Abstract
In the light of rising concerns over safe staffing, this is a particularly intriguing paper! The authors argue that the literature suggests tentative connections between three constructs, namely teamwork, staffing and workload. They posit a theory that ‘given the outcomes of high workload on nurses, healthcare organisations should explore methods for reducing the impact of low staffing and high workload to stabilise the future of their nursing workforce. One avenue to consider is bolstering teamwork among nurses when staffing is low and workload is high’.
To examine their theory they undertake a secondary analysis of a large (unpublished) qualitative dataset, where nurses and others were interviewed as part of a major trans-organisational development project, undertaken by a different research team. The authors report that the primary study researchers asked participants their views on the strengths and weaknesses of their units and the changes they desired. Teamwork, staffing and workload were identified as themes (presumably amongst others, of which only a few are disclosed). The authors then purposefully re-examined the data collated within these themes and present a small number of quotes to illustrate the evidence underpinning each theme. They also offer quotes which they argue serve to illustrate connections between the themes. The authors further categorised the quotes as ‘workgroup’ strengths or weaknesses, and quantified the frequency of quotes within each category before undertaking statistical analysis to look for quantitative evidence of correlations between the themes as a means of strengthening their argument.
This is a bold endeavour and the authors are to be commended for their enterprise. However, the paper is somewhat opaque in places. It is not altogether clear how they obtained access to these ‘confidential’ data. The authors do not problematize using these data for a purpose for which it was not originally intended: they appear to assume that a declaration of ethical approval is sufficient, which I would argue is not. Although they cite the age of the data as a limitation, little space is given to defending its contemporary relevance.
However, over and above these methodological challenges I find this paper problematic on two counts. The first is that I feel that the authors over-claim on the basis of the evidence presented, and second, from a critical perspective I am concerned about the potential of nurses being expected to collude with a managerialist agenda that is becoming increasingly unsustainable. I cannot see in the evidence presented that ‘when facing workload challenges created by understaffing… . participants directly attributed their units’ ability to meet the needs of patient care to the levels of the unit’s team work’. I can accept the argument that teamwork helps to mitigate the stresses and strains of inadequate staffing and ever increasing workloads, but I am troubled by the proposal that ‘teamwork’ is presented as the ‘antidote’ to the unsustainable and the inexcusable. As Traynor points out ‘when a situation is intolerable, coping and resilience is not a good answer’ (Traynor, 2017: p. 27).