Multicultural Nursing Team in ICU: Intraprofessional Collaboration and Job Performance
Abstract
Background: The United Arab Emirates’ nursing workforce has a remarkable diversity, including a range of cultural, linguistic, clinical, and educational backgrounds. While a source of richness, this diversity poses challenges to effective collaboration among Intensive Care Unit (ICU) nurses. This study aimed primarily to analyze the relationship between nurse collaboration and self-perceived performance in ICUs. Therefore, the study is significant for its potential to improve collaborative practices within the nursing profession, leading to elevated patient care standards in a diverse and demanding clinical environment.
Methods: One hundred and forty-seven ICU nurses participated in this cross-sectional study. The “Nurse–Nurse Collaboration Scale” and the “Six-Dimension Scale for Nursing Performance” were used to collect the study data. Data were statistically analyzed using multiple linear regression with 10 independent variables.
Results: The overall mean scores for nurse–nurse collaboration exhibit a statistically significant difference between Arabic and overseas nurses (p = 0.002). Similarly, the total mean scores for perceived job performance also show a significant difference. The standardized beta coefficient indicates that nurse–nurse collaboration is a significant predictor (β = 0.470, p = 0.001) as well as nurse-to-patient ratio (β = −0.233, p = 0.003).
Conclusion: The study revealed a statistically significant difference in coordination among nurses from different ethnic backgrounds. Better team collaboration and a lower nurse-to-patient ratio are two major aspects that nurse administrators can work on to enhance job performance among ICU nurses in the United Arab Emirates, achieving optimal performance in resource deployment and quality of service.
Implications for Nursing Practice: This study highlights the intricate dynamics of nursing teamwork within the multicultural ICU settings. Identifying and addressing the nuances of teamwork, alongside the critical factors affecting nurse collaboration and job performance, is vital for improving patient outcomes and fostering a positive work environment.
1. Introduction
The United Arab Emirates’ nursing workforce showcases a remarkable diversity, including a range of cultural, linguistic, religious, economic, clinical, and educational backgrounds. This diversity, while an intrinsically valuable source of richness in terms of cultural and professional sensitivities and expertise, poses unique challenges to effective collaboration among nurses, highlighting the necessity for cohesive teamwork in ensuring high-quality patient care and healthcare delivery [1].
Intraprofessional nursing collaboration is defined as an intraprofessional process where nurses collaborate as a team to address patient care or healthcare system issues while sharing knowledge and ideas in a respectful and efficient manner [2]. It is the knowledge of individual nurse’s roles and skills and the roles and skills of others. Intraprofessional nursing collaboration has a positive impact on healthcare professionals as well as the patients especially in Intensive Care Units (ICUs). It promotes a culture of trust and mutual understanding among team members, fostering job satisfaction, professional development, and retention of skilled staff [3]. The previous literature has opined that health workers in unified teams can achieve superior safety and care quality for service users due to aligned objectives [4–6].
However, this multicultural composition would pose some challenges. The diversity might hinder nurse–patient and nurse–nurse interaction [7]. Healthcare contexts with personnel and service users from diverse cultures can hinder critical care nurses’ abilities if these pose inhibitions to skill deployment due to distinct professional expectations and cultures, conflicts in clinical decisions, and implicit (or explicit) prejudices [7, 8]. The high rate of attrition among non-native nurses could also pose an additional significant challenge to the stability of nursing teams and the preservation of institutional knowledge, underscoring the importance of strategic succession planning [1].
To navigate such challenges, it is imperative to foster effective nurse–nurse collaboration within the United Arab Emirates’ multicultural healthcare settings. Leadership’s role in bridging cultural divides and cultivating an inclusive culture is crucial for leveraging diversity toward enhanced patient outcomes and workforce stability.
ICUs in particular are high-risk environments, where the complexities of patient illnesses demand exceptional levels of performance and teamwork. Patients in ICUs often present with life-threatening or severe conditions that require close monitoring and extensive medical intervention. The management of such patients involves intricate decision-making processes, continuous assessment, and the application of advanced therapeutic technologies [9]. This high-technology environment necessitates a comprehensive understanding of sophisticated medical equipment and the ability to adapt to rapidly changing clinical situations [10]. Effective teamwork within the ICU is critical to achieve effective job performance, as it ensures cohesive action among healthcare professionals from diverse specialties, integrating their expertise to provide the best possible care for critically ill patients [11]. The synergy between skilled professionals in such a demanding setting underscores the importance of clear communication, mutual respect, and a shared commitment to patient-centric goals [12].
