Originally published: May 21, 2022. Last updated: Oct 17, 2026.
If there is one skill that nurses need to excel at, it is teamwork. Teamwork sits at the heart of everything a nurse does, and even when a nurse is working one-on-one with a patient, the larger team is always part of the picture. Teamwork in nursing involves everything from building care plans with physicians and pharmacists to coordinating with fellow nurses so that no patient falls through the cracks between shifts. When it works well, teamwork improves the quality of care, reduces the chance of medical errors, and makes the whole facility run more smoothly. When it breaks down, patients pay the price. Communication failures have long been cited as a leading root cause of serious adverse events, and trade summaries of patient-safety data routinely note that up to 80 percent of serious errors involve some form of communication lapse, particularly around handoffs, shift reporting, and escalation of abnormal results.
The case for investing in nursing teamwork has only grown stronger since 2022. In 2024, the Agency for Healthcare Research and Quality released TeamSTEPPS 3.0, a major update to its evidence-based teamwork and communication program. Hospitals now have a clearer, free, nationally supported framework for turning teamwork from a vague aspiration into a trainable skill set. At the same time, the economics have become impossible to ignore. According to the 2025 NSI National Health Care Retention and RN Staffing Report, the average cost of turnover for one bedside registered nurse reached 61,110 dollars in 2024, and national staff RN turnover ran at 16.4 percent. Strong teamwork does not just protect patients. It protects staffing budgets, retention, and morale.
Why Teamwork in Nursing Is a Patient Safety Issue, Not a Soft Skill
It is tempting to file teamwork under soft skills, the kind of thing that appears on posters in the break room but never gets measured. That view is wrong, and patient-safety data proves it. In 2024, healthcare facilities voluntarily reported 1,575 sentinel events to The Joint Commission, the accrediting body that tracks patient safety events resulting in death or serious harm. Patient falls were the most frequently reported category at 49 percent, followed by wrong-site surgery, delays in treatment, and suicide. Across years of these reports, the same root causes keep appearing: failures in communication, teamwork, and consistently following established policies and procedures. The 2024 data also made clear that reporting is voluntary and represents only a small portion of actual events, which means the real burden of preventable harm is larger than any single dataset shows.
This is why nursing leaders increasingly treat teamwork as a clinical intervention rather than a personality trait. A team that communicates crisply during an emergency, that uses a shared mental model of the plan, and that monitors the situation together will catch the wrong dose, the missed allergy, and the deteriorating patient before harm occurs. A team where everyone works in silos will not. The evidence behind structured teamwork training is substantial: AHRQ notes that effective teamwork and communication are foundational to providing every patient with high-quality, safe care, and its TeamSTEPPS program was specifically designed to optimize the performance of healthcare teams using tools proven in military and aviation safety.
1. Increase and Standardize Communication
The first and highest-impact way to improve teamwork is to standardize how team members communicate, especially during handoffs. Informal, improvised communication is where details die. Structured communication is where they survive.
Start with the SBAR format (Situation, Background, Assessment, Recommendation), one of the core tools in the TeamSTEPPS system. SBAR gives nurses, physicians, and other team members a common script for raising concerns and handing off patients, so a night-shift nurse can convey the essential story of a patient in under a minute without losing the critical detail. For full shift handoffs, the I-PASS bundle, developed from TeamSTEPPS-derived teamwork training, provides a mnemonic: illness severity, patient summary, action list, situation awareness and contingency plans, and synthesis by the receiver. The results are striking. In a multicenter study across 32 adult, pediatric, academic, and community hospitals, implementation of the I-PASS program was associated with a 47 percent reduction in both major and minor handoff-related adverse events, alongside major improvements in the completeness of verbal and written handoffs.
Unit leaders can also audit communication channels. Are there too many channels (pages, texts, phone calls, sticky notes) and no agreement on which one matters? Consolidate. Do physicians prefer a call for urgent issues and a message for routine ones? Write that down and share it. Standardized communication does not make interactions robotic; it removes the guesswork that causes delays and errors.
2. Build Psychological Safety and Transparency
A team only works well if every member feels safe to speak honestly. Psychological safety means that a junior nurse can question a senior physician, a nursing assistant can flag that a patient looks different, and a pharmacist can push back on an unclear order without fear of ridicule or retaliation. Without it, transparency is impossible, and problems stay hidden until they become emergencies.
