During the height of the pandemic, healthcare organizations found themselves confronted with a supply and demand challenge, scrambling to care for a surge of extremely ill patients with too few bedside nurses.
They shifted resources to meet the demand, pivoting to care for as many patients as possible. While COVID-19 is no longer a national health crisis, similar challenges persist today. Exhausted and burned out, hundreds of thousands of nurses have resigned, retired, or sought role changes, resulting in alarmingly few nurses safely delivering care – at least under today’s primary nursing model.
While nursing schools are doing their part to graduate the next generation of nurses, they also struggle with shortages of faculty and clinical sites impacting much-needed real-world training. It is widely accepted that the vast majority of new graduates are not fully practice-ready upon graduation, most needing support and supervision by more experienced nurses to ease the transition.
Adopting a team-based model
“The primary nursing model is no longer working in many healthcare organizations,” explains Wolters Kluwer Chief Nurse Anne Dabrow Woods, DNP, RN, CRNP, ANP-BC, AGACNP-BC, FAAN. “Lack of an adequate number of competent nurses at the bedside is leading many organizations to implement a team model of care.”
This involves pairing experienced nurses to oversee the care provided by novice and support personnel. Unlike today’s primary nurse model, it permits fewer registered nurses and more support personnel to manage a larger number of patients and allows for the adoption of telehealth, which rapidly expanded during the pandemic.
This more agile care-delivery approach ensures nurses are proficient in both primary- and team-based models, so hospitals can switch between them depending on the situation. It also ensures that nurses are trained in remote care delivery via telehealth.
Team-based care is not new
The team-based care concept dates back to World War II when the military faced a shortage of nurses to care for patients, training ancillary staff and medics to work with nurses in a team-based model. Later adopted by the Veterans Administration hospital system, it eventually spread to other hospitals.
Today’s team-based model differs from its predecessor in two important ways:
- It relies more on an interdisciplinary approach to care by expanding to other healthcare professionals beyond nurses to manage critically ill patients; and
- Teams are managed by a team leader with knowledge and experience in critical care or specialty care who can oversee nurses and other personnel moved to the unit to assist with care as direct caregivers.
Because the model accommodates staffing agility, hospitals can quickly train support staff such as unlicensed assistive personnel, physical therapists, respiratory therapists, and others to assist with patient care. This interdisciplinary team-based approach facilitates the rapid deployment of staff to areas most in need.
Another approach to patient-centered care, adopting a team-based model takes advantage of each team member's talents and experience and provides an alternative care delivery framework. It also increases flexibility and agility, allowing nurses to work at the full scope of their practice and licensure.
Research supports team-based nursing
Research shows that team-based nursing can improve quality, patient safety, and levels of staff satisfaction. One transitional care unit implemented team-based nursing in its 18-bed high-acuity, bedside telemetry, step-down unit in response to an influx of new hires, increased levels of patient acuity, and decreased staff morale. The team-based nursing model was easily adapted to meet the needs of the unit, providing staff with the support and collaboration they were craving and resulting in:
- 88% compliance rate in team-based nursing participation
- 11% increase in staff feeling supported during their shift
- 20% increase in staff being held accountable by peers
- 45% increase in staff perception of continuity of care
Looking to the future
Ultimately, team-based models support a more diversified workforce that is prepared to care for a disparate population, promote wellness and address systemic inequities. Nurses are in a unique position to facilitate today’s changing paradigms of care, especially in collaboration with nursing education.
“Now is time,” says Woods, “for healthcare organizations to update their staffing strategies to become more agile and efficient, building on lessons learned and institutionalizing those learnings into a team-based nursing delivery approach in collaboration with academia. Healthcare and academia need to evolve to address the changing landscape of healthcare to support innovation and collaboration between interdisciplinary healthcare and practice teams.”
To learn more, download our eBook, “Transforming the Nursing Workforce: Keys to Delivering Health Equity and Fostering Resilience,” here.