Leadership and Staff Perceptions on Long-term Care Staffing Challenges Related to Certified Nursing Assistant Retention.

OBJECTIVE: This study investigates practices that may help retain certified nursing assistants (CNAs) and address the staffing challenges faced in long-term care. BACKGROUND: CNAs are critical to quality care and retention has never been more challenging. To solve this staffing crisis, understanding the unique perspective of CNAs is imperative. METHODS: In semistructured interviews, 5 nursing assistants, the director of nursing, and the nursing home administrator at 59 long-term care facilities answered 4 questions, providing multiple perspectives about causes and solutions to CNA staffing challenges. RESULTS: Key responses for each stakeholder group were identified. CNAs highlighted the nature of the job as a bigger challenge than leadership recognized. Although pay is a top concern, emotional support, training, relationship-building, communication, and the work culture can be equally important in reducing turnover. CONCLUSION: When organizational leaders understand how to meet the needs and interests of CNAs, they can reduce turnover.

Acceptability of Using a Robotic Nursing Assistant in Health Care Environments: Experimental Pilot Study.

BACKGROUND: According to the US Bureau of Labor Statistics, nurses will be the largest labor pool in the United States by 2022, and more than 1.1 million nursing positions have to be filled by then in order to avoid a nursing shortage. In addition, the incidence rate of musculoskeletal disorders in nurses is above average in comparison with other occupations. Robot-assisted health care has the potential to alleviate the nursing shortage by automating mundane and routine nursing tasks. Furthermore, robots in health care environments may assist with safe patient mobility and handling and may thereby reduce the likelihood of musculoskeletal disorders. OBJECTIVE: This pilot study investigates the perceived ease of use and perceived usefulness (acceptability) of a customized service robot as determined by nursing students (as proxies for nursing staff in health care environments). This service robot, referred to as the Adaptive Robotic Nurse Assistant (ARNA), was developed to enhance the productivity of nurses through cooperation during physical tasks (eg, patient walking, item fetching, object delivery) as well as nonphysical tasks (eg, patient observation and feedback). This pilot study evaluated the acceptability of ARNA to provide ambulatory assistance to patients. METHODS: We conducted a trial with 24 participants to collect data and address the following research question: Is the use of ARNA as an ambulatory assistive device for patients acceptable to nurses? The experiments were conducted in a simulated hospital environment. Nursing students (as proxies for nursing staff) were grouped in dyads, with one participant serving as a nurse and the other acting as a patient. Two questionnaires were developed and administrated to the participants based on the Technology Acceptance Model with respect to the two subscales of perceived usefulness and perceived ease of use metrics. In order to evaluate the internal consistency/reliability of the questionnaires, we calculated Cronbach alpha coefficients. Furthermore, statistical analyses were conducted to evaluate the relation of each variable in the questionnaires with the overall perceived usefulness and perceived ease of use metrics. RESULTS: Both Cronbach alpha values were acceptably high (.93 and .82 for perceived usefulness and perceived ease of use questionnaires, respectively), indicating high internal consistency of the questionnaires. The correlation between the variables and the overall perceived usefulness and perceived ease of use metrics was moderate. The average perceived usefulness and perceived ease of use metrics among the participants were 4.13 and 5.42, respectively, out of possible score of 7, indicating a higher-than-average acceptability of this service robot. CONCLUSIONS: The results served to identify factors that could affect nurses' acceptance of ARNA and aspects needing improvement (eg, flexibility, ease of operation, and autonomy level).

Infrecuente lavado de manos antes de recepcionar material estéril en un hospital de Lima-Perú / Infrequent hand-washing before receiving sterile material in a hospital in Lima-Peru

No disponible

The development of the new assistant practitioner role in the English National Health Service: a critical realist perspective.

Adopting a critical realist perspective, this article examines the emergence of a relatively new non-professional healthcare role, the assistant practitioner (AP). The role is presented as a malleable construct cascading through and sensitive to structure-agency interaction at different levels of NHS England: the sector, organisation and department. At the core of the analysis is the permissiveness of structures established at the respective levels of the NHS, facilitating or restricting agency as the role progresses through the healthcare system. A permissive regulatory framework at the sector level is reflected in the different choices made by two case study NHS acute hospital trusts, in their engagement with the AP role. These different choices have consequences for how the AP impacts at the departmental level.