Leaders build psychological safety through visible behavior: thanking staff who raise concerns, admitting their own mistakes openly, and responding to bad news with curiosity rather than blame. One practical ritual is the post-event debrief, a short, blame-free conversation after a difficult shift or near miss that asks what went well, what was confusing, and what should change. Another is the safety huddle, a five-minute daily stand-up where the oncoming team surfaces risks for the day ahead. Both rituals work only when the charge nurse or manager models candor first. Research on team training during the COVID-19 pandemic found that TeamSTEPPS training promoted a shared mental model, clarified roles, and increased a sense of value and respect among healthcare teams, particularly in crisis conditions, which is exactly what psychological safety looks like in practice.
3. Clarify Roles and Responsibilities
Nothing poisons teamwork faster than unclear roles. When two nurses both assume the other gave the medication, or when everyone assumes the physician will call the family, accountability evaporates. Every team needs explicit role clarity: who is responsible for what, who backs up whom, and how tasks get reallocated when the unit gets busy.
In practice, this means more than job descriptions. It means clear assignment at the start of each shift, including a buddy or backup system so that no nurse is ever truly alone with an overwhelming load. It means cross-training so nurses can step into adjacent roles safely during surges. And it means teaching the TeamSTEPPS concept of mutual support: team members are expected to notice when a colleague is overloaded and offer help before being asked. For nurses exploring specialized nursing career paths, understanding role boundaries and advanced responsibilities becomes even more important as clinical scope expands.
4. Promote an Adaptability Culture
Hospitals never run exactly to plan. Admissions surge, staff call in sick, a patient codes in the hallway. Adaptable teams treat change as normal rather than as an interruption. Leaders can build this culture by running tabletop drills and simulations for scenarios like a sudden influx of patients, a code, or an evacuation, so the team practices flexing together rather than freezing.
The TeamSTEPPS 3.0 curriculum is instructive here. Released in 2024 after input from frontline providers, patients, families, and teamwork experts, it consolidated earlier versions into one integrated, modular resource designed for hospitals, long-term care facilities, and outpatient settings. It reflects five major areas of emphasis, including putting patients and family caregivers at the center of the team, integrating previously segmented materials into a single accessible platform, and using active learning strategies in a modular course design that trainers can adapt to their setting. AHRQ began offering free TeamSTEPPS training in 2024, which removes the budget excuse for units that have been postponing teamwork education. An adaptable unit adopts frameworks like this instead of inventing its own process from scratch every time.
5. Follow Up on Handoffs and Near Misses
Communication without follow-up is a wish, not a system. After any handoff, the receiving nurse should synthesize back the plan in their own words, confirming illness severity, pending actions, and what to watch for. This closed-loop step is built into the I-PASS mnemonic as synthesis by the receiver, and it is the moment where misunderstandings get caught instead of compounding across a shift.
Equally important is following up on near misses and adverse events. Units that track handoff quality, code blue response times, and incident reports can spot patterns: Are errors clustering around 7 p.m., when two shifts overlap and handoffs happen in a rush? Is one physician consistently unreachable? Data turns vague frustration into fixable problems. Nurses managing the stress of handoffs will also benefit from techniques for addressing pre-shift and post-shift anxiety, since handoffs are among the highest-pressure moments in a nursing shift.
6. Complete Regular Team Training
Teamwork is a perishable skill. Without practice, even good teams drift back into silos, especially after turnover changes the roster. That is why regular, structured team training matters more than a single annual workshop.
The most practical path in 2026 is TeamSTEPPS 3.0. The curriculum includes six welcome guides tailored to different audiences, frontline providers, trainers of pre-professional students, administrators, patients and family caregivers, and new and experienced TeamSTEPPS trainers, plus a pocket guide of tools and concepts and training videos that illustrate the techniques in realistic scenarios. The four core modules cover communication, team leadership, situation monitoring, and mutual support, followed by a section on implementation. Training is delivered using active learning strategies in a modular course design, which means sessions can run at different lengths, in person or virtually, to fit a unit’s schedule. Because AHRQ offers the training at no cost to participants, a nursing manager can launch a unit-level program without a capital request, and continuing education units are available for staff who need them.
Beyond TeamSTEPPS, units should run their own regular drills: rapid response simulations, code blue practice, and bedside handoff audits where a peer observes and gives feedback. The goal is not a one-time certificate but a rhythm of practice, ideally quarterly, that keeps shared language fresh.
7. Set the Example From the Top
Every teamwork initiative lives or dies on leadership behavior. If the nurse manager encourages speak-up culture but publicly shuts down a nurse who questions an order, the culture becomes the shutdown, not the slogan. Leaders set the example by doing what the training teaches: using SBAR themselves, attending handoffs rather than skipping them, admitting uncertainty, and publicly crediting team members who catch errors.