Effective intraprofessional collaboration and the positive effects of workplace relationships on quality of care reaffirm the value of constructive job performance in improving patient outcomes [13, 14]. Effective leadership and management practices [15, 16], alongside transformational leadership approaches [17], are instrumental in fostering culturally competent care and improving team functionality in multicultural environments. Moreover, overcoming communication barriers, especially language differences, is imperative for ensuring the delivery of high-quality care, further highlighting the need for effective communication strategies [18].
A previous study examined the relationship between nurse–nurse collaboration and self-perceived nurse performance, but it was limited to Jordanian ICU nurses [13]. Another study conducted by Moussa et al. [19] in Saudi Arabia aimed to assess collaborative team performance among nurses; however, it did not analyze the data based on the nurses’ cultural backgrounds. Nevertheless, to the best of our knowledge, there is a lack of studies investigating these variables within the diverse workforce in the United Arab Emirates, especially in ICUs.
The present study aimed at investigating the level of Arabic and overseas ICU nurses’ perceived performance of their roles and their teamwork with peers in the United Arab Emirates. Specifically, this study was undertaken in order to (a) determine internurse teamwork and performance (self-perceived) for both Arabic and overseas ICU nurses, (b) determine whether any sociodemographic characteristics are instrumental in nurse–nurse collaboration and self-perceived nurse performance and among critical care nurses, and (c) investigate the relationship between nurse–nurse collaboration and self-perceived nurse performance among ICU nurses.
2. Methods
2.1. Research Design, Sampling, and Setting
This study adopted a cross-sectional design. This design is particularly suitable for our research aim, as it efficiently captures data on the diverse perspectives of Arabic and overseas ICU nurses, facilitating a comparative analysis. The study was conducted in two governmental hospitals in Sharjah, UAE. The study focuses on critical care settings, specifically the ICU, Coronary Care Unit (CCU), and Emergency Department (ED). The participants were selected using a convenience sampling technique and included two groups of participants: a group of Arabic speakers who are often influenced by Arabic cultural norms, values, and practices and a group coming from Middle Eastern countries, i.e., Jordan, Egypt, Lebanon, and Syria. While the other group of participants, overseas nurses, primarily communicate in languages other than Arabic and come from a variety of cultural backgrounds. This group encompasses a diverse array of ethnicities and cultural identities, each characterized by unique norms, values, and practices that may influence their interactions within a multicultural environment, such as the healthcare setting in the United Arab Emirates. Participants from this group include individuals from non-Arab countries, particularly Asian nations such as India, the Philippines, Pakistan, and Indonesia, as well as African countries such as Somalia. Inclusion criteria specified that participants had to be registered nurses with a minimum of 1 year of clinical experience in critical care. Using G ∗ Power analysis, the required sample size was determined with the following assumptions: a medium effect size of 0.15, an α of 0.05, and a power of 0.8. In addition, multiple linear regressions, with 10 independent variables, were used as a statistical test. Based on these assumptions, 118 participants were adequate to run the analysis; however, 147 participants were invited to account for nonresponse and missing data.
2.2. Data Collection
The managers of units in the selected departments identified the potential participants. Subsequently, eligible nurses received a participant consent form, with an explanatory cover letter, outlining the study’s purpose, relevance, and procedures. Participation was voluntary, and confidentiality was assured. Those who agreed to participate and signed the informed consent were provided access to an online survey via their professional emails. A reminder email was sent 48 h later to maximize response rates. Data were collected between January and April, 2023.
2.3. Instruments
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Part 1: Demographic and work characteristics include age, gender, ethnicity, marital status, workplace, work experience, income, and nurse-to-patient ratio.
