Building a Culture of Team Backup - Emerging Nurse Leader

By Rose O. Sherman, EdD, RN, NEA-BC, FAAN

Casey Stengel, the late and great coach of the Yankees, once noted that you can hire great players but getting them to play together is another story. Most nurse leaders would agree with this assessment. Building effective teams can be very challenging in nursing especially with 12-hour shifts where team composition is constantly shifting. Recently, several managers have presented me with scenarios involving situations where their team members are not helping one another even when there is a clear need. New staff see this culture of not helping and eventually stop asking. “It’s not my job” can easily become a cultural norm that govern how staff function when working on a team. Teamwork becomes difficult and work-life is unpleasant. Lack of team backup dramatically impacts the patient experience. Patients can clearly see when the team is not working well together and it erodes their confidence. The team lacks psychological safety.

Team backup is an important concept in healthcare and has been addressed in the TeamSTEPPS guidelines. It is rooted in everyone’s understanding that they are part of something larger than themselves, everyone relies on one another and that healthcare is delivered by teams not individuals. Mutual support is a core team skill and a crucial component in any teamwork process. It includes a team’s willingness to reallocate functions, compensate when a team member is overloaded, distribute work thoughtfully and provide feedback during the shift about workload. When Google researchers studied team effectiveness as part of Project Aristotle, they learned that team backup and dependability was one of 5 essential ingredients to building an effective team.

Strong team backup should be a core value in any organization and one that is emphasized to nursing staff from the point of the initial interview. Ask potential candidates to give you specific examples of how they have backed up other team members in prior jobs or while in school. Adam Grant in his book Give and Take recommends that leaders should look for signs that the person has a spirit of giving and is not a taker or a matcher. Leaders need to be sure that they role model this behavior when working with others.

Some key questions to ask team members to assess team backup include the following:

Do you feel safe asking your team members for help when you need it?
Do you have a system on the team to let others know when you need help? (Some units use a traffic light system to signal a staff member is feeling overwhelmed).
How do your team members respond when you ask for help?
Is “it’s not my job” a phrase used on the unit?
When patients ask for help on the unit, does the responding team member try to solve the problem?
What happens when team members are running late with their assignments during a shift?

If the answers to these questions indicate that team backup is a problem, then it will need to be reaffirmed as a core value on the unit along with expected behaviors. A failure to have strong team backup is ultimately a patient safety issue and one that leaders need to directly address.

Read Rose Sherman’s new book available now – The Nurse Leader Coach: Become the Boss No One Wants to Leave