Over the last decades, converging pressures in nursing care, including cost-containment policies, mounting healthcare demands, and shortages in the supply of nursing professionals to deliver care, have fuelled the search for novel models of nursing care delivery that optimizes the utilization of available nursing resources while guaranteeing safe, high-quality care (Dubois et al., 2012). The present paper aims to analyze one such model of nursing care, referred to as team nursing, and how it is applied at a unit level at Lincoln Medical and Mental Health Center.
The team nursing model can be described “…as care delivered to a group of patients by a team of nurses and other staff with varying levels of education and skills, under the direction of an RN, often referred to as the team leader” (Tran et al., 2010, p. 149). Owing to its application at the unit level of the medical facility, it is imperative to note that this model of care is supported by the organization’s leadership and management, has clearly defined standards, and is firmly grounded on evidence-based practice and principles (Duffield et al., 2010).
Since a nursing care delivery method is basically a method adopted to allocate workload (patients) to staff (nurses), it is also important to mention how the team nursing model of care delivery is operationalized. Led by three registered nurses (RNs) with a professional work experience of ten years each, the team nursing model at the Lincoln’s Medical and Mental Health Facility utilizes enrolled nurses (ENs), assistants in nursing (AINs), students, licensed practical nurses (LPNs), and other orderlies to provide care to a group of patients. Consequently, it can be suggested that the RNs in the team nursing model of care delivery not only deliver nursing services to critical areas where assistant nursing staff /orderlies are unable to assist, but also supervise the type of care given to patients (Dubois et al., 2012), and act as a beacon of strength, hope, and social support to the assistant staff (Duffield et al., 2010). The role of the assistant staff (ENs, LPNs, AINs, and other orderlies) therefore becomes that of providing care and delivering nursing services in designated areas of the unit, but under the supervision of RNs.
In work coordination, extant literature demonstrates that “…the RN team leader supervises lesser-trained patient care providers and performs direct patient care that lesser-skilled staff [are] not qualified or licensed to provide” (Duffield et al., 2010, p. 2243). It, therefore, follows that the less-trained members of the team are supposed to report to the more qualified members for advice and directions on how to handle particular patient cases, with the overall head of the team being the RN. The same approaches are applied at Lincoln, where members of the unit team provide direct care to assigned patients, but directly report to the three RNs in case they encounter difficulties. The RNs act as overall supervisors, who have the authority, responsibility, and accountability for determining suitable staffing assignments. Lastly, it is important to note that all RNs have a bachelor’s degree in nursing or higher, while other members of the team have divergent skills, educational statuses, and levels of expertise.
Issues of Cost, Quality of Care & Satisfaction
More effective and efficient use of staff in the team nursing model ensures that hospital costs are kept at a minimum. The utilization of assistant staff with varying levels of skill mix also keeps recruitment and remuneration costs low, meaning that the health facility is able to free up more resources towards the provision of quality care to patients. Indeed, extant literature demonstrates that most of the existing models of care delivery came as a reaction to the problem of nursing shortage (Dubois et al., 2012), implying that Lincoln Health Center always takes into consideration the availability of RNs to supervise the team. The team nursing model cannot be operationalized without involving the input of RNs with wide-ranging skills and expertise, and demonstrating effective leadership and mentorship qualities (Fairbrother et al., 2010).
Available literature demonstrates that the quality of care in the team nursing model may be compromised not only because of minimal utilization of qualified nursing personnel (RNs) but also due to the overreliance of assistant staff and other nursing orderlies in the provision of care (Fairbrother et al. 2010). The health facility has been able to avoid this shortcoming by ensuring that members of the team strictly adhere to the rules and regulations governing the team, particularly in work coordination, roles and responsibilities, as well as reporting relationships.
Duffield et al (2010) argue that “…patient satisfaction is positively associated with the number of RNs, a better nurse-to-patient ratio and level (years) of experience, but often, patients are unaware which model is being used” (p. 2244). The team nursing model used at the unit level utilizes three RNs with experience spanning over ten years each, implying that they can improve on variables that lead to patient satisfaction, including continuity of care and effective communication.