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Part 2: The “Nurse–Nurse Collaboration Scale” was developed by Dougherty and Larson [20], which consists of 35 items measuring five subdomains: conflict management (seven items), communication (eight items), shared process (eight items), coordination (five items), and professionalism (seven items). These items are answered with a four-point rating scale, ranging from “strongly disagree” (1) to “strongly agree” (4). Conversely, Items 29, 30, 31, 32, 33, 34, and 35 are exceptions to this scoring rubric and are scored in the reverse manner (i.e., from four to one to indicate increasing agreement). Greater scores are indicative of superior collaboration among nurses. The instrument attained Cronbach’s alpha of 0.89 (ranging from 0.66 to 0.091 for subscales) [20], and overall Cronbach’s alpha for the scale is 0.89, ranging from 0.66 to 0.91 for the five subscales.
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Part 3: The “Six-Dimension Scale for Nursing Performance” was developed by Schwirian [21], which consists of 52 questions grouped into six subscales: leadership (five items), critical care (seven items), teaching/collaboration (11 items), planning/evaluation (seven items), interpersonal relations/communications (12 items), and professional development (10 items). It explores how well nurses perform their duties, with a four-point wellness scoring system, ranging from “not very well” (1) to “very well” (4), whereby greater scores pertain to superior self-reported performance. According to Schwirian [21], the tool has acceptable Cronbach’s alpha coefficients ranging from 0.844 to 0.978 (for the “leadership” and “professional development” subscales, respectively).
2.4. Data Analysis
IBM SPSS software (version 28) was used to analyze the data. Descriptive statistics (including M ± SD or numbers and percentages) were used for demographic data, internurse collaboration, and scores for performance (self-perceived). Independent samples’ t-test examined differences in mean scores based on dichotomous demographic variables, while one-way analysis of variance (ANOVA) with post hoc analysis compared mean scores for variables with more than two categories. Pearson’s correlation coefficient explored relationships between continuous variables and job performance scores. The research question was tested using stepwise multiple linear regression for Arabic and overseas ICU nurses.
2.5. Ethical Considerations
Ethical approval was obtained from the Research Ethics Committee (REC) at the University of Sharjah (REC-23-02-23-07S). Participants had the right to participate or withdraw with guaranteed confidentiality. Anonymity was maintained through assigned code numbers. The study’s purpose was explained, and anonymity, confidentiality, and the right to refuse to participate in the study were assured for all participants. Fully informed written consent was obtained from each participant before participation in the study.
3. Results
Table 1 presents the mean and standard deviation (SD) values for nurse–nurse collaboration and ICU nurses’ perceived job performance, categorized by ethnicity into two groups: Arabic and overseas. Regarding nurse–nurse collaboration, the difference between Arabic and overseas nurses is statistically significant only in terms of coordination (p = 0.004∗). While conflict management, communication, shared process, and professionalism show moderate differences, and these are not statistically significant (p > 0.05). The overall mean scores for nurse–nurse collaboration do exhibit a statistically significant difference between Arabic and overseas nurses (p = 0.002). Additionally, the table includes perceived job performance scores across different categories. Notably, there are statistically significant differences in planning and evaluation (p = 0.003∗), critical care (p = 0.002∗), and leadership (p = 0.004∗). The total mean scores for perceived job performance also show a significant difference (p = 0.003∗).
| Nurse–nurse collaboration (mean ± SD) | Perceived job performance (mean ± SD) | ||||||
|---|---|---|---|---|---|---|---|
| Category | Arabic nurses | Overseas nurses | p | Category | Arabic nurses | Overseas nurses | p |
| Conflict management | 2.97 ± 0.38 | 2.98 ± 0.40 | 0.11 | Professional development | 3.66 ± 0.38 | 3.61 ± 0.48 | 0.59 |
| Communication | 2.63 ± 0.25 | 2.58 ± 0.25 | 0.26 | Planning and evaluation | 3.44 ± 0.56 | 3.55 ± 0.46 | 0.003 ∗ |
| Shared process | 3.34 ± 0.39 | 3.19 ± 0.42 | 0.15 | Interpersonal relationship and communication | 3.56 ± 0.37 | 3.61 ± 0.39 | 0.20 |
| Coordination | 3.42 ± 0.48 | 3.31 ± 0.45 | 0.004 ∗ | Critical care | 3.56 ± 0.41 | 3.70 ± 0.39 | 0.002 ∗ |
| Professionalism | 3.53 ± 0.26 | 3.44 ± 0.45 | 0.38 | Teaching and collaboration | 3.34 ± 0.55 | 3.41 ± 0.55 | 0.60 |
| Total mean score | 3.18 ± 0.25 | 3.10 ± 0.28 | 0.002 ∗ | Leadership | 3.35 ± 0.52 | 3.55 ± 0.47 | 0.004 ∗ |
| Total mean score | 181.6 ± 21.7 | 184.61 ± 21.5 | 0.003 ∗ | ||||
- ∗indicates significant value in the table.
