Rebuilding 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 could hire great players but getting them to play together is another story. Most nurse leaders would agree with this assessment. Building effective teamwork and team backup has always been challenging in nursing, especially in the post-pandemic environment where turnover has skyrocketed to 27% yearly, and the use of travel nurses is now part of strategic staffing.

Younger Generation Z nurses are more individualistic in their approach and may not have had exposure to strong teamwork during their clinical education. Answering a patient’s call light that is not part of their assignment may seem like a foreign concept. Recently, several managers have presented me with scenarios where their team members are not helping one another even when there is a clear need. One ED director told me that he reminds his young nurses at least five times daily that “nobody sits down until everyone can sit down.” There is not a teamwork mindset that is so critical in emergency departments.

Team backup is an essential concept in healthcare. In this era of short staffing, it has become even more critical. In reality, we can’t do primary nursing care as we have in the past. There are simply not enough RNs, and there won’t be for many years to come. By necessity, care needs to be delivered using a team approach. John Maxwell reminds us of this in his Law of Everest – “The Law of Everest: As the Challenges Escalate, the Need for Teamwork Elevates.”

Teaching Team Backup to Nurses

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 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 look for signs that the person has a spirit of giving and is not a taker or a matcher. Leaders must be sure to 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 needed?
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?

Initiatives to Build a Team Back-up Culture

Some nurse leaders are already at work to emphasize the importance of teamwork and team backup. Examples of creative initiatives include the following:

The Team Scavenger Hunt – every staff member on the unit is asked to come up with one question, usually something personal about themselves, for new team members to ask. During orientation, the new staff member goes on a scavenger hunt and must meet every team member, filling in the blanks on the questions.
The Emergency Pit Crew – on many units, when complex patients are admitted, the emergency pit crew approach is adopted to facilitate that patient’s timely admission and treatment. We drop everything and go in and help so no one gets behind or overwhelmed.
A Buddy On Every Shift – to help build relationships and promote team backup, a backup buddy is now increasingly being designated on assignment sheets.
The Battle Buddy Program – is an initiative I wrote about in a blog to promote friendships on teams and a spirit of camaraderie.
Fishbowl Fridays – a critical care director talked about her fishbowl Fridays, which she initiated to promote team backup. Every week, staff nominate other staff who have helped them with their work. On Fridays, they “go fishing” and choose the nominee who demonstrates a spirit of teamwork. That person gets a prize.
No Nurse Left Behind – a nurse manager shared her initiative based on her experience as a Marine. We would never leave anyone behind on a mission; she observed – why do nursing teams think it is okay to leave nurses overwhelmed with things they have not completed at the end of their shift? This is not okay in my world, and I have told them we can accomplish much more together.

Building strong team backup is critical to staff retention. Team inclusion is a vital aspect of building psychological safety. When there is no strong team culture – it is very easy to leave a unit and never look back. Committing to a culture of team backup is an inexpensive retention intervention and is vital to the future of nursing.

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