The team nursing model – what it’s and make it work

In March, throughout the first surge of Covid-19 patients, some institutions implemented alternative staffing and deployment models to enhance care and maximize patient and staff safety. Now, as hospitals experience one other surge in growth, the team nursing model will be seen as needed and effective as ICUs increase bed capability to accommodate more patients, while the variety of ICU nurses often stays the identical and even decreases as staff are liable to contracting or being infected with the Covid-19 virus and are unable to work.

Team nursing in motion

Within the team nursing model, it’s needed to vary the way in which of pondering from “me” to “we”. As a substitute of pondering “I’ll do x, y and z for this patient today,” as is typical when using the first care nursing model that a lot of us are accustomed to, we’d like to maneuver to “we are going to do x, y and z for this patient today,” while specifying exactly who might be liable for each of those activities.

Roles and responsibilities

Within the team nursing model, an experienced nurse on a ward or floor supervises the work of a team of doctors and support staff on a bunch of patients. What this looks like and the way it really works will vary depending on the hospital, floor, stage and patient volume. This video from the American Association of Critical Care Nurses (AACN) by Rose O. Sherman, EdD, RN, NEA-BC, CNL, FAAN defines the roles and responsibilities of the ICU as described below.

Band leader

The team leader must be an experienced intensive care nurse with clinical and organizational knowledge. This person must think critically not only concerning the patient’s care, but in addition concerning the patient’s tasks. Excellent interpersonal skills are essential for effectively delegating tasks and managing conflicts.

Team members

Team members will vary depending on the provision and redeployment of staff and resources, but may include:

• Medical/Surgical Nurses
• Perioperative nurses
• CRNA
• Pediatric nurses
• Pharmacists
• Respiratory therapists
• Physiotherapists
• Dietary
• Unlicensed support staff
  • Certified Nursing Assistants
  • Personal care assistants
  • Nursing students
  • Patient Care Technicians

Duties

In a team approach, it can be crucial to think about the abilities and strengths of every team member. For instance, CRNAs and respiratory therapists often tackle the role of ventilator managers, and pediatric nurses will be the primary source of communication inside the family. The team leader might be liable for delegating responsibilities, but must do not forget that scope of practice doesn’t necessarily equal competence, subsequently communication between the team is important to properly define roles and responsibilities, equivalent to:

• Rating
• Administration of medicines
• Supervision of non-public protective equipment, including donning and doffing
• Respirator management
• Changing positions, including lying on the stomach
• Activities of every day living (ADL)
• Communication with family

Orders and prohibitions regarding delegation

Although most of us know the laws to manage medications by heart, these delegation rights could also be less familiar (NCSBN and ANA, 2019):

1. The best task
2. The best circumstance
3. The best person
4. Proper guidance and communication
5. Appropriate supervision and evaluation

When delegating unlicensed support staff, remember the next dos and don’ts:

Delegate

• ADL
• Range of motion/positioning
• Data collection (input and output, weight, etc.)

Don’t delegate

• Assessments and reassessments
• Care planning and assessment
• When to contact your doctor, nurse practitioner or physician assistant

Seeking to the longer term

The growing variety of patients, various degrees of severity and changing staffing needs require us to be flexible in our approach to patient care. One department that employed team nurses resulting from turnover, an influx of latest hires, and declining staff morale reported a rise in nurse satisfaction because nurses felt supported, the atmosphere was collaborative, and communication amongst staff improved (Dickerson and Latina, 2017).

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Will team nursing change into the usual of care? This stays to be seen, but for now this approach must be regarded as we proceed to fight Covid-19. There are limitless variations to this model, and its flexibility permits you to leverage existing expertise to serve more patients. For those who use the team nursing model, please leave a comment and share your experiences.

Cassidy, L. (2020, May 5). Team nursing and respite staffing resulting from Covid-19. American Association of Critical Care Nurses. https://www.aacn.org/blog/team-nursing-and-covid-19-surge-staffing

Dickerson, J., and Latina, A. (2017). Team nursing: A collaborative approach improves patient care. Nursing2017, 47(10). https://www.nursingcenter.com/journalarticle?Article_ID=4345497&Journal_ID=54016&Issue_ID=4345459

National Council of State Boards of Nursing (NCSBN) and American Nurses Association (ANA). (2019, April 29). National guidelines for nursing delegations. https://www.ncsbn.org/NGND-PosPaper_06.pdf

Sherman, R. (2020, April 13). Team-based nursing revisited during Covid-19. Emerging leader of the Supervisory Board. https://www.emergingrnleader.com/revisiting-team-nursing-during-covid-19/

Woods, A. (2020, March 26). Reclaiming the team approach: It is time for alternative staffing and onboarding models. Lippincott Nursing Center. https://www.nursingcenter.com/ncblog/march-2020/alternative-staffing-and-onboarding-models