The Team Nursing Model is a collaborative approach to patient care where a group of healthcare professionals—led by a registered nurse (RN)—work together to provide comprehensive nursing services. This model enhances efficiency, improves communication, and ensures that patients receive well-coordinated care.
How to Make It Work
1. Clear Role Definition and Delegation
- Define Roles: Start by clearly outlining the roles of each team member. The team leader’s role is crucial for assessing patient needs, delegating tasks based on individual competencies, and maintaining overall coordination within the group.
- Task Allocation: Ensure that each member knows which tasks they’re responsible for. For instance, some may focus on direct patient care while others handle monitoring and documentation.
2. Effective Communication
- Regular Briefings: Implement frequent hand-offs and team briefings at the beginning, during, and at the end of shifts. Clear communication helps you anticipate changes in patient conditions and adjust responsibilities accordingly.
- Structured Reporting: Use standardized tools and protocols (such as SBAR—Situation, Background, Assessment, Recommendation) to share critical patient information efficiently.
3. Training and Competency Development
- Cross-Training: Equip team members with the knowledge and skills to perform multiple roles as needed. This might include simulation training, in-service education, and mentorship from experienced nurses.
- Leadership Development: Provide opportunities and training for nurses who will serve as team leaders to enhance their delegation, communication, and conflict-resolution skills.
4. Patient-Centered Focus
- Holistic Approach: All team members should collaborate to ensure that care is seamless and centered around the patient. This means integrating patient preferences, ensuring continuity of care, and being proactive about changes in a patient’s condition.
- Flexibility in Care Delivery: The model should allow for real-time adjustments. For example, if a particular patient’s condition deteriorates, the team leader can reassign tasks swiftly to provide enhanced monitoring or intervention.
5. Institutional Support and Continuous Improvement
- Administrative Buy-In: For the team nursing model to succeed, leadership at all levels must support it by adjusting staffing models, revising policies, and providing the necessary resources.
- Feedback and Evaluation: Regular performance evaluations and team feedback sessions can help identify areas for improvement, ensuring the model evolves to meet patient care challenges. Continuous quality improvement initiatives are key to sustaining and refining the model.
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.
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
Pros and Cons of Team Nursing
Some benefits to using a team nursing model include:
- Better distribution of human resources
- All team members’ strengths are used
- Individualized patient care is prioritized
- Team members work together to make decisions
- Creating a learning environment for less experienced team members
There are also some drawbacks to the team nursing approach such as:
- Heavy reliance on effective communication between multiple members
- All activities are coordinated through one person who does not perform the tasks
- It creates a very high-pressure situation for the team lead
REFERENCES
- Lippincott Nursing Center. Team Nursing Model – What it is and How to Make it Work. https://www.nursingcenter.com/ncblog/december-2020/team-nursing-model
- Beckett CD, Zadvinskis IM, Dean J, Iseler J, Powell JM, Buck-Maxwell B. An Integrative Review of Team Nursing and Delegation: Implications for Nurse Staffing during COVID-19. Worldviews Evid Based Nurs. 2021 Aug;18(4):251-260. doi: 10.1111/wvn.12523. PMID: 34355844; PMCID: PMC8450812.
- Cassidy, L. (2020, May 5). Team Nursing and COVID-19 Surge Staffing. American Association of Critical Care Nurses. https://www.aacn.org/blog/team-nursing-and-covid-19-surge-staffing
- Dickerson, J. & 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 the American Nurses Association (ANA). (2019, April 29). National Guidelines for Nursing Delegation. https://www.ncsbn.org/NGND-PosPaper_06.pdf
- Sherman, R. (2020, April 13). Revisiting Team Nursing During COVID-19. EmergingRNLeader. https://www.emergingrnleader.com/revisiting-team-nursing-during-covid-19/
- Woods, A. (2020, March 26). Bringing Back the Team Approach: It’s Time for Alternative Staffing and Onboarding Models. Lippincott NursingCenter. https://www.nursingcenter.com/ncblog/march-2020/alternative-staffing-and-onboarding-models
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