Table 2 shows the variations in nurse–nurse collaborations based on demographic factors such as gender, marital status, educational level, workplace, working shift, years of experience, income, and nurse-to-patient ratio. Significant differences were found for nurses working in the ED in terms of collaboration (p = 0.006), and by working shift, with day shift nurses having higher collaboration scores than night shift ones (p = 0.012 and p = 0.002 for Arabic and overseas nurses, respectively). There is a significant difference in collaborations based on the nurse-to-patient ratio (p = 0.001).
| Variable | Category | Nurse–nurse collaborations | |||||
|---|---|---|---|---|---|---|---|
| Total | t/F, p value | Arabic nurses (n = 25) | t/F, p value | Overseas nurses (n = 122) | t/F, p value | ||
| Gender | Female | 3.09 ± 0.27 | −1.10, 0.27 | 3.22 ± 0.27 | 0.53, 0.60 | 3.10 ± 0.27 | −1.20, 0.23 |
| Male | 3.10 ± 0.28 | 3.16 ± 0.25 | 3.14 ± 0.28 | ||||
| Marital status | Single | 3.08 ± 0.25 | −0.78, 0.22 | 3.12 ± 0.24 | −1.33, 0.19 | 3.06 ± 0.24 | −0.77, 0.51 |
| Married | 3.13 ± 0.28 | 3.24 ± 0.24 | 3.11 ± 0.29 | ||||
| Educational level | B.Sc. | 3.13 ± 0.27 | 1.72, 0.08 | 3.19 ± 0.26 | 0.81, 0.68 | 3.12 ± 0.27 | 1.47, 0.14 |
| Master | 2.97 ± 0.30 | 2.97 ± 0.00 | 2.97 ± 0.32 | ||||
| Workplace | ICU | 3.22 ± 0.27 | 6.71, 0.002 ∗ | 3.19 ± 0.21 | 1.38, 0.27 | 3.24 ± 0.35 |
|
| CCU | 3.03 ± 0.26 | 3.08 ± 0.28 | 3.12 ± 0.26 | ||||
| ED | 3.20 ± 0.30 | 3.29 ± 0.24 | 3.17 ± 0.27 | ||||
| Working shift | Day | 3.16 ± 0.29 | 1.40, 0.003 ∗ | 3.13 ± 0.26 | 0.24, 0.001 ∗ | 3.09 ± 0.25 | 1.23, 0.002 ∗ |
| Night | 3.01 ± 0.25 | 3.08 ± 0.37 | 2.90 ± 0.25 | ||||
| Years’ experience | 10.03 ± 5.05 | r = −0.61, 0.50 | 7.28 ± 5.76 | r = −0.09, 0.64 | 10.60 ± 4.72 | r = −0.024, 0.79 | |
| Income (AED) | 8643.4 ± 1632.7 | r = −0.13, 0.89 | 9526.7 ± 3083.2 | r = −0.10, 0.64 | 8446.2 ± 1000.6 | r = −0.038, 0.71 | |
| Nurse-to-patient ratio | 1:1 | 3.16 ± 0.28 | r = −2.48, 0.001 ∗ | 3.18 ± 0.27 | r = −0.13, 0.003 ∗ | 3.15 ± 0.28 | r = −0.12, 0.004 ∗ |
| 1:2 | 3.06 ± 0.25 | 2.08 ± 0.28 | 3.04 ± 0.27 | ||||
| 1:3 | 3.17 ± 0.27 | 2.29 ± 0.24 | 3.01 ± 0.28 | ||||
- ∗indicates significant value in the table.
