The team nursing model has been popping up in hospitals and medical facilities over the last few years. The pandemic has brought waves of patient intake to an already stressed and short-staffed nursing workforce. The model dates back to the 1950s when it was pioneered by Eleanor C. Lambertsen, a bedside nurse, for years before writing about the team nursing model concept in her Ph.D. dissertation in 1953 and later publishing a book about it.
The team nursing model is one of four nursing work models developed and utilized over the years. The other three are functional nursing, primary care nursing, and individual nursing. While primary care nursing has been a favorite model of use over the years, the team nursing model came back during the pandemic as staff resources were reallocated for crisis response and support.
Working within the model of team nursing, a team of nursing staff composed of registered nurses (RNs), licensed practical nurses (LPNs), certified nursing assistants (CNAs), and allied health workers are, as a whole, responsible for the care of a large number of patients. Other nursing models tend to have one nurse focus on the complete care of one patient or a small number of patients. In contrast, team nursing, by contrast, has multiple clinicians responsible for specific tasks for a large number of patients.
The team nursing model has faced stark criticism due to concerns that the team approach resulted in fragmented patient care, created loopholes for professional accountability, or resulted in clinicians and unlicensed personnel acting beyond their scope of care. Nevertheless, the team nursing model can be successfully applied when appropriately implemented.
How Does Team Nursing Work?
Establishing an appropriate team leader is the most fundamental piece of team nursing because the team leader will be responsible for effectively delegating nursing tasks across the team. Not only must the team leader be an RN, but they must have these three skills.
- Critical thinking - the team leader RN must be able to think critically not only about patient care but about how to appropriately utilize the other members of the team, which often include licensed allied health workers such as respiratory and physical therapists, and unlicensed nursing staff such as CNAs, patient care technicians, and even nursing students.
- Efficient delegation - the team leader RN must possess the knowledge, foresight, and capacity to appropriately and efficiently delegate nursing tasks to the nursing team members. They must not ask clinicians to perform duties outside their scope of care and intuit where each team member can best utilize them.
- Communication - the team leader RN will need to be able to communicate effectively with members of the nursing team, attending physicians, and surgeons, thereby identifying and addressing any conflicts that arise.
Nurse Delegation Tips
When the team nursing model was redeployed in the first waves of the pandemic, old criticisms came back to the fore, and nurses began asking for more guidance on effectively leading nursing teams. In 2019, the National Council of State Boards of Nursing (NCSBN) and the American Nurses Association (ANA) jointly published the Five Rights of Delegation. They are:
- Right task - The delegated task falls within the scope of care and the facility's policies for the team member.
- Right circumstance - The patient's condition is stable. If not, the team member must report to the team leader for a reassessment of the patient's care plan.
- Right person - The team leader and team members agree that the delegated task is appropriate.
- Right directions and communication - Each delegated task should be specific to individual patients. Questions must be addressed, and modification of the task by the team member is not allowed without express communication and agreement from the team leader.
- Proper supervision and evaluation - The team leader is responsible for the supervision and follow-up of tasks with each team member.
Additional important professional nursing tips that will lead to the successful implementation of the team nursing staff model are as follows:
- Professional etiquette - introduce yourself to your patients and your team.
- Positive attitude - your attitude can be the difference between success and failure.
- Body language awareness - remember that our bodies sometimes speak as loudly as our voices.
- Clarify - when your task is unclear, don't muddle through or ask someone else for advice. Seek clarity from the team leader.