Dimensioning of nursing staff in outpatient chemotherapy: application of the Workload Indicators of Staffing Need.

OBJECTIVE: To apply the method developed by the World Health Organization, called Workload Indicators of Staffing Need for dimensioning the nursing staff for the care of cancer patients in a Chemotherapy outpatient clinic. METHOD: This is a quantitative, observational, documentary field study with an intentional sample. Prospective data were collected through the work sampling method. RESULTS: Seventeen nurses and 12 nursing technicians participated in the study. A total of 3,727 observations were performed and were obtained the mean times and the relative working time of 23 nurses' interventions and 18 nursing technicians' interventions. The interventions corresponded to 88.5% of the relative working time of nurses and 83.9% of nursing technicians. Personal activities accounted for 8.2% of the relative working time of nurses and 7.9% of nursing technicians. The reliability test resulted in 86.3% concordance. CONCLUSION: The similarity between the staff required according to the method studied and the current staff showed that the Workload Indicators of Staffing Need has great potential and applicability for dimensioning nursing professionals safely.

[The activities/tasks performed by health care aids in hospital settings: a mixed-methods study]. / Le attività degli Operatori Socio-Sanitarinei contesti ospedalieri:uno studio mixed-method.

. The nurses' tasks performed by aids in hospital settings: a mixed-methods study. INTRODUCTION: The role of Nurses' aides (NAs) in the clinical practice has been widely debated to date. AIMS: To describe the activities/tasks performed by NAs and the dedicated time; to identify the activities/tasks shifted from nurses to NAs and to investigate the motivations. METHODS: A multi-center mixed-methods study was conducted. Fifty-six NAs working in 17 hospitals in the North-Italy were observed during daily practice and then interviewed about the motivations associated with task shifting. RESULTS: NAs mainly performed direct care tasks (67.7% of the observed time), such as helping with personal hygiene, feeding and mobilization. Larger hospitals (p = 0.034), surgical units (p = 0.001), a skill mix> 40% (p = 0.044) and a reduced nurse to patient ratio (p = 0.041), were significantly associated with a higher amount of indirect care activities/tasks performed by NAs. The tasks shifted most frequently from nurses to NAs were: mobilization (22; 39.3%) and personal hygiene (21; 37.5%) of unstable patients, feeding patients with dysphagia (19; 34%), intra-venous set replacement (16; 28.6%) and pressure ulcers' dressing (11; 19.6%). NAs reported that they chose to act autonomously because of their experience and the trust-based relationship with nurses, in order to promptly respond to patients needs and to reduce nurse workload. CONCLUSIONS: It is necessary to further assess the development of the NAs role in the hospital setting to understand their inclusion in the nursing care.

The role of collective labor contracts and individual characteristics on job satisfaction in Tuscan nursing homes.

BACKGROUND: The role played by remuneration strategies in motivating health care professionals is one of the most studied factors. Some studies of nursing home (NH) services, while considering wages and labor market characteristics, do not explicitly account for the influence of the contract itself. PURPOSE: This study investigates the relationship between the labor contracts applied in 62 Tuscan NHs and NH aides' job satisfaction with two aims: to investigate the impact of European contracts on employee satisfaction in health care services and to determine possible limitations of research not incorporating these contracts. METHODOLOGY: We apply a multilevel model to data gathered from a staff survey administered in 2014 to all employees of 62 NHs to analyze two levels: individual and NH. Labor contracts were introduced into the model as a variable of NH. RESULTS: Findings show that the factors influencing nursing aides' satisfaction occur at both the individual and NH levels. Organizational characteristics explain 16% of the variation. For individual characteristics, foreign and temporary workers emerge as more satisfied than others. For NH variables, results indicate that the labor contract with the worst conditions is not associated with lower workers' satisfaction. CONCLUSION: Although working conditions play a relevant role in the job satisfaction of aides, labor contracts do not seem to affect it. Interestingly, aides of the NHs with the contract having the best conditions register a significantly lower level of satisfaction compared to the NHs with the worst contract conditions. This suggests that organizational factors such as culture, team work, and other characteristics, which were not explicitly considered in this study, may be more powerful sources of worker satisfaction than labor contracts. PRACTICE IMPLICATIONS: Our analysis has value as a management tool to consider alternative sources as well as the labor contract for employee incentives.

Classification of patients and nursing staff's sizing: contributions of a management technology. / Classificação de pacientes e dimensionamento de profissionais de enfermagem: contribuições de uma tecnologia de gestão.

