When Nursing Teams Fall Apart - Emerging Nurse Leader

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

Over the past six months, frontline leaders have talked to me about the changes in their teams since 2019. These include the following:

An onboarding of many new nurses who have failed to establish a strong connection with their organization and unit.
Young new graduates precepting other recent graduates and taking charge before they have been fully socialized.
Significant numbers of agency and travel nurses on teams who are there to work their contracts and “stay out of the politics of the team.”
The retirement of many seasoned nurses who were part of the core team staffing for many years.
The wearing of PPE makes it difficult to read facial expressions or sometimes recognize the staff member.
Socialization restrictions and rules that limit the use of break rooms and lounges.
A loss of most team rituals including eating lunch, having baby showers, and socializing after work. Without them, teams struggle to build meaning in their work.

One manager told me, “Over the past two years, I have watched my team fall apart. Everything today is so transactional. My turnover is high, and staff is angry. They work with travelers making 4-6X what they do and feel underappreciated by the organization. I heard a surgeon tell one of my nurses the other day that she did not need to put up with this understaffing – she should go to work for an agency. I see a big difference in the level of staff attachment to the organization. There is very little “social glue” holding things together.”

I have long believed that this loss of teamwork and team rituals is essential for staff turnover and discontentment. We now have new data from Press Gainey that supports so many frontline leaders’ observations. In a flight risk assessment study involving more than 100,000 healthcare workers, Press Gainey researchers now estimate that up to 30% of the RN workforce are at risk of leaving their organizations. Young nurses are especially at high risk of leaving. Some of the other interesting trends included:

New hires who don’t connect with their team, managers, or organization are at the greatest risk for turnover. About one in five nurses who fit this profile leaves their job.
Employee engagement ratings dropped at twice the rate among RNs compared with non-RNs in the past 12 months.
Shift schedules play a significant role in employee engagement: Nurses who work night and weekend shifts reported lower levels of engagement than their day-shift counterparts.

Press Gainey recommends a sharper focus on nurse engagement. Improving a sense of team belonging is a solid and effective retention strategy for health systems. We know especially for new graduates, professional support, finding meaning in their work, and socialization to the team is critical to a successful transition in the first year. When teams are in a state of turmoil, they may not receive this.

One crucial step to successful retention and engagement of nurses right now is focusing on rebuilding our work teams. The place for frontline leaders to begin their assessment is with these six essential questions:

Do we know one another?
Are staff inclusive of new team members?
Do team members recommend our unit as a good place to work?
Is there psychological safety on our team?
Do we provide each other team backup?
Is bullying and/or incivility tolerated?

Coming together after falling apart is not easy but is important work right now on many nursing units. Without it, even the best recruitment and retention plans won’t be successful.

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