Nursing faculty are an endangered group. The shortage of individuals entering the academic environment as nursing faculty impacts not only the nursing workforce but ultimately, care provided to patients. Nursing faculty are an important part of the “supply chain” for the healthcare industry, generating an average of 6 nurses/faculty member/year and supporting $704,000 of care annually (Kowalski & Kelley, 2013). It is estimated that nursing schools in the U.S. turned away 64,067 qualified applicants in 2016 due to a number of reasons including lack of qualified nursing faculty (American Association of Colleges of Nursing, 2017).
Nurses often choose the faculty route for their career after several years of clinical practice, with the desire to use knowledge and wisdom to prepare the next generation of nurses. However, many faculty are soon disillusioned with the academic environment due in part, to the lack of mentoring and support from senior faculty (Goodrich, 2014). In many cases, the lack of support is accompanied by more concerning behaviors such as feeling devalued or undermined, thus, impacting job satisfaction and ultimately resulting in turnover (Peters, 2014; Clark, Olender, Kenski, & Cardoni, 2013).
Addressing faculty-to-faculty incivility must be a priority to mitigate the damaging effects to faculty as well as the nursing profession (Peters, 2014; Clark, Olender, Kenski, & Cardoni, 2013). Strategies to foster civility focus on interventional strategies targeting improvements in communication and teamwork, implementing policies and protocols, fostering effective leadership, dealing directly with conflict, and actively building relationships (American Nurses Association, 2015; Clark, 2013).
During Fall 2017, the SON at NIU was entering a transitional time as 37 faculty/instructors/staff, as well as the SON chair, left for a variety of reasons including retirements and other employment opportunities. To fill these vacancies, 47 people were hired including nine tenure-track faculty and an interim chair. The turnover rate for Fall 2015 through Fall 2017 was approximately 50%. Turnover not only impacts research, teaching and service, but the associated costs of recruiting, hiring and training personnel (Bucklin, Valley, Welch, Tran, & Lowenstein, 2014). Even with the addition of these necessary resources at NIU, the environment did not improve.
During this same time period, it was noted, anecdotally, that the culture reflected a lack of teamwork and the environment was lacking in supportive peer to peer relationships. The SON began to look towards the future, and in doing so realized that nursing faculty, instructors, and staff could benefit from team training as a precursor to strategic planning and other curricular changes. Coincidentally, this came at a time when a person with experience in team training and development at the hospital and national level, joined the faculty. Capitalizing on this unique situation, we saw the opportunity to take a well-renowned team training program, adapt it for an academic settingpopulation and evaluate its effectiveness as this has been identified as a gap in the healthcare team training literature.
Study DescriptionThis quality improvement study compared perception of teamwork at baseline (November 2017) against data collected at two time points (May 2018 and August 2018) after an educational intervention administered to employees of the NIU SON. The educational intervention was an adaptation of the Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPSâ) curriculum that was developed by the U.S. Department of Defense and the U.S. Agency for Healthcare Research and Quality (AHRQ) (AHRQ, 2017a). The educational intervention consisted of a six hour training session involving the concepts of team structure, communication, leadership, situational monitoring and mutual support and application of those concepts, followed by biweekly emails to reinforce concepts, share examples and provide resources. To our knowledge, this is the first study to evaluate whether TeamSTEPPSâ training improves faculty/staff/instructors perception of teamwork utilizing the TeamSTEPPSâ Team Perceptions Questionnaire (TPQ) (AHRQ, 2017b).
Since the inception, TeamSTEPPSâ has been implemented across many disciplines and has been found to improve teamwork, communication and collaboration through the use of the TeamSTEPPSâ training and the tools such as SBAR, briefings, checklists and huddles. This allows for a common language among healthcare providers and across practice settings (Gillespie, Chaboyer, & Murray, 2010). Most team training in healthcare has been focused on the core clinical team with less than 40% of team training involving individuals responsible for establishing and communicating vision, developing expectations related to teamwork and redesigning processes (Weaver, Dy, & Rosen, 2014).
The perception of teamwork, in the areas of team structure, communication, leadership, situational monitoring and mutual support, was measured using an adaptation of the TPQ (AHRQ, 2017b). This survey measures individual perception of group-level team skills and behavior and is a self-report measure of teamwork within a unit or department (AHRQ, 2017b). The study sought to answer the question: Does TeamSTEPPSâ training improve faculty/staff/instructors’ perception of teamwork?
ResultsFrom baseline TPQ to TPQ 2, 31 of 34 areas demonstrated improvement, with the greatest improvement in the domain of Mutual Support, specific to the questions: School of Nursing team members are comfortable bringing up challenges or concerns and School of Nursing team members resolve their conflicts, even when the conflicts become personal.
A comparison between TPQ 1 and TPQ 2 indicated improvement in 33 of 34 questions with the greatest improvement in the domains of Leadership and Team Structure. The statements with the most improvement are as follows: My supervisor/manager ensures that team members are aware of any situations or changes that may affect our work; School of Nursing team members are held accountable for their actions; Staff/faculty/instructors can meet deadlines; All members of the School of Nursing team communicate frequently and; School of Nursing team members are comfortable bringing up challenges or concerns.
ImplicationsTeamwork training is an effective strategy to improve communication, collaboration and conflict resolution, and thereby combat faculty-to-faculty incivility in schools of nursing (American Nurses Association, 2015; Clark, 2013). In the clinical setting where TeamSTEPPSâ is typically used, quality control is imperative to safety. Although the measures in an academic setting differ, we view “high stakes” as that of an environment that functions to its highest level of teamwork potential in order to provide the best educational experience for students.
The study outcomes from the teamwork strategy implemented at the NIU SON suggest improvement in such key domains as related to civility as well as those affiliated with faculty retention and resource management. Building on these outcomes, we aim to more thoroughly assess the perception of teamwork on a larger scale and further develop tools to support teamwork training, pilot test the tools to refine the content and delivery of teamwork strategies, and evaluate the effectiveness of the teamwork training and delivery methodology.
Limited information exists regarding teamwork training programs that have been developed and deployed to address incivility in the academic environment. If successful, these training programs may mitigate faculty-to-faculty incivility and improve efficiency and resource allocation, ultimately leading to increased quality of care outcomes. Additional studies integrating teamwork training in various SON programs are currently warranted to prevent the ongoing prevalence of faculty endangerment.