OBJECTIVE: Applying PRAXIS® technology resources for patient classification and nursing professional sizing in university hospital inpatient unit. METHOD: Convergent Care Research following the design and instrumentation phases - defined the research theme and purpose, performed in a medical clinic hospital unit involving 633 participants; scrutiny - classification of patients during 30 days of June 2016, followed by sizing, analysis and interpretation of the results - elaborated with the support of the management theorization in hospital nursing. RESULTS: Amongst the total of 633 classifications made, 29.38% were patients in minimal care, 35.71% were intermediate care patients, 33.02% were highly dependent, 1.42% were semi-intensive and 0.47% were in intensive care. Two references were used to carry out the sizing; in both the available team showed to be in deficit. CONCLUSION: The classification of patients and the sizing of nursing professionals are directly related, they are indispensable for management in nursing and difficult to perform daily. Computerized technologies are useful for performing these activities.

The role of unregulated care providers in Canada-A scoping review.

AIMS AND OBJECTIVES: This scoping review explored: (i) the role of unregulated care providers in the healthcare system; (ii) their potential role on interprofessional teams; (iii) the impact of unregulated care provider's role on quality of care and patient safety; and (iv) education and employment standards. BACKGROUND: Unregulated care providers in Canada assist older adults with personal support and activities of daily living in a variety of care settings. As the care needs of an aging population become increasingly complex, the role of unregulated care providers in healthcare delivery has also evolved. Currently, many unregulated care providers are performing tasks previously performed by regulated health professionals, with potential implications for quality of care and patient safety. Information is fragmented on the role, education and employment standards of unregulated care providers. METHODS: A scoping review was conducted following the methods outlined by Arksey and O'Malley (International Journal of Social Research Methodology, 8, 2005, 19) and Levac, Colquhoun, and O'Brien (Implementation Science, 5, 2010, 69). An iterative search of published and grey literature was conducted from January 2000 to September 2016 using Medline, CINAHL, SCOPUS and Google. Inclusion and exclusion criteria were applied to identify relevant studies published in English. RESULTS: The search yielded 63 papers for review. Results highlight the evolving role of unregulated care providers, a lack of recognition and a lack of authority for unregulated care provider decision-making in patient care. Unregulated care providers do not have a defined scope of practice. However, their role has evolved to include activities previously performed by regulated professionals. Variations in education and employment standards have implications for quality of care and patient safety. CONCLUSIONS: Unregulated care providers are part of an important workforce in the long-term care and community sectors in Canada. Their evolving role should be recognised and efforts made to leverage their experience on interprofessional teams and reduce variations in education and employment standards. IMPLICATIONS FOR PRACTICE: This study highlights the evolving role of unregulated care providers in Canada and presents a set of recommendations for implementation at micro, meso, and macro policy levels.

Recognition and assessment of resident' deterioration in the nursing home setting: A critical ethnography.

AIMS AND OBJECTIVES: To explore the recognition and assessment of resident deterioration in the nursing home setting. BACKGROUND: There is a dearth of research exploring how nurses and personal-care-assistants manage a deteriorating nursing home resident. DESIGN: Critical ethnography. METHODS: Observation and semi-structured interviews with 66 participants (general medical practitioners, nurses, personal-care-assistants, residents and family members) in two Australian nursing homes. The study has been reported in accordance with the Consolidated Criteria for Reporting Qualitative Research guidelines. RESULTS: The value of nursing assessment is poorly recognised in the nursing home setting. A lack of clarity regarding the importance of nursing assessments associated with resident care has contributed to a decreasing presence of registered nurses and an increasing reliance on personal-care-assistants who had inadequate skills and knowledge to recognise signs of deterioration. Registered nurses experienced limited organisational support for autonomous decision-making and were often expected to undertake protocol-driven decisions that contributed to potentially avoidable hospital transfers. CONCLUSIONS: Nurses need to demonstrate the importance of assessment, in association with day-to-day resident care and demand standardised, regulated, educational preparation of an appropriate workforce who are competent in undertaking this role. Workforce structures that enhance familiarity between nursing home staff and residents could result in improved resident outcomes. The value of nursing assessment, in guiding decisions at the point of resident deterioration, warrants further consideration.

The evolving role of the personal support worker in home care in Ontario, Canada.