Visible leadership also means investing in the conditions that let teamwork work. Adequate staffing ratios, protected time for handoffs and huddles, and functioning communication technology are leadership decisions, not nursing decisions. A manager who fights for those resources is doing teamwork improvement, not just management. For nurses considering the broader trajectory of job opportunities after earning a nursing degree, leadership and teamwork competence increasingly distinguishes candidates for charge nurse, manager, and advanced practice roles.
The Business Case: What Poor Teamwork Costs a Nursing Unit
Teamwork improvement is often pitched as a patient-safety initiative, and it is, but the financial argument may persuade executives faster. The 2025 NSI National Health Care Retention and RN Staffing Report put the average cost of turnover for a single bedside registered nurse at 61,110 dollars, up 8.6 percent from the prior year, with costs ranging from roughly 49,500 to 72,700 dollars depending on specialty and region. The national staff RN turnover rate stood at 16.4 percent in 2024. Each one percentage point of RN turnover costs or saves the average hospital roughly 289,000 dollars per year. For a typical hospital, total annual losses tied to RN turnover fall in the range of several million dollars.
Turnover and teamwork are linked. The same report’s underlying data shows that the highest-turnover units are often behavioral health, step-down, and emergency departments, exactly the high-stress, high-handoff environments where teamwork quality matters most. It takes an average of 83 days to recruit an experienced RN, which means every departure leaves the remaining team shorthanded for nearly three months, multiplying the workload on the nurses who stayed and raising the odds that more of them leave. Investing in teamwork training, retention bonuses, residency programs, and flexible scheduling is not a luxury expense. It is cheaper than the alternative, and it directly improves the working conditions that drive resignations.
How to Measure Whether Teamwork Is Improving
What gets measured gets managed. A unit that wants better teamwork should track a small set of indicators over time: handoff completeness (audited with a simple checklist), the number of voluntary safety reports filed per month (which should rise as reporting culture improves, then fall as fixes take hold), nurse turnover and vacancy rates by unit, overtime hours, and patient outcomes tied to communication such as fall rates and medication errors. The Joint Commission’s annual sentinel event summaries provide a national reference point for the kinds of events teamwork failures produce. Pairing unit-level data with patient-safety dashboards keeps the work grounded in results, not just intentions. A quarterly review of these metrics, shared openly with the team, closes the loop between training investment and visible change.
Frequently Asked Questions
Why is teamwork important for nursing?
Teamwork is essential in nursing because patients are cared for by many hands across shifts and disciplines. Strong teamwork improves care quality, reduces medical errors, shortens the response to emergencies, raises job satisfaction, and lowers turnover. Weak teamwork shows up as missed handoffs, unclear orders, and preventable harm, which is why The Joint Commission consistently cites communication and teamwork failures among the leading causes of reported sentinel events.
What are the seven ways to improve teamwork in a nursing unit?
The seven strategies are to increase and standardize communication with tools like SBAR and I-PASS, build psychological safety so staff speak up, clarify roles and responsibilities, promote an adaptability culture, follow up on handoffs and near misses, complete regular team training such as TeamSTEPPS 3.0, and set the example from leadership. Together they address the systems, skills, and culture that determine whether a team functions under pressure.
What is TeamSTEPPS 3.0 and who offers it?
TeamSTEPPS 3.0 is the 2024 update of the Agency for Healthcare Research and Quality’s evidence-based teamwork and communication program for healthcare teams. It covers four modules, communication, team leadership, situation monitoring, and mutual support, plus implementation guidance, with welcome guides for frontline providers, trainers, administrators, and patients and family caregivers. AHRQ offers the training at no cost, and continuing education units are available for a fee.
How does I-PASS improve handoffs between shifts?
I-PASS standardizes handoffs with a mnemonic covering illness severity, patient summary, action list, situation awareness and contingency plans, and synthesis by the receiver. A multicenter study across 32 hospitals found that implementing I-PASS was associated with a 47 percent reduction in major and minor handoff-related adverse events, along with large improvements in the completeness and quality of both verbal and written handoffs.
How much does nurse turnover cost a hospital?
According to the 2025 NSI National Health Care Retention and RN Staffing Report, the average cost of turnover for one bedside registered nurse was 61,110 dollars in 2024, and each percentage point of RN turnover costs or saves the average hospital about 289,000 dollars per year. With national staff RN turnover at 16.4 percent and an average of 83 days to recruit an experienced RN, turnover is one of the largest avoidable expenses in hospital operations.
How can a nursing unit measure teamwork improvement?
Track a small dashboard of indicators over time: handoff completeness from audits, voluntary safety report volume, unit-level nurse turnover and vacancy rates, overtime hours, and communication-linked outcomes such as falls and medication errors. Review the metrics quarterly with the whole team, celebrate improvements, and tie the next round of training to whatever the data flags as the weakest link.
