NURS 522 Week 5 Paper 1 on Building an Effective Team Example

Paper 1: Two Units, One Team? Applying Wheelan's Model of Group Development to a Medical-Surgical Merger That Stalled in Conflict

Introduction

When two medical-surgical units in a 300-bed community hospital were merged into a new 44-bed unit after a renovation, leaders expected the combined staff to settle into one team within a few months. Six months later, nurses still sit with their former colleagues at lunch, assignments are argued over at the start of every shift, and a daily safety huddle created to unite the staff is attended by fewer than half of the nurses on duty. Unplanned call-outs have risen from about 3% of scheduled shifts before the merger to 7%, and four experienced nurses have resigned. This paper applies the integrated model of group development set out by Wheelan (2016) to the merged unit, diagnoses the stage at which the team has stalled, and recommends actions for members, the nurse manager and the organization, supported by recent evidence. It closes with a plan for measuring whether the team is developing and a biblical perspective on unity.

Wheelan's Integrated Model of Group Development

Wheelan (2016) describes groups as moving through recognizable stages. In the first, dependency and inclusion, members are polite, look to the leader for direction and are concerned with belonging. In the second, counterdependency and fight, members challenge the leader and one another, subgroups form, and conflict over goals, roles and procedures becomes open. If the group works through that conflict, it moves into trust and structure, in which members negotiate clear roles and norms and communication becomes more open, and then into work and productivity, in which the group focuses its energy on achieving goals. A final stage occurs when a group ends. The model's central point for leaders is that conflict is not a sign of failure but a normal, necessary stage, and that groups which cannot resolve it stall rather than mature.

Diagnosing the Merged Unit

The merged unit shows the marks of a group stuck in counterdependency and fight. The most visible sign is the persistence of subgroups organized by former unit: nurses describe colleagues as "the fourth-floor nurses" and "the fifth-floor nurses," and each group believes the other's routines are less safe. Conflict over procedures is constant, from how assignments are made to where supplies are kept, because the two former units did things differently and no shared standard has been agreed. Members also challenge the leader. The nurse manager, who came from one of the former units, is seen by the other group as partial, and decisions are debated in the break room rather than discussed openly. The low attendance at the safety huddle is less a scheduling problem than a quiet vote of no confidence in a shared identity that has not yet formed. Rising call-outs and resignations are consistent with the strain of a team that has been in conflict for months without resolution. Exit interviews with two of the nurses who resigned mention the same theme in different words: neither felt that the new unit was theirs. That sense of not belonging is what Wheelan's first stage is meant to settle, and its persistence six months on suggests that the unit moved into conflict before inclusion was complete, which may explain why the conflict has been so stubborn.

At the same time, the unit is not hopeless. Nurses still help one another in emergencies regardless of former unit, and the charge nurses from both groups have begun to share report sheets. Those are early signs that members want the trust and structure Wheelan describes. The task is to help the team resolve its conflict rather than suppress it.

What Team Members Must Do

Wheelan (2016) emphasizes that effective groups depend on members, not only on leaders. Members of a group in conflict move it forward when they raise disagreements openly and constructively, focus on shared goals, and accept roles that serve the group. On the merged unit, that means nurses bringing their objections about procedures to the unit practice council rather than to the break room, and being willing to adopt the better practice from the other former unit rather than defending their own by habit.

Recent evidence on teamwork supports this emphasis on members' behavior. Pooling the findings of 29 qualitative studies from operating rooms, Chen et al. (2026) identified individualistic behavior as a major barrier to teamwork and found that professional skills, role awareness and team familiarity were key facilitators. Their findings suggest that members help their teams most when they understand one another's roles and have chances to work together repeatedly. On the merged unit, scheduling nurses from the two former units together on the same shifts, rather than allowing informal swaps that keep the groups apart, would build the familiarity that Chen et al. found helpful.

What the Nurse Manager Must Do

The manager's first task is to name the conflict as normal and as solvable. Wheelan (2016) advises leaders of groups in counterdependency to avoid either suppressing conflict or taking sides, and instead to help the group agree on goals and procedures. Because the manager is seen as belonging to one former unit, the process for deciding shared procedures must be visibly fair, such as a working group with equal membership from both former units that reviews each disputed practice against evidence and recommends one standard.

Transparency is central. Across the 19 studies Oweidat et al. (2026) combined, nurses who saw their leaders as open were markedly less cynical about their organizations, and openness went along with more trust, lower exhaustion and teams that pulled in the same direction. For the merged unit, transparency means explaining why each decision was made, sharing the unit's data openly at huddles, and admitting where the merger was handled poorly. Communication competence matters as well. González-García et al. (2026), reviewing studies of how nurse managers communicate, treated that skill as a foundation for coordinating teams, keeping units aligned with the organization, sharing decisions and keeping care safe. The manager can practice this by holding listening sessions with each shift, closing the loop on concerns raised, and speaking in the same terms to both former groups.

The manager must also protect psychological safety. Nurses interviewed in the studies Bolton et al. (2026) synthesized described leaders as shaping whether they felt safe to speak, how they reasoned through ethical problems and how well they recovered, and they said moral distress grew when leaders offered little support. That review included only two studies, so its findings are limited, but they match Chen et al.'s (2026) identification of punitive management as a barrier to teamwork. If nurses fear that raising a problem will be held against them or their former group, they will keep raising it in the break room instead.

