Back in March, during the first surge of COVID-19 patients,
alternative staffing and onboarding models were implemented by some institutions to improve care and maximize patient and staff safety. Now, as hospitals are in the midst of another surge, the team nursing model may be considered necessary and effective as intensive care units increase their number of beds to accommodate more patients while the number of critical care nurses often remains the same, or even decreases as staff are exposed to COVID-19 or infected, and not able to work.
Team Nursing in Action
In the team nursing model, a shift in mindset from “I” to “we” is necessary. Rather than thinking “
I will do x, y, and z for this patient today,” as is typical when using the primary nursing care model many of us are used to, we must pivot to “
We will do x, y, and z for this patient today,” while defining exactly who will be responsible for each of those actions.
Roles & Responsibilities
In the team nursing model, an experienced nurse for the unit or floor oversees the work of a team of clinicians and support staff for a group of patients. What this looks like and how it works will vary by hospital and by floor, acuity, and number of patients.
This video from the American Association of Critical Care Nurses (AACN) by Rose O. Sherman, EdD, RN, NEA-BC, CNL, FAAN outlines the roles and responsibilities for an ICU as described below.
Team Leader
The team leader should be an experienced critical care nurse with clinical and organizational knowledge. This person must be a critical thinker not only about patient care, but also about patient assignments. Excellent interpersonal skills are a must for effective delegation and conflict management.
Team Members
The team members will vary depending on availability and redeployment of staff and resources, but may include:
- Medical/surgical nurses
- Perioperative nurses
- CRNAs
- Pediatric nurses
- Pharmacists
- Respiratory Therapists
- Physical Therapists
- Dietary
- Unlicensed assistive personnel
- Certified Nursing Assistants
- Personal Care Assistants
- Nursing students
- Patient Care Technicians
Responsibilities
With the team approach, it’s important to consider the skills and strengths of each team member. For example, CRNAs and respiratory therapists will often take on the role of ventilator management and pediatric nurses may be the go-to resources for family communication. The team leader will be responsible for the delegation of responsibilities but must remember that scope of practice does not necessarily equal competency, so communication among the team is essential to appropriately define roles and responsibilities, such as:
- Assessment
- Medication administration
- Oversight of PPE, including donning and doffing
- Ventilator management
- Repositioning, including prone positioning
- Activities of daily living (ADLs)
- Communication with family
Dos and Don’ts of Delegation
While most of us know by heart the rights of medication administration, these rights of delegation may be less familiar (NCSBN & ANA, 2019):
- Right task
- Right circumstance
- Right person
- Right directions and communication
- Right supervision and evaluation
When delegating to unlicensed assistive personnel, remember these dos and don’ts:
Do delegate
- ADLs
- Range of motion/positioning
- Data collection (intake and output, weight, etc.)
Don’t delegate
- Assessments and reassessments
- Care planning and evaluation
- When to contact physician, nurse practitioner, or physician assistant
Looking ahead
Increasing numbers of patients, variations in acuity, and fluctuating staffing needs require us to be flexible in our approach to patient care. One unit that employed team nursing due to turnover, an influx of new nurse hires, and a decrease in staff morale reported increased nurse satisfaction because nurses felt supported, the environment was collaborative, and staff communication improved (Dickerson & Latina, 2017).
“One of the most positive outcomes so far from this crisis has been the high level of teamwork and collaboration. Crises have a funny way of forcing all of us to focus on a purpose and work together more harmoniously. We don’t worry as much about power and control because we have so little against this virus.”
Rose O. Sherman, EdD, RN, NEA-BC, FAAN
Will team nursing become the standard of care? That remains to be seen, but for now the approach is one to be considered as we continue the fight against COVID-19. There are endless variations to the model and its flexibility allows the leveraging of existing expertise to serve larger numbers of patients. If you are using the team nursing model, please leave a comment and share your experiences.
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