNs scored highest for the shared mental model subscale but lowest for the team orientation subscale. Factors including qualification level, years of working experience, perceived job staffing adequacy and job satisfaction were found to influence teamwork. Three themes emerged from the qualitative findings: expectations of each other's role, delegation practices and interpersonal relationships. ENs and RNs differed in their expectations of their role in basic patient care activities and faced power struggles related to delegation practices. Open and structured communication was deemed essential in building interpersonal relationships. Conclusion The ENs and RNs have clear understanding of their personal roles and responsibilities towards achieving a common goal. However, teamwork may be improved with a shared mental model in performing basic nursing care tasks, mutual support for workload management, better delegation practices, effective communication, enhanced interpersonal relationships and better team orientation. Relevance to clinical practice Nurse managers and educators need to work collaboratively to foster positive delegation practices in clinical practice supported by applicable team training that enhances mutual trust, backup behaviours and collective orientation in nursing teams.