A mixed-methods study of the causes and impact of poor teamwork between junior doctors and nurses

Int J Qual Health Care. 2016 Jun;28(3):339-45. doi: 10.1093/intqhc/mzw036. Epub 2016 Apr 18.


Objectives: This study aimed to collect and analyse examples of poor teamwork between junior doctors and nurses; identify the teamwork failures contributing to poor team function; and ascertain if particular teamwork failures are associated with higher levels of risk to patients.

Design: Critical Incident Technique interviews were carried out with junior doctors and nurses.

Setting: Two teaching hospitals in the Republic of Ireland.

Participants: Junior doctors (n = 28) and nurses (n = 8) provided descriptions of scenarios of poor teamwork. The interviews were coded against a theoretical framework of healthcare team function by three psychologists and were also rated for risk to patients by four doctors and three nurses.

Results: A total of 33 of the scenarios met the inclusion criteria for analysis. A total of 63.6% (21/33) of the scenarios were attributed to 'poor quality of collaboration', 42.4% (14/33) to 'poor leadership' and 48.5% (16/33) to a 'lack of coordination'. A total of 16 scenarios were classified as high risk and 17 scenarios were classified as medium risk. Significantly more of the high-risk scenarios were associated with a 'lack of a shared mental model' (62.5%, 10/16) and 'poor communication' (50.0%, 8/16) than the medium-risk scenarios (17.6%, 3/17 and 11.8%, 2/17, respectively).

Conclusion: Poor teamwork between junior doctors and nurses is common and places patients at considerable risk. Addressing this problem requires a well-designed complex intervention to develop the team skills of doctors and nurses and foster a clinical environment in which teamwork is supported.

Keywords: communication; human factors; intern; junior doctor; nurse; patient safety; teamwork.

MeSH terms

  • Attitude of Health Personnel
  • Communication
  • Cooperative Behavior
  • Female
  • Group Processes*
  • Health Knowledge, Attitudes, Practice
  • Hospitals, Teaching
  • Humans
  • Interprofessional Relations*
  • Interviews as Topic
  • Ireland
  • Leadership
  • Male
  • Medical Staff, Hospital / psychology*
  • Nursing Staff, Hospital / psychology*
  • Patient Care Team / organization & administration*
  • Patient Care Team / standards