Abstract
A postal questionnaire survey of 10 022 staff nurses in 32 hospitals in England was undertaken to explore the relationship between interdisciplinary teamwork and nurse autonomy on patient and nurse outcomes and nurse assessed quality of care. The key variables of nursing autonomy, control over resources, relationship with doctors, emotional exhaustion, and decision making were found to correlate with one another as well as having a relationship with nurse assessed quality of care and nurse satisfaction. Nursing autonomy was positively correlated with better perceptions of the quality of care delivered and higher levels of job satisfaction. Analysis of team working by job characteristics showed a small but significant difference in the level of teamwork between full time and part time nurses. No significant differences were found by type of contract (permanent v short term), speciality of ward/unit, shift length, or job title. Nurses with higher teamwork scores were significantly more likely to be satisfied with their jobs, planned to stay in them, and had lower burnout scores. Higher teamwork scores were associated with higher levels of nurse assessed quality of care, perceived quality improvement over the last year, and confidence that patients could manage their care when discharged. Nurses with higher teamwork scores also exhibited higher levels of autonomy and were more involved in decision making. A strong association was found between teamwork and autonomy; this interaction suggests synergy rather than conflict. Organisations should therefore be encouraged to promote nurse autonomy without fearing that it might undermine teamwork.
Key Words: teamwork; nursing autonomy; interprofessional working; quality of care
Full Text
The Full Text of this article is available as a PDF (175.2 KB).
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Aiken L. H., Clarke S. P., Sloane D. M. Hospital restructuring: does it adversely affect care and outcomes? J Nurs Adm. 2000 Oct;30(10):457–465. doi: 10.1097/00005110-200010000-00003. [DOI] [PubMed] [Google Scholar]
- Aiken L. H., Clarke S. P., Sloane D. M., Sochalski J. A., Busse R., Clarke H., Giovannetti P., Hunt J., Rafferty A. M., Shamian J. Nurses' reports on hospital care in five countries. Health Aff (Millwood) 2001 May-Jun;20(3):43–53. doi: 10.1377/hlthaff.20.3.43. [DOI] [PubMed] [Google Scholar]
- Aiken L. H., Patrician P. A. Measuring organizational traits of hospitals: the Revised Nursing Work Index. Nurs Res. 2000 May-Jun;49(3):146–153. doi: 10.1097/00006199-200005000-00006. [DOI] [PubMed] [Google Scholar]
- Aiken L. H., Sloane D. M., Lake E. T., Sochalski J., Weber A. L. Organization and outcomes of inpatient AIDS care. Med Care. 1999 Aug;37(8):760–772. doi: 10.1097/00005650-199908000-00006. [DOI] [PubMed] [Google Scholar]
- Aiken L. H., Smith H. L., Lake E. T. Lower Medicare mortality among a set of hospitals known for good nursing care. Med Care. 1994 Aug;32(8):771–787. doi: 10.1097/00005650-199408000-00002. [DOI] [PubMed] [Google Scholar]
- Buchan J. Lessons from America? US magnet hospitals and their implications for UK nursing. J Adv Nurs. 1994 Feb;19(2):373–384. doi: 10.1111/j.1365-2648.1994.tb01095.x. [DOI] [PubMed] [Google Scholar]
- Casey N., Smith R. Bringing nurses and doctors closer together. BMJ. 1997 Mar 1;314(7081):617–618. doi: 10.1136/bmj.314.7081.617. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Dechairo-Marino A. E., Jordan-Marsh M., Traiger G., Saulo M. Nurse/physician collaboration: action research and the lessons learned. J Nurs Adm. 2001 May;31(5):223–232. doi: 10.1097/00005110-200105000-00002. [DOI] [PubMed] [Google Scholar]
- Firth-Cozens J. Celebrating teamwork. Qual Health Care. 1998 Dec;7 (Suppl):S3–S7. [PubMed] [Google Scholar]
- Firth-Cozens J. Multidisciplinary teamwork: the good, bad, and everything in between. Qual Health Care. 2001 Jun;10(2):65–66. doi: 10.1136/qhc.10.2.65. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Irvine D., Sidani S., Hall L. M. Finding value in nursing care: a framework for quality improvement and clinical evaluation. Nurs Econ. 1998 May-Jun;16(3):110-6, 131. [PubMed] [Google Scholar]
- McKee M., Aiken L., Rafferty A. M., Sochalski J. Organisational change and quality of health care: an evolving international agenda. Qual Health Care. 1998 Mar;7(1):37–41. doi: 10.1136/qshc.7.1.37. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Mechanic D., Aiken L. H. Sounding Board. A cooperative agenda for medicine and nursing. N Engl J Med. 1982 Sep 16;307(12):747–750. doi: 10.1056/NEJM198209163071211. [DOI] [PubMed] [Google Scholar]
- Shortell S. M., Zimmerman J. E., Rousseau D. M., Gillies R. R., Wagner D. P., Draper E. A., Knaus W. A., Duffy J. The performance of intensive care units: does good management make a difference? Med Care. 1994 May;32(5):508–525. doi: 10.1097/00005650-199405000-00009. [DOI] [PubMed] [Google Scholar]
- Sochalski J., Aiken L. H., Fagin C. M. Hospital restructuring in the United States, Canada, and Western Europe: an outcomes research agenda. Med Care. 1997 Oct;35(10 Suppl):OS13–OS25. doi: 10.1097/00005650-199710001-00004. [DOI] [PubMed] [Google Scholar]
- Stein L. I. The doctor-nurse game. Arch Gen Psychiatry. 1967 Jun;16(6):699–703. doi: 10.1001/archpsyc.1967.01730240055009. [DOI] [PubMed] [Google Scholar]
- Stein L. I., Watts D. T., Howell T. The doctor-nurse game revisited. N Engl J Med. 1990 Feb 22;322(8):546–549. doi: 10.1056/NEJM199002223220810. [DOI] [PubMed] [Google Scholar]
- Zimmerman J. E., Rousseau D. M., Duffy J., Devers K., Gillies R. R., Wagner D. P., Draper E. A., Shortell S. M., Knaus W. A. Intensive care at two teaching hospitals: an organizational case study. Am J Crit Care. 1994 Mar;3(2):129–138. [PubMed] [Google Scholar]