Assessing Unit Culture

Identify and Prioritize Opportunities to Enhance Teamwork and Inclusion.

Rose O. Sherman, EdD, RN, NEA-BC, FAAN; Tanya M. Cohn, PhD, MEd, RN


Am Nurs Journal. 2023;18(2) 

In This Article

Abstract and Introduction


Mark is the new director of a busy neonatal intensive care unit (NICU). When reviewing the unit's most recent Glint Nurse Engagement scores, he notes that most staff don't recommend the unit as an excellent place to work. Staff comments include "Not an inclusive culture," "Cliques are present in this environment," and "Staff gossip about one another." Mark realizes that significant problems exist with the unit culture but wants to learn more before designing specific interventions.


Many new leaders like Mark find issues with their unit cultures, especially after the COVID-19 pandemic. During the height of the pandemic in 2020, most leaders successfully kept their teams together and marveled at the level of team collaboration. However, that cohesiveness fell apart in 2021 with politicization of the vaccine and disinformation about the virus. Nurses became more pessimistic about the future. According to Nursing Solutions, Inc., nurse turnover skyrocketed to the current annual rate of 27% in acute care environments, and the use of travel and agency nurses to supplement core team staffing have become commonplace.

With social distancing and mask-wearing, nursing teams also lost their rituals, such as meals together, socializing outside of work, and celebrating events in the lives of staff. In her book Rituals Roadmap, Erica Keswin describes rituals as an evidence-based practice for building strong cultures. They help us connect in meaningful ways. When we lose rituals, our connections to one another weaken. Celebrating birthdays, baby showers, or group dinners revitalize us in ways other activities don't and help us to know more about each other. In the absence of solid team connections, unit cultures can erode.

Mark is wise to realize that he needs to quickly address the problems raised in the engagement survey before they become normalized. Unit culture significantly impacts a range of performance metrics, which drive reimbursement. Team members in dysfunctional cultures are less likely to communicate about problems, resulting in more hidden medical errors and safety issues.