The Covid-19 pandemic has been massively disruptive to nursing teams. Nationwide, leaders now struggle with picking up the pieces and rebuilding their teams. Even leaders who had cohesive teams in 2020 at the beginning of the pandemic find themselves in 2022 in a very different place. Some of the challenges that leaders have talked with me about include the following:

• Many nurses were onboarded during the COVID pandemic and have failed to establish a strong connection with their organization, unit, and team.
  
• Young new graduates entered high acuity care environments with few seasoned nurses to mentor them. As an outcome, some new nurses were never fully socialized into their professional roles.
  
• Trust and psychological safety on teams waivered as environments became increasingly chaotic and the turnover of team members escalated.
  
• As an outcome of nursing shortages, many agency and travel nurses supplemented core staffing and were never fully integrated into nursing teams.
  
• The experience with COVID accelerated the number of seasoned nurse retirements impacting their teams in profound ways.
  
• A significant number of nurses disengaged from work during COVID, impacting the effectiveness of shared governance and unit practice councils.
  
• The wearing of PPE made it difficult to read facial expressions or sometimes recognize and talk with other staff members.
  
• Socialization distancing rules during COVID restricted the use of break rooms and lounges, limiting informal team interaction.
  
• Team rituals such as eating together, having baby showers, and socializing after work were lost. Without new rituals, teams struggle to build meaning in their work and lack the social glue that keeps teams together.
  

Health care has always been a team sport. Nurses are highly reliant on one another to deliver safe and quality care. Team backup is essential. The good news is that it is possible to rebuild teamwork, but not without intentional work. The dynamic changes that occurred during COVID with team composition made it hard for leaders to sustain the mental models that staff need to work together effectively. Tennenbaum and Salas,1 who research team effectiveness, discuss the following 4 essential attitudes and beliefs on teams that directly impact team functioning:

1. Trust—Do I expect my teammates do the right thing? Is there positive intent on this team, or are members focusing on their own needs?
   
2. Psychological Safety—Can I make mistakes and not be penalized? Can I share my beliefs and perspectives, even if different from other team members? Are bullying and incivility tolerated on the team?
   
3. Collective Efficacy—Do we believe that this team can move forward in the face of these challenges and get the work done?
   
4. Cohesion—To what extent are we committed to working as a team and providing backup to each other? Do we know each other? Do we have rituals in place that will help connect us?
   

Of these 4, trust and psychological safety on the team need to be high priority areas right now. We know from the work of Patrick Lencioni2 that the absence of either one leads to team dysfunction. Psychological safety creates an environment of respect where nurses feel they can bring their whole selves to work. Stephen Covey3 reminds us that trust is the glue of life and relationships. A lack of trust in a team slows every decision, every communication, and every relationship.

Many leadership resources exist to help leaders build trust and psychological safety, but some of the best assessment tools are free from Google. In 2011, researchers at Google initiated Project Aristotle and studied 180 teams at Google.4 They found that hiring the best software engineers did not always lead to the best team synergy or outcomes. Psychological safety and trust in teams mattered more.

Sometimes leaders hesitate to do these assessments feeling they either already know the problems or fear difficult feedback. But you need baseline data as a team to learn and grow. If you don't ask, you won't know what to start doing, stop doing, or continue doing. Coming together after falling apart is not easy, but it is important work today on many nursing teams. Without it, even the best recruitment and retention plans won't be successful.

As Published on NurseLeader.com