Table 3 presents the variations in nurses’ perceived job performance based on demographic factors such as gender, marital status, educational level, workplace, working shift, years of experience, income, and nurse-to-patient ratio. Significant differences in nurses’ perception toward their job performance were found among nurses who are married (p = 0.001) and among Arab nurses who have more work experience (p = 0.002). There is a significant negative correlation in perceived job performance based on the low nurse-to-patient ratio (r = −2.36, p = 0.001). The relation between the total collaboration and perceived job performance is statically significant among the total study population (r = 0.499, p < 0.001) and among the Arabic and overseas groups (r = 0.452, p < 0.05; 0.512 and p < 0.001, respectively).
| Variable | Category | Perceived job performance | |||||
|---|---|---|---|---|---|---|---|
| Total | t/F, p value | Arabic nurses (n = 25) | t/F, p value | Overseas nurses (n = 122) | t/F, p value | ||
| Gender | Female | 3.54 ± 0.37 | −0.502, 0.62 | 3.43 ± 0.40 | −0.726, 0.07 | 3.56 ± 0.37 | −0.332, 0.74 |
| Male | 3.57 ± 0.43 | 3.55 ± 0.39 | 3.58 ± 0.45 | ||||
| Marital status | Single | 3.39 ± 0.40 | −2.50, 0.001 ∗ | 3.26 ± 0.28 | −3.83, 0.001 ∗ | 3.49 ± 0.45 | −0.91, 0.36 |
| Married | 3.60 ± 0.39 | 3.75 ± 0.34 | 3.58 ± 0.40 | ||||
| Educational level | B.Sc. | 3.57 ± 0.40 | 1.18, 0.23 | 3.52 ± 0.38 | 1.74, 0.09 | 3.57 ± 0.41 | 0.721, 0.47 |
| Master | 3.41 ± 0.43 | 2.86 ± 0.00 | 3.47 ± 0.40 | ||||
| Workplace | ICU | 3.47 ± 0.31 | 2.82, 0.06 | 3.46 ± 0.24 | 2.47, 0.11 | 3.48 ± 0.41 | 1.33, 0.26 |
| CCU | 3.49 ± 0.44 | 3.37 ± 0.45 | 3.51 ± 0.44 | ||||
| ED | 3.56 ± 0.38 | 3.77 ± 0.37 | 3.63 ± 0.38 | ||||
| Working shift | Day | 3.48 ± 0.45 | −0.185, 0.85 | 3.44 ± 0.40 | 104, 0.09 | 3.50 ± 0.47 | −0.82, 0.91 |
| Night | 3.50 ± 0.38 | 3.40 ± 0.24 | 3.51 ± 0.39 | ||||
| Years’ experience | 10.03 ± 5.05 | r = 0.114, 0.16 | 7.28 ± 5.76 | r = 0.386, 0.002 ∗ | 10.60 ± 4.72 | r = 0.10, 0.14 | |
| Income (AED) | 8643.4 ± 1632.7 | r = −0.153, 0.08 | 9526.7 ± 3083.2 | r = −0.717, 0.80 | 8446.2 ± 1000.6 | r = −0.24, 0.81 | |
| Nurse-to-patient ratio | 1:1 | 3.51 ± 0.43 | r = −2.36, 0.001 ∗ | 3.40 ± 0.42 | r = −1.55, 0.001 ∗ | 3.55 ± 0.43 | r = −0.16, 0.003 ∗ |
| 1:2 | 3.54 ± 0.42 | 3.68 ± 0.32 | 3.52 ± 0.42 | ||||
| 1:3 | 3.72 ± 0.27 | 3.78 ± 0.30 | 3.72 ± 0.26 | ||||
- ∗indicates significant value in the table.