To meet increasing demand for home care, the role of personal support workers (PSWs) is shifting from providing primarily personal and supportive care to include care activities previously provided by regulated health professionals (RHPs). Much of the research examining this shift focuses on specialty programmes, with few studies investigating the daily care being provided by PSWs, frequency of care activities being provided by PSWs, and characteristics of the population receiving more complex tasks. Between January and April 2015, a review of 517 home-care service user charts was undertaken in Ontario, Canada, to: (1) describe the range of tasks being performed by PSWs in home care, (2) identify tasks transferred by RHPs to PSWs, and (3) examine characteristics of service users receiving transferred care. Findings indicate that normally, PSWs provide personal and supportive care commensurate with their training. However, in approximately one quarter of care plans reviewed, PSWs also completed more complex care activities transferred to them by RHPs. Service users receiving transferred care were older and had higher levels of cognitive and functional impairment. Although there is potential for the expansion of home-care services through increased utilisation of PSWs, healthcare leadership must ensure that the right provider is being utilised at the right time and in the right place to ensure safe and effective quality care. Thus, several actions are recommended: PSW core competencies be clearly articulated, processes used to transfer care activities from RHPs to PSWs be standardised and a team-based approach to the delivery of home-care services be considered. Utilisation of a team-based model can help establish positive relationships among home-care providers, provide increased support for PSWs, allow for easier scheduling of initial training and ensure regular reassessments of PSW competence among PSWs providing added skills.

Staff Empowerment Practices and CNA Retention: Findings From a Nationally Representative Nursing Home Culture Change Survey.

This article examines whether staff empowerment practices common to nursing home culture change are associated with certified nursing assistant (CNA) retention. Data from 2,034 nursing home administrators from a 2009/2010 national nursing home survey and ordered logistic regression were used. After adjustment for covariates, a greater staff empowerment practice score was positively associated with greater retention. Compared with the low empowerment category, nursing homes with scores in the medium category had a 44% greater likelihood of having higher CNA retention (odds ratio [OR] = 1.44; 95% confidence interval [CI] = [1.15, 1.81], p = .001) and those with high empowerment scores had a 64% greater likelihood of having higher CNA retention (OR = 1.64; 95% CI = [1.34, 2.00], p < 001). Greater opportunities for CNA empowerment are associated with longer CNA retention. This research suggests that staffing empowerment practices on the whole are worthwhile from the CNA staffing stability perspective.

Classificação de pacientes e dimensionamento de profissionais de enfermagem: contribuições de uma tecnologia de gestão / Clasificación de pacientes y dimensionamiento de profesionales de enfermería: contribuciones para una tecnología de gestión / Classification of patients and nursing staff's sizing: contributions of a management technology

Resumo OBJETIVO Aplicar recursos da tecnologia PRAXIS® para classificação de pacientes e dimensionamento de profissionais de enfermagem em unidade de internação de hospital universitário. METODO Pesquisa Convergente Assistencial seguindo as fases de concepção e instrumentação - definidos tema e objetivo da pesquisa, realização em uma unidade hospitalar de clínica médica envolvendo 633 participantes; perscrutação - classificação dos pacientes durante 30 dias de junho de 2016, seguido de dimensionamento; análise e interpretação dos resultados-elaborada com suporte da teorização de gestão em enfermagem hospitalar. RESULTADOS Realizadas 633 classificações e encontrados 29,38% pacientes em cuidados mínimos, 35,71% cuidados intermediários, 33,02% alta dependência, 1,42% semi-intensivos e 0,47% cuidados intensivos. Para realização do dimensionamento utilizou-se duas referências; em ambas a equipe disponibilizada mostrou-se deficitária. CONCLUSÃO Classificação de pacientes e dimensionamento de profissionais de enfermagem estão diretamente relacionados, são indispensáveis para gestão em enfermagem e de difícil realização cotidiana. Tecnologias informatizadas são úteis para realização destas atividades.

