Reclaiming the team approach: It is time for alternative staffing and onboarding models

I actually have been a nurse for the reason that mid-Nineteen Eighties and through that point I actually have witnessed quite a lot of staffing and onboarding models. In times of nurse shortages, we used a team nursing approach through which one RN led a team of LPNs and authorized nursing assistants to take care of 10 or sometimes more patients. Because the nursing shortage decreased, we moved to a primary care model where one RN would take care of 5-6 patients on the medical/surgical unit, and if the nurse was lucky, there could be a CNA to help with activities of each day living, monitoring vital signs, intake, and excretion and monitoring blood glucose levels. Often the CNA was shared with other RNs. There continues to be a team model in long-term care, but on this case the RN is accountable for a much larger variety of patients.

Today we’re in crisis due to coronavirus, or Covid-19. We’re seeing a surge in patient numbers that’s overwhelming our healthcare system, and in lots of the hardest-hit areas, hospitals have been allowed to expand their bed capability. While this sounds great to the general public, it’s a nightmare for hospital administrators and people of us on the front lines of care.

We want to ask ourselves who will take care of these patients?

The nursing shortage – we have been talking about it coming back for the last 10 years – is a serious problem straight away. Not only are there not enough nurses to take care of patients attributable to the extra beds we’ve got added and the increased patient volume, but nurses are also getting sick with Covid-19. And let’s be clear, this shortage doesn’t just impact nursing; it also affects doctors, nurses, physician assistants and other health care employees and hospital support staff.

The health care system must find a unique option to take care of patients and staff in these beds. So what can our health systems do to rapidly expand their workforce?

1. Leverage existing staff.

First, take a look at the specialties in your hospital and utilize the staff you might have. Many hospitals have canceled elective surgeries, so nurses and CRNAs can be available to take care of the increased variety of patients. CRNAs and plenty of PACU nurses have extensive critical care training; these people can work in intensive care units after quick orientation or admission to those units. For those who employ nurse practitioners or physician assistants in specialties that do not see many patients, resembling cardiac surgery (CT), use these people to complement your in-house hospital and important care teams.

2. Reach out to retired nurses and nurses in other specialties.

You must hire nurses who’re retired or work in specialized offices that don’t see many patients. These nurses could be quickly deployed to enrich medical/surgical nurses. Let’s not ignore LPNs and CNAs who can even provide primary care to patients.

3. Hire experienced medical/surgical nurses to work in transitional units.

There is no such thing as a reason why a medical/surgical nurse cannot work with a fill-in nurse in a team model; a medical/surgical nurse may handle basic nursing needs, while a charge nurse may concentrate on managing the more critical needs of the patient. Some hospitals may have to employ experienced medical/surgical ICU nurses to complement the ICU nursing staff. It can be crucial to recollect how necessary competences are in such situations. Concentrate on the talents medical/surgical nurses could have and reserve critical care skills for critical care nurses.

4. Implement an “onboarding essentials” program.

We’re in a crisis situation and we shouldn’t have time for a protracted, in-depth orientation program. Provide recent team members with the data they should take care of patients alongside more experienced nurses. Concentrate on what’s “must know” and leave the “nice to know” for later. Ask the skilled development team to work with providers to create quick-learning procedure packs and exercises for every area that highlight probably the most common diagnoses and basic procedures the nurse might want to know, resembling operating intravenous pumps, performing an EKG, inserting a catheter urinary tube or nasogastric tube in a medical/surgical ward. Within the intensive care unit, the main target must be on basic skills resembling recognizing fatal arrhythmias resembling urokolia, ventricular tachycardia, and ventricular fibrillation; correct insertion of electrodes monitoring heart rate; and knowledge of the fundamentals of ventilator management. The skilled development team or staff educators are more necessary than ever in this case because they’re accountable for quickly onboarding nurses to recent and different departments and may be sure that nurses have the talents needed to offer secure and effective care.

5. Implement a team-based approach to care.

Have additional staff report on to an experienced physician/surgeon or critical care nurse. It will enable experienced nurses in each area to supervise more patients and could have sufficient nursing support to handle the patient’s basic nursing needs. Each department might want to determine what number of patients an experienced nurse/team leader can handle, considering the severity and variety of patients. This approach may work in medical services.