Table 4 presents the predictors of perceived job performance. The standardized beta coefficient indicates that nurse–nurse collaboration is a significant predictor (β = 0.470, p = 0.001), suggesting that higher collaboration scores are associated with better perceived job performance. The nurse-to-patient ratio is also a significant predictor (β = −0.233, p = 0.003), indicating that a lower nurse-to-patient ratio is associated with better perceived job performance. The model’s overall statistics include an R2 of 27%, suggesting that the predictors explained 27% of the variance in perceived job performance.
| Variable | Standardized β | t | p | Model statistics |
|---|---|---|---|---|
| 1:1 nurse-to-patient ratio | −0.233 | 2.17 | 0.003 |
|
| Nurse-nurse collaboration | 0.470 | 6.04 | 0.001 |
4. Discussion
4.1. Main Outcomes
The diversity of the United Arab Emirates’ nursing workforce, characterized by a wide range of cultural, linguistic, religious, economic, clinical, and educational backgrounds, plays a pivotal role in the dynamics of ICUs within the country. These settings are defined by the critically important care provided within them, and the inherent complexity of ICU patient conditions necessitates exceptional individual and team performance among multidisciplinary healthcare teams. This study investigated the level of Arabic and overseas ICU nurses’ collaboration and perceived job performance in the United Arab Emirates. Nurse–nurse collaboration and nurse-to-patient ratio were found to be significant predictors, suggesting that higher collaboration scores and a lower nurse-to-patient ratio are associated with better perceived job performance.
The first notable finding of this research is the statistically significant difference in coordination among nurses from different ethnic backgrounds, specifically between Arabic and overseas nurses. This has profound implications for the functioning of ICUs in the United Arab Emirates. This divergence in coordination capacities suggests that cultural variances substantially influence teamwork dynamics, potentially impacting the efficiency and effectiveness of patient care in these critical settings. In high-stakes ICU environments, where the margin for error is minimal, the effectiveness of teamwork directly influences the QoC and patient safety [4]. A study conducted by Nobahar et al. in 2023 [22] demonstrated that enhanced teamwork among ICU nurses was linked to greater moral sensitivity, a decrease in missed nursing care, and an improvement in the quality of care. Therefore, identifying and addressing the root causes of coordination disparities could lead to improvements in patient outcomes, as well as enhanced job satisfaction and retention rates among nurses.
Furthermore, the fact that identified variances in conflict management, communication, shared processes, and professionalism being moderate and nonsignificant should not be interpreted as evidence of their irrelevance. Rather, these minor differences may hold clinical significance, as these elements are essential for the seamless operation of any team, especially within the high-pressure context of ICUs. Effective conflict management and communication within culturally diverse healthcare teams are essential for ensuring patient safety and optimal care outcomes in such high-pressure environments [23, 24]. The critical role of these elements in facilitating efficient patient care and cultivating a conducive workplace atmosphere is paramount, underscoring their intrinsic value in healthcare settings [23].
The significant differences observed in planning and evaluation, critical care, and leadership in perceived job performance among nurses of different ethnicities further underscore the impact of cultural diversity on perceptions of job performance. This perspective aligns with El Amouri and O’Neill’s [25] study, which emphasizes the crucial role of leadership in navigating cultural differences to improve job performance in healthcare settings. Their findings suggest that leadership styles that embrace and effectively manage cultural diversity can lead to significant improvements in team performance. Furthermore, Almutairi et al. [26] indicated that a supportive work environment tailored to cultural diversity positively influences nurses’ job performance and satisfaction, thereby reinforcing the critical role of leadership in multicultural healthcare settings. In terms of planning, evaluation, and critical care, both subscales showed higher levels among Arabs and those overseas compared to a previous study [13].
The present study also showed that there are some demographic and work-related factors which could affect the collaboration and job performance, such as workplace, working shift, and nurse-to-patient ratios. A prior European study investigated the extent of teamwork and the factors influencing it in certain hospitals. The researchers found that variations in teamwork levels were influenced by unit type, education, hours worked, overtime hours, and perceived staff adequacy [27]. This would offer a new dimension to understand the dynamics of multicultural teams. The finding of significant differences in collaboration among nurses working in the ED (p = 0.006) can be attributed to the unique pressures and demands of the ED environment. EDs are characterized by high patient turnover, acute care situations, and the need for rapid decision-making, which necessitates a higher level of teamwork and communication to ensure effective patient care [28]. The urgency and unpredictability of the ED likely cultivate a more collaborative culture out of necessity, as staff must frequently work together closely to address immediate patient needs.