It has been mentioned in the literature that the team nursing model has resulted in “…improvements in staff satisfaction, recruitment and retention of staff and reduction in sick leave, improved team spirit and a cleaner ward environment (Tran et al., 2010, p 150). Additionally, the job satisfaction level of junior staff is increased by the social support received from their supervisors as well as peers in nursing teams (Duffield et al., 2010). Indeed, this factor has contributed immensely to the elevated job satisfaction level at the Lincoln Medical and Mental Health Center as team members are always assured of technical assistance and social support from RNs.
Pros & Cons of the Care Delivery Model
In terms of advantages, available literature demonstrates that the team nursing model of nursing care delivery “…has the potential to maximize the use of each member’s skills and experience for the effective and efficient delivery of care and can accommodate varying levels of staff mix” (Tran et al., 2010, p. 149). The second benefit of this model of care is that it directly addresses the problem of nursing shortage by reducing turnover and quit intentions, and providing nurses with justification to stay on the job through improved staff satisfaction and team spirit. Another advantage stems from the fact that the model actualizes the potential to develop or support the RN’s role as leader and coordinator of care, implying that it provides opportunities for RNs to demonstrate their leadership capabilities in the process of providing care. Fourth, it is a well-known fact that “…the use of team nursing is considered to provide patients with continuity of care by a team, therefore addressing the potential for fragmented care often resulting from more task-oriented care delivery models” (Cioffi & Ferguson, 2009, p. 3). Lastly, this is the model of choice in many health institutions due to prevalent shortages of registered nurses (Fairbrother et al. 2010).
In terms of drawbacks, it has been noted in the literature that this model is bound to fail in the absence of excellent communication between all members comprising the team (Tran et al., 2010). Concerns over reduced availability of experienced members of staff to cater for serious cases or emergencies have been expressed in some health facilities using this model of nursing care (Duffield et al., 2010), though such a scenario is yet to be experienced at the Lincoln Medical and Mental Health Center due to exhaustive contingency care programs put in place by management. A third drawback rests on the premise that this model of care delivery often leaves senior members of staff extremely exhausted owing to the need for constant supervision. This scenario may be counterproductive to the health institution as it may trigger the quit/turnover intentions of key staff. Available literature demonstrates that it is often difficult to replace key members of staff than it is to replace junior staff (Cioffi & Ferguson, 2009).
From the ongoing, it is clear that the team nursing model of care delivery presents health facilities with the opportunity to deal with the biting nurse shortages, but more importantly, to provide quality care to patients and enhance patient as well as staff satisfaction. However, stakeholders need to develop strategies and policies to address the various challenges and drawbacks associated with the model, with the view to enhance patient safety.
Cioffi, J., & Ferguson, L. (2009). Team nursing in acute care settings: Nurse’s experiences. Contemporary Nurse: A Journal for the Australian Nursing Profession, 33(1), 2-12.
Dubois, C.A., D’Amour, D., Tchouaket, E., Rivad, M., Clarke, S., & Blais, R. (2012). A taxonomy of nursing care organization models in Hospitals. BMC Health Services Research, 12(1), 286-300.
Duffield, C., Roche, M., Diers, D., Catling-Paull, C., & Blay, N. (2010). Staffing, skill mix and the model of care. Journal of Clinical Nursing, 19(2), 2242-2251.
Fairbrother, G., Jones, A., & Rivas, K. (2010). Changing models of nursing care from individual patient allocation to team nursing in the acute inpatient environment. Contemporary Nurse: A Journal for the Australian Nursing Profession, 35(2), 202-220.
Tran, D.T., Johnson, M., Fernandez, R., & Jones, S. (2010). A shared care model vs. a patient allocation model of nursing care delivery: Comparing nursing staff satisfaction and stress outcomes. International journal of Nursing Practice, 16(2), 148-158.