- Jee Hae Kim
History of Team Nursing
Team nursing started from the 1950s to improve nursing services by using the knowledge and skills of professional nurses and to supervise the increasing numbers of supporting nursing staff. The result was an improvement in patient and staff satisfaction. This try requires critical leadership and good communication skills to bring several nurses together, led by a leader, to work cooperatively to deliver a better nursing care than possible with individual nurses working alone (Dobson, Adamson, and Drexler, 2007). Experiences of nurses delivering care in teams have been explored from the perspective of nurses, team leaders and nurse managers (Ferguson and Cioffi, 2011). The model used a group of nurses with diversity in education, skills and professional registration status (Fairbrother, Jones, & Rivas, 2010). From 1960s to 1970s, it was the golden age of team nursing. Applying humanistic values in the workplace became increasingly important during this period (Tiedeman & Lookinland, 2004 cited in Fairbrother, et.al, 2010) and the team approach seemed to account for the whole patient (as primary nursing had done) within the context of a multi-level skill mix and responsibility mix environment.
What personnel are utilized? & what are their roles and responsibilities?
Team nursing consists of a charge nurse leading nursing assistants and other personnel to provide care to a group of patients. Health care professionals work in a team to complete all assignments for each shift. As registered nurses, charge nurses are held accountable for unlicensed personnel.
In the team nursing RN functions as a team leader and coordinates the small group (no more than four or five) of ancillary personnel to provide care to a small group of patients.
As coordinator of the team, the RN must know the condition and needs of all patients assigned to the team and plan for the individualized care for each patient. (Marquis and Huston, 2003)
The team leader is also responsible for encouraging a cooperative environment and maintaining clear communication among all team members. The team leader’s duties include planning care, assigning duties, directing and assisting team members, giving direct patient care, teaching and coordinating patient activities.
How is the work coordinated?
Patient care is delivered through the coordination and cooperation of each team member through delegation of assignments with respect to the team member’s level of responsibility and accountability. Delegation of patients and duties are done at the beginning of the shift, while a summary of care given and outcomes resulting from patient care is conveyed at the end. Any action that is done by unlicensed assistive personnel, nursing aid or nurse volunteer is the responsibility and accountability of the team leader, the registered nurse.
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The team leader assigns each member specific responsibilities dependent on the role. The members of the team report directly to the team leader, who then reports to the charge nurse or unit manager. Communication is enhanced through the use of written patient assignments, the development of nursing care plans, and the use of regularly scheduled team conferences to discuss the patient status and formulate revisions to the plan of care.
However, for team nursing to succeed, the team leader must have strong clinical skills, good communication skills, delegation ability, decision-making ability, and the ability to create a cooperative working environment.
What are the reporting relationships?
For nurses, the benefits have been identified as improved working relationships increased ability to share and work together and availability of a shared network. However, some issues identified with team nursing have been inadequate preparation for team nursing. For example, there is an increased responsibility for registered nurses particularly when in the role of team leader, unfair and uneven workloads leading to overburdening of staff and confusion around roles and responsibilities in the team (Furguson & Cioffi, 2011).
Team leaders reported that their job satisfaction improved particularly through enhanced relationships and seeing staff develop. These findings clearly indicate gains for both patients and staff can be made with team nursing. From the perspective of nurse managers, findings show relationships for patients, relatives and staff improved, staff morale and motivation increased and communications improved (Furguson & Cioffi, 2011).
What are the educational requirements for the various positions?
The managers who implemented team nursing identified retrospectively that more information and educational support is essential. As little is currently known about nurse managers’ experiences with team nursing this study explored and described managers’ experiences of team nursing (Furguson & Cioffi, 2011).
Discuss how team nursing model affects or influences cost, quality of care and patient satisfaction
When nursing units are inadequately staffed, the consequences include higher costs and poorer outcomes for patients and nurses. Overall costs are reduced when nurses are retained, which is more likely in healthy environments that support professional nursing practice and nurses’ health and work-life balance (O’Brienâ€Pallas, Meyer, Hayes, & Wang, 2011).
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According to research related to team nursing experiment, the team nurses found that 62% of patients were very satisfied about their care. After three weeks of implementing team nursing care, patient satisfaction data were again collected daily for one month. These data revealed that 91% of patients were very satisfied with the care they received (Snide & Nailon, 2013).
How is the availability of resources taken into consideration when adopting this model?
Main findings show nurse managers’ experiences of team nursing focused on the adaptation to team nursing with its associated gains and concerns. Managers identified that similar factors had precipitated the change to team nursing within their ward areas and it was acknowledged the implementation process needed to be better planned to include collaboration with staff, clear protocols and roles for teams.
How does the delivery model affect job satisfaction?
The results indicated that RNs were significantly happier at work than any of the other staff categories at both baseline and follow up. When considering the direction of change in job satisfaction (i.e. baseline vs follow up) by staff category, small net negative changes were noticed for RNs and positive changes were noted for the other three groups. The proportionally largest change was detected among new graduate RNs, whose mean scores were markedly improved at follow up. This difference was marginally statistically significant. A statistically significant result was unlikely to be obtainable with the small numbers of new graduates surveyed (Fairbrother, et.al, 2010). This supports that teamâ€‘based models can improve patient safety, quality of care and the work environment.
Summarize the pros and cons of team nursing care delivery model.
The advantage of team nursing is that the total number of absences and leaves related to over-work and medical conditions related to stress and fatigue is lessened. This is due to the sharing of workload between each team members, enabling them to do a huge amount of work in such a short time without undue exertion. This delegation of duties will also enable team members to hone their skills in different nursing tasks, and also improve their ability to communicate and coordinate. Each can also learn from each other during team conference while discussing on ways how to go about in caring for different patients. Once the team has established themselves as members and not as individuals each would feel that they belong thereby increasing nurse morale. This in turn would improve the quality of care each would give to the clients, leading to better patient satisfaction. Each will realize each team member’s role in caring is important for the client, minimizing the barrier between each profession.
By the way, a lack of communication can be occurred in team nursing due to the shared work load. If team members are constantly being re-shuffled, the continuity of care can be interrupted, leading to patient dissatisfaction. Patients are more likely to become uncomfortable with numerous team members providing care, as this can be distracting.
- Dobson, C., Adamson, N. and Drexler, D. (2007). Medicalâ€‘surgical unit team nursing: Description challenges and measurement in a complex system. Nurse Leader, 5(3):55â€‘60
- Fairbrother, G., Jones, A., & Rivas, K. (2010). Changing model of nursing care from individual patient allocation to team nursing in the acute inpatient environment. Contemporary Nurse, 35(2), 202-220.
- Ferguson, L., & Cioffi, J. (2011). Team nursing: experiences of nurse managers in acute care settings. Australian Journal of Advanced Nursing. ND, 28(4), 5-11.
- O’Brienâ€Pallas, L., Meyer, R. M., Hayes, L. J., & Wang, S. (2011). The Patient Care Delivery Model–an open system framework: conceptualization, literature review and analytical strategy. Journal of clinical nursing, 20(11â€12), 1640-1650.
- Snide, J., & Nailon, R. (2013). Nursing Staff Innovations Result in Improved Patient Satisfaction. AJN The American Journal of Nursing, 113(10), 42-50.
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