The differences in collaboration based on the working shift, with day shift nurses displaying higher collaboration scores for Arabic and overseas nurses, respectively, can be rationalized by examining the operational dynamics of hospitals. Day shifts typically involve more interactions with the broader healthcare team, including doctors, management, and ancillary staff, facilitating more opportunities for collaboration. Additionally, day shifts coincide with more administrative activities and decision-making processes, requiring nurses to engage more frequently in collaborative efforts. In contrast, night shifts might limit such interactions due to reduced staffing levels and the absence of full administrative support, potentially impacting collaborative opportunities. The significance of these dynamics is underscored by the findings of Aljuaid et al. [29], who identified that errors in administering medicines were less prevalent during daytime shifts, highlighting the challenges of maintaining effective collaboration and communication in the absence of optimal working conditions.
The significant difference in collaboration based on the nurse-to-patient ratio (p = 0.05) highlights the critical role of workload management in fostering effective teamwork. A lower nurse-to-patient ratio often means nurses have more time to engage in thorough communication and coordination, directly influencing the quality of collaboration. Conversely, higher ratios may strain resources, leading to increased stress levels and reduced time for nurses to collaborate effectively. This finding aligns with the existing literature that underscores the importance of adequate staffing levels in promoting not only patient safety and QoC but also teamwork and job satisfaction among healthcare professionals. An umbrella review by Blume et al. [30] emphasized that optimal staffing levels and models are essential for ensuring quality care across different settings and patient demographics, reinforcing the need for operational excellence and context-awareness in promoting effective collaboration and job performance among diverse nursing teams.
These findings highlight the multifaceted factors that influence collaboration within nursing teams, emphasizing the need for targeted strategies to enhance teamwork across different settings and conditions. Addressing these factors through tailored interventions—such as adjusting staffing models, providing shift-specific teamwork training, and fostering a culture of collaboration across all levels of the healthcare organization—can ultimately lead to improved patient care outcomes and a more supportive work environment for nurses.
This study revealed that marital status and work experience have a noteworthy impact on how Arabic nurses perceive their job performance, with married individuals and those with more years of service reporting significantly higher satisfaction levels. Such findings suggest that the stability and support inherent in marital life, coupled with the confidence and expertise gained through prolonged professional exposure, play crucial roles in bolstering nurses’ self-assessment of their performance.
Moreover, our analysis identified a significant negative correlation between perceived job performance and nurse-to-patient ratios, highlighting the impact that excessive workloads have on nurses′ ability to provide quality care, consequently impacting their self-perception to their performance negatively. This finding aligns with Liu et al. [31], who identified key criteria and causal relationships affecting nurses’ job satisfaction, emphasizing the importance of workplace conditions, perceived job performance, and supervisor support in enhancing job satisfaction.
Equally important is the substantial link between collaboration and perceived job performance, with this association being particularly pronounced among both Arabic and overseas nursing groups. This finding is indicative of the fundamental role that effective teamwork plays within healthcare settings. A cohesive team environment not only optimizes operational efficiency and patient care but also significantly enhances individual nurses’ perceptions of their job performance [32]. The conflict management subscale of the nurse–nurse collaboration scale was an independent and significant predictor of self-perceived performance among ICU nurses in Jordan [13].
The success achieved through collective efforts tends to elevate each team member’s view of their own contribution and effectiveness [33]. Thus, these insights underscore the critical need for healthcare administrations to foster a work culture that values collaboration, recognizes the importance of supportive personal circumstances, ensures adequate staffing levels, and appreciates the enrichment brought by professional experience. Addressing these elements is essential for not only enhancing nurses’ job satisfaction and perceived efficacy but also for achieving superior patient care outcomes.
Within our analysis, key predictors of perceived job performance among nurses have emerged, shedding light on the factors that critically influence how nurses evaluate their own effectiveness in the workplace. Notably, the nurse–nurse collaboration stands out as a significant predictor, demonstrating that higher levels of collaboration among nurses are strongly associated with more positive perceptions of job performance. This finding underscores the vital role that teamwork and cooperative interactions play in shaping nurses’ self-assessment of their job capabilities, suggesting that fostering a culture of collaboration within healthcare settings can significantly enhance job satisfaction and perceived effectiveness among nursing staff.
