Brief History

During World War II, multilevel training programs were developed to teach auxiliary personnel how to perform simple care and technical procedures. In the military, these trained workers were called corpsmen. Outside of the military, there were 1- year programs developed to teach technical nursing care. On- the- job training programs were established to produce what would today be called nursing assistance. The model of the team nursing was developed after war in an effort to utilize these trained workers and to ease the shortage of nurses that most hospitals were experiencing and decrease the problems associated with the functional organization of patient care. Many believed that despite the continued shortage of professional nursing staff, a patient care system had to be developed that reduce the fragmented care that accompanied functional nursing.

Description

- Team nursing is a care delivery model that assigns staff to teams that then are responsible for a group of patients. A unit may be divided into two teams, and each team is led by a registered nurse.

- team leader supervises and coordinates all the care provided by those on his team. The team is most commonly made up LPNs and UAP, but occasionally there is another RN.

Charge Nurse RN

Team Nursing Model (Heidenthal, 2003)

RNTeam leader

RN LPN

UAP

RNTeam leader

RN LPN

UAP

15 Patients 15 Patients

Team Nursing Model ( Marquis,2003)

- the nurse is responsible for knowing the condition and deeds of all the patients assigned to the team and for planning individual care. The team leader’s duties vary depending on the patient’s needs and the workload. These duties may include assisting team members, giving direct personal care to patients, teaching, and coordinating patient activities.

- care is divided into the simplest components and then assigned to the appropriate care provider.

- aside from supervision duties, the team leader also is responsible for providing professional direction to those on his team regarding the care provided.

Through extensive team communication, comprehensive care can be provided for patients despite a relatively high proportion of ancillary staff. This communication occurs informally between the team leader and the individual team members and formally through regular team planning conferences. A team should consist of not more than five people or it will revert to more functional lines of organization.

Modular Nursing Delivery System

Nursing Staff

Nursing Staff

Patients/Clients

Charge Nurse

Nursing Staff

Nursing Staff

Patients/Clients

Nursing Staff

Nursing Staff

Patients/Clients

- is a kind of team nursing that divides a geographic space into modules of patient with each module cared for by a team of staff led by an RN. The modules may vary in size, but typically there is one RN with an LPN and nursing assistant to make up the team. In this case, the RN is responsible for the overall care of the patient in her module.

- team nursing, as originally design, has undergone much modification in the last 25 years. Most team nursing was never practiced in its purest form but was instead a combination of team and functional structure. Recent attempts to refine and improve team nursing have resulted in the concept of “modular nursing”, which is mini-team (two or three members) approach.

- keeping the team small and attempting to assign personnel to the same team as often as possible should allow the professional nurse more time for planning and coordinating team members.

- smaller team requires less communication, allowing members better use of their time for direct patient care activities.

Advantages and Disadvantages of Team Nursing

Team nursing allows members to contribute their own special expertise or skills. Team leaders, then, should use their knowledge about each member’s abilities when making patient assignments. Recognizing the individual worth of all employees and giving team members autonomy result in high job satisfaction.

In team nursing and modular nursing, the RN is able to get work done through others, but patients often receive fragmented, depersonalized care. Communication in these models is complex. There is shared responsibility and accountability, which can cause confusion and lack of accountability. These factors contribute to RN dissatisfaction with these models. These models required the RN to have very good delegation and supervision skills.

Team nursing is usually associated with democratic leadership. Group members are given as much autonomy as possible when performing assigned task, although the team shares responsibility and accountability collectively. The need for excellent communication and coordination skills makes implementing team nursing difficult and requires great self-discipline on the part of the team members.

Disadvantages to team nursing are associated primarily with improper implementation rather than with the philosophy itself. Frequently, insufficient time is allowed for team care planning and communication. This can lead to blurred lines of responsibility, errors, and fragmented patient care. For team nursing to be effective, the leader must have a good communication, organizational, management, and leadership skills must be an excellent practitioner.

References:

Heidenthal, Patricia Kelly. NURSING LEADERSHIP AND MANAGEMENT. 4th Edition. Thomson Delmar Pte, LTD. 5 Shenton Way #01-01 UIC Building, Singapore. ©2003. p. 255-256.

Marquis, Bessie L. and Huston, Carol J. LEADERSHIP ROLES AND MANAGEMENT FUNCTIONS IN NURSING: THEORY AND APPLICATION. 4th Edition. Lippincott Williams & Wilkins. Philadelphia, U. S. A. © 2003. p. 213-214.