Resumen OBJETIVO aplicar recursos de la tecnología PRAXIS® para la clasificación y dimensionamiento de profesionales de enfermería en una unidad de internación de un hospital universitario. MÉTODO investigación convergente asistencial, siguiendo las etapas de concepción e instrumentación - definidos el tema y objetivo de la investigación, realización en una unidad hospitalaria de clínica médica involucrando a 633 participantes; escrutación - clasificación de los pacientes durante 30 días de junio de 2016, seguida de dimensionamiento. Análisis e interpretación de los resultados elaborados con soporte de la teorización de gestión en enfermería hospitalaria. RESULTADOS se realizaron 633 puntuaciones y se encontraron 29,38% pacientes en cuidados básicos, 35,71% en cuidados intermedios, 33,02% en alta dependencia, 1,42% en semi-intensivos, y 0,47% en cuidados intensivos. Para realizar el dimensionamiento, se utilizaron dos referencias. En ambos el equipo disponible se mostró deficiente. CONCLUSIÓN la clasificación de pacientes y el dimensionamiento de los profesionales de enfermería están directamente vinculados, son indispensables para la gestión en enfermería y de difícil realización cotidiana. Las tecnologías informatizadas son útiles para realizar estas actividades.

Abstract OBJECTIVE Applying PRAXIS® technology resources for patient classification and nursing professional sizing in university hospital inpatient unit. METHOD Convergent Care Research following the design and instrumentation phases - defined the research theme and purpose, performed in a medical clinic hospital unit involving 633 participants; scrutiny - classification of patients during 30 days of June 2016, followed by sizing, analysis and interpretation of the results - elaborated with the support of the management theorization in hospital nursing. RESULTS Amongst the total of 633 classifications made, 29.38% were patients in minimal care, 35.71% were intermediate care patients, 33.02% were highly dependent, 1.42% were semi-intensive and 0.47% were in intensive care. Two references were used to carry out the sizing; in both the available team showed to be in deficit. CONCLUSION The classification of patients and the sizing of nursing professionals are directly related, they are indispensable for management in nursing and difficult to perform daily. Computerized technologies are useful for performing these activities.

Calidad de vida de los auxiliares y técnicos de enfermería jubilados en un hospital universitario / Qualidade de vida de auxiliares e técnicos de enfermagem aposentados em um hospital universitário / Quality of life of nursing assistants and retired nursing technicians in a university hospital

Objetivo: Analizar la calidad de vida de auxiliares y técnicos de enfermería jubilados en un hospital universitario. Material y métodos: Estudio transversal realizado con 61 auxiliares y técnicos de enfermería jubilados en un hospital universitario de una universidad pública paranaense. Los datos se recolectaron en el período de enero a mayo de 2014, a través de dos herramientas: una encuesta para caracterización de los entrevistados y el Short-Form Health Survey SF-36 para evaluar la calidad de vida. Los datos se analizaron por estadística descriptiva e inferencial. Resultados: El promedio de los valores de los ochos dominios del SF-36 fueron: capacidad funcional: 70; aspectos físicos: 75; dolor: 72; estado general de salud: 62; vitalidad: 65; aspectos sociales: 75; aspectos emocionales: 100; y salud mental: 76. La práctica de actividad física, la presencia de enfermedades crónicas, la jubilación en sí y los años de trabajo se relacionaron, de forma paralela, a los dominios que componen la calidad de vida. Conclusión: Los auxiliares y técnicos de enfermería jubilados encuestados presentaron una buena percepción de su calidad de vida (AU)

Objetivo: Analisar a qualidade de vida de auxiliares e técnicos de enfermagem aposentados em um hospital universitário. Material e Métodos: Estudo transversal realizado com 61 auxiliares e técnicos de enfermagem aposentados em um hospital universitário de uma universidade pública paranaense. Os dados foram coletados no período de janeiro a maio de 2014, por dois instrumentos: um questionário para caracterização dos entrevistados e o Short-Form Health Survey SF-36 para avaliar a qualidade de vida. Os dados foram analisados por estatística descritiva e inferencial. Resultados: As medianas dos valores dos oito domínios do SF-36 foram: Capacidade Funcional: 70; Aspectos Físicos: 75; Dor: 72; Estado Geral de Saúde: 62; Vitalidade: 65; Aspectos Sociais: 75; Aspectos Emocionais: 100 e Saúde Mental: 76. Prática de atividade física, presença de doenças crônicas, motivo de aposentadoria e tempo de serviço estiveram relacionados independentemente aos domínios que compõem a qualidade de vida. Conclusão: Os auxiliares e técnicos de enfermagem aposentados pesquisados apresentaram uma boa percepção de sua qualidade de vida (AU)