What the Organization Must Do

Wheelan (2016) is clear that teams cannot develop without organizational support, including training, information and recognition. The hospital merged two units but provided no team training for the combined staff. Alsabri et al. (2022) reviewed sixteen emergency department studies of team and communication training and judged crisis resource management courses and TeamSTEPPS to be among the programs with the most impact on safety culture. The review also noted that study designs and evaluation methods varied widely, so how much benefit to expect is uncertain, even though the included studies mostly pointed the same way. The hospital could provide a TeamSTEPPS course for the merged unit's staff, scheduled so that nurses from both former units attend together, which would build shared tools for communication and conflict as well as familiarity. The organization can also help by protecting the manager's time for the working group and by recognizing the unit's progress publicly when shared measures improve.

Measuring Team Development and Performance

Poister et al. (2015) want measures to reach past activity to results, and they want results placed in front of the staff who are able to change them. For the merged unit, three kinds of measures would show whether the team is moving from conflict toward productive work. The first is a team development measure, such as a short teamwork survey that every nurse completes now and again each quarter, with results shared at a staff meeting. The second is a set of operational indicators: unplanned call-outs as a percentage of scheduled shifts, voluntary turnover, and attendance at the daily safety huddle, each reported monthly. The third is patient outcomes the unit already tracks, such as falls with injury and patient ratings of nurse communication, since a mature team should produce better care. Targets for the first year might be call-outs back below 4%, huddle attendance above 85% and no further increase in turnover. Reporting these measures openly also supports the transparency the evidence recommends.

A Biblical Perspective on Unity

Paul urged the church in Ephesus to be "eager to maintain the unity of the Spirit in the bond of peace" (English Standard Version Bible, 2001/2016, Ephesians 4:3). The verse treats unity as something that must be actively maintained, not assumed, and it pairs unity with peace, suggesting that unity is built through relationships rather than imposed by structure. For a merged nursing unit, that principle supports the approach in this paper: rather than declaring the two groups one team, leaders and members must work to build the trust and shared practices that make unity real. The Christian nurse leader can also model humility, acknowledging the losses each group feels from the merger and treating both groups' practices with respect.

Conclusion

The merged medical-surgical unit has stalled in Wheelan's counterdependency and fight stage, marked by subgroups, conflict over procedures and challenges to the leader. Moving it forward requires members who raise conflict constructively and work together, a manager who leads a fair process with transparency, clear communication and psychological safety, and an organization that provides team training and recognition. Recent evidence on teamwork, leadership and training supports each of these actions, and a measurement plan drawn from Poister's framework can show whether the team is developing. Unity, as Scripture describes it, is maintained through effort and peace, and that is the work this unit now needs.

References

Alsabri, M., Boudi, Z., Lauque, D., Dias, R. D., Whelan, J. S., Östlundh, L., Alinier, G., Onyeji, C., Michel, P., Liu, S. W., Jr., Camargo, C. A., Jr., Lindner, T., Slagman, A., Bates, D. W., Tazarourte, K., Singer, S. J., Toussi, A., Grossman, S., & Bellou, A. (2022). Impact of teamwork and communication training interventions on safety culture and patient safety in emergency departments: A systematic review. Journal of Patient Safety, 18(1), e351-e361. https://doi.org/10.1097/PTS.0000000000000782

Bolton, S., Baldwin, A., Adams, A. M. N., Willis, E., Cutmore, E., Johnston, S., Snaith, N., & Dafny, H. A. (2026). The moral of the story: Perception of leadership with moral distress in registered nurses: A qualitative systematic review. Journal of Clinical Nursing, 35(10), 4106-4123. https://doi.org/10.1111/jocn.70354

Chen, Y., Zhang, Y., Zhang, J., & Luo, J. (2026). Facilitators of and barriers to teamwork between operating room nurses and other practitioners: A meta-synthesis of qualitative studies. BMJ Open, 16(4), Article e098386. https://doi.org/10.1136/bmjopen-2024-098386

English Standard Version Bible. (2016). Crossway. (Original work published 2001)

González-García, A., Marqués-Sánchez, P., Martín-Vázquez, C., Serrano-Gemes, G., Bermejo-Martínez, D., & Pérez-González, S. (2026). Characteristics of communication competency in nurse managers: A systematic review. Healthcare, 14(17), Article 2814. https://doi.org/10.3390/healthcare14172814

Oweidat, L., Ayyad, A., Alosta, M., Al Mugheed, K., ALBashtawy, M., & Alkhawaldeh, A. (2026). Relationship between leadership transparency and workplace cynicism among nurses: A systematic review and meta-analysis. Nursing Management, 33(5), 34-41. https://doi.org/10.7748/nm.2026.e2209

Poister, T. H., Aristigueta, M. P., & Hall, J. L. (2015). Managing and measuring performance in public and nonprofit organizations: An integrated approach (2nd ed.). Jossey-Bass.

Wheelan, S. A. (2016). Creating effective teams: A guide for members and leaders (5th ed.). SAGE Publications.