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nursing, patient safety, scale, survey, teamwork, psychometrics, work environment



  1. Kalisch, Beatrice J.
  2. Lee, Hyunhwa
  3. Salas, Eduardo


Background: There is a lack of an acceptable, reliable, and valid survey instruments to differentiate levels of nursing teamwork on inpatient units in acute care facilities.


Objective: The aim of this study was to test the psychometric soundness of the Nursing Teamwork Survey (NTS).


Methods: The survey was administered to 1,758 inpatient nursing staff members using the NTS (return rate = 56.9%), and measures of content, predictive (concurrent), and construct (factorial, contrast, and convergent) validity were completed.


Results: Content validity was established by a panel of experts. Concurrent validity showed a significant correlation between teamwork scores and an imbedded question related to overall satisfaction with teamwork (r = .633, p < .001). The exploratory factor analysis on a random half of the sample predicted a 33-item five-factor solution, whereas the confirmatory factor analysis on the remaining half of the sample confirmed the factor structure (comparative fit index = .884, root mean square error of approximation = 0.055, standardized root mean square residual = 0.045). Contrast validity showed that staff in a non-inpatient unit did not answer the questions in the same way (rWG(J) = .25) as the inpatient unit staff (rWG(J) > .90). Convergent validity of the teamwork tool was measured by correlating the Teamwork subscale of the Safety Attitudes Questionnaire with the NTS (r = .76, p < .01). The NTS had good test-retest reliability (r = .92 for overall 33 items; r = .77 to.87 for the five subscales) and internal consistency ([alpha] = .94 for overall items; [alpha] = .74 to.85 for the subscales). Aggregation of individual-level responses to the unit level was supported by intraclass correlation coefficient 1 = .16 (p < .001), intraclass correlation coefficient 2 = .9 (p < .001), and mean rWG(J) = .98.


Discussion: The NTS was demonstrated to have good psychometric properties. Further NTS research should include testing the tool in hospitals with varying characteristics and exploring the links to clinical and operational outcomes.