Objective: To analyze the quality of life of nursing assistants and technicians retired from a university hospital. Material and Methods: This is a cross-sectional study composed of 61 nursing assistants and technicians who retired from a university hospital of a public university in the state of Paraná. The data was collected from January to May of 2014, by two instruments: a questionnaire to characterize the interviewees, and the Short-Form Health Survey SF-36 to evaluate their quality of life. The Data has been analyzed by descriptive and inferential statistics. Results: The average values of the eight SF-36 domains were: Functional Capacity: 70; Physical Aspects: 75; Pain: 72; General Health Status: 62; Vitality: 65; Social Aspects: 75; Emotional Aspects: 100, and Mental Health: 76. The practice of physical activity, presence of chronic diseases, the reason for retirement and time of service have been independently related to the domains that make up the quality of life. Conclusion: The retired nursing assistants and technicians surveyed have presented a good perception of their quality of life (AU)

Healthcare professionals' accounts of challenges in managing motor neurone disease in primary healthcare: a qualitative study.

Motor neurone disease (MND) is a progressive neurological disease causing muscle wasting, gradual paralysis and respiratory failure, with a life expectancy of 2-4 years. In order to better understand how MND is managed in the community, we conducted a qualitative study to explore the challenges healthcare professionals encounter when managing MND in primary healthcare. Based on data from 15 semi-structured interviews with primary healthcare professionals in Norway, we found that MND is viewed as a condition that requires exceptional effort and detailed planning. Healthcare professionals reported five main challenges in managing MND in primary healthcare: (i) building relationships with those giving and receiving care in the home; (ii) preventing caregiver burnout and breakdown; (iii) providing tailored care; (iv) ensuring good working conditions in patients' homes; and (v) recruiting and retaining qualified nursing assistants. Healthcare professionals reported needing working conditions that allow them to tailor their approach to the personal, emotional and existential nature of care preferences of those living with MND. However, people with MND and their families were sometimes perceived by healthcare professionals to prefer a strictly task-focused relationship with care providers. Such relationships limited the healthcare professionals' control over the MND trajectory and their capacity to prevent family caregiver burnout and breakdown. Adequate resources, along with training and support of nursing assistants, may increase the continuity of nursing assistants. Responsiveness to patient and family needs may enhance collaboration and promote tailored primary care and support for patients with MND and their families.

Development and Validation of A Scheduled Shifts Staffing (ASSiST) Measure of Unit-Level Staffing in Nursing Homes.

Purpose of the study: To (a) describe A Scheduled Shifts Staffing measure (ASSiST) to derive care aide worked hours per resident day (HCA WHRD) at facility and unit levels in nursing homes, (b) report reliability through comparisons to administrative staffing data; (c) report validity by examining associations between HCA WHRD, staff outcomes (job satisfaction, emotional exhaustion), and resident quality indicators (QIs) (e.g. falls, delirium, stage 2+ pressure ulcers), and (d) explore intrafacility variation in staffing intensity levels related to unit-level variation in resident and staff outcomes. Design and Methods: We used data from 40 care units in 12 Canadian nursing homes between 2007 and 2012. Descriptive statistics and tests of association and difference described relationships of two measures of staffing with resident and staff outcomes. Results: Annualized rates of HCA WHRD from both data sources compared well at the facility level (Pearson Product Correlation; R = 0.847, p < .001), and were correlated similarly to staff work life and many QIs. Using ASSiST data, we show that staffing levels can vary by up to 40% at the unit-level within nursing homes. Implications: ASSiST is easy to collect, more timely to retrieve than administrative data, has good criterion and construct validity, and reflects intrafacility variation in health care aide staffing levels.

The nursing associate role: have we been here before?

What should the nursing workforce of the future look like? It is a question all nurse leaders should ask themselves.

Strategies used by nurses to promote teamwork in an emergency room. / Estratégias utilizadas pelos enfermeiros para promover o trabalho em equipe em um serviço de emergência.

Objective to analyze the strategies used by nurses to promote teamwork in a hospital emergency room. Method qualitative case study research with 20 nurses in the emergency unit of a university hospital in southern Brazil. Data were collected between June and September 2009 through participant observation and semi-structured interviews, and analyzed using thematic analysis. Results the strategies used by the nurses to promote teamwork in the emergency unit were articulating professional actions; establishing relationships of cooperation; building and maintaining friendly ties; and managing conflict. Conclusion nurses notably make the connections between the practices of the health teams and mediate the relationships established between health professionals to improve care practices.