Additionally, the nurse-to-patient ratio is identified as another crucial predictor of perceived job performance. This indicates that more favorable nurse-to-patient ratios, where nurses are responsible for fewer patients, are linked to better perceptions of job performance. This relationship highlights the importance of optimal staffing levels, suggesting that managing workloads effectively by ensuring a manageable nurse-to-patient ratio is a key to enabling nurses to feel more competent and successful in their roles.
Moreover, the model’s overall statistics, with an R2 of 27%, reveal that the identified predictors account for a significant proportion of the variance in perceived job performance among ICU nurses. This considerable explanatory power emphasizes the importance of both collaborative dynamics and staffing adequacy as fundamental aspects that influence nurses’ perceptions of their job performance. Healthcare leaders and administrators should prioritize initiatives that promote strong team collaboration and maintain appropriate nurse-to-patient ratios. By addressing these critical factors, healthcare institutions can not only enhance the job satisfaction and performance perceptions among their nursing staff but also improve the overall QoC provided to patients.
4.2. Study Strengths and Limitations
The study addresses the gap in the research regarding the impact of cultural diversity on the nurse–nurse collaboration and performance within the United Arab Emirates’ nursing workforce, particularly in ICUs. The findings may inform healthcare policies and leadership practices aimed at creating inclusive and supportive work environments for diverse nursing teams. Insights from the study can also guide nurse mangers in developing training and resource allocation that effectively leverage the strengths of a culturally diverse workforce. The study sets the groundwork for further research into the dynamics of multicultural nursing teams. There are certain limitations that need to be acknowledged in this study. The main limitation of this study was that the generalizability is axiomatically restricted to public hospital nurses in the studied context. Furthermore, the self-reported performance data are inherently predisposed to social desirability bias, even if it was administered online to reduce such potential. Clinical observations to complement these findings would help add veracity to the insights gleaned from self-reported data. The research specifically focused on a small number of nurses working in the ICUs, which hinders the generalizability of the results. Moreover, the reliance on an online self-administered questionnaire means that the findings are derived from the perspectives of ICU nurses rather than being directly observed in their actual performance (rendering the data prone to the potentially idealized perceptions of participants of their own performance).
5. Conclusion
This study highlights the nursing collaboration and job performance of the nursing teamwork within the United Arab Emirates’ multicultural ICU settings. The study showed a significant difference in coordination among nurses from different ethnic backgrounds, specifically between Arabic and overseas nurses. The total mean scores for perceived job performance also show a significant difference. Future strategies should prioritize tailored interventions to enhance teamwork, recognizing the unique challenges and opportunities presented by the diverse nursing workforce. Nurse mangers should focus on fostering better collaboration among team members and lowering the nurse-to-patient ratio, both of which are critical factors in improving job performance among ICU nurses in the United Arab Emirates. By implementing these strategies, healthcare facilities can enhance nurse retention and ultimately achieve optimal performance in patient care. This research should be replicated with a larger sample size for a more comprehensive analysis. Finally, future researchers might consider broadening the focus of this study to include other healthcare settings.
Ethics Statement
This study has been contacted according to the Declaration of Helsinki, 1964. Ethical approvals were gained from the Institutional Review Board of the University of Sharjah.
Consent
The authors have nothing to report.
Conflicts of Interest
The authors declare no conflicts of interest.
Author Contributions
F.R.A.: conceptualization, methodology, formal analysis, writing – original draft, writing – review and editing, and project administration.
L.K.: conceptualization, methodology, software, validation, and data curation.
H.M.: conceptualization, methodology, software, validation, and data curation.
H.I.F.A.: conceptualization, methodology, software, validation, and data curation.
T.G.T.I.: conceptualization, methodology, software, validation, and data curation.
N.A.-Y.: formal analysis, investigation, and writing – original draft.
A.A.: investigation and writing – original draft.
M.H.: writing – review and editing and visualization.
M.A.S.: validation, investigation, and visualization.
R.M.: validation, writing – review and editing, and visualization.
M.E.A.: formal analysis, investigation, and writing – original draft.
Funding
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Acknowledgments
Our sincere appreciation goes to all participants of the present study.
Open Research
Data Availability Statement
Data will be available upon request.
