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The Impact of Team Nursing on Long Term Care Patient Outcomes

Jasmine Shaw

Denver College of Nursing

The Impact of Team Nursing on Long Term Care Patient Outcomes

Introduction

Worldwide there is an increasing need for long term care as the post World War II Baby Boomers age, requiring substantially increased provision of (daily) medical, mental and physical care. In 2016, “Long-term care services were provided by 4,800 adult day services centers, 12,400 home health agencies 4,000 hospices, 15,600 nursing homes, and 30,200 assisted living and similar residential care communities” (Kojetin, et al., 2016). Although the need for long term nursing care continues to increase, there is a multifactorial quandary that continues to have an impact on patient outcomes, further resulting in the need for reorganization of most nursing personnel. Evidence supports that the use of team nursing in the long-term care setting ensures that, “High-quality, safe and effective care can be provided with a relatively high proportion of support staff and/or UAP” (Cherry & Jacob, 2016).

Relevant Definitions and Explanation of Concepts

Patient outcomes and satisfaction is often the priority of many nursing facilities, which makes them appealing to many individuals who have several needs that must be addressed frequently. In the United States, “Nursing homes, skilled nursing facilities, and assisted living facilities, (collectively known as long-term care facilities, LTCFs) provide a variety of services, both medical and personal care, to people who are unable to manage independently in the community” (Nursing Homes, 2017). The term ‘long term care facility’ can be used to describe any of the facilities as mentioned above, which provide wide-ranging services that are available to a variety of individuals with a multitude of medical, physical and emotional diagnosis. Within long term care facilities, there are several managerial positions that are assumed by individuals with a variety of backgrounds, including but not limited to: nurses, executives, social workers, and dieticians. Within the facilities mentioned above, the term management defines, “The activities needed to plan, organize, motivate, and control the human and material resources needed to achieve outcomes consistent with the organization’s mission and purpose” (Yoder-Wise, 2015). Ultimately, satisfactory patient outcomes are a reflection of exceptional management and leadership styles.

Literature Review

Many long-term care facilities are staffed with a registered nurse, licensed practical nurse, certified nursing assistant, and many others depending on the number of patients at a given time. Nursing managers have the responsibility to determine which nursing model they wish to follow, along with how many of each nursing position will need to be filled for the given shift. One type of nursing that has been particularly effective is team nursing because, “Each team member participates in decision making and contributes his or her own special expertise in caring for patients,” further resulting in improved patient satisfaction and outcomes (Cherry & Jacob, 2016). This model of nursing typically involves two registered nurses as the team leaders, two licensed practical nurses (one for each team), and several certified nursing assistants, all of which are assigned to a team and a skill (i.e. medication administration, head-to-toe assessment, vital signs) for a group of patients. According to Cherry and Jacob (2016), team nursing is extremely effective if the team leader has strong, developed leadership skills. Furthermore, if nurse managers staff their unit using the team nursing model and their strongest staff members as leaders, patient satisfaction and outcomes will likely improve.

Using the team nursing model provides a foundation for exceptional care to be provided because it reorganizes the structure of nursing care, further allowing each team member to use their individual expertise in given setting. In many situations, where the registered nurse assumes total care of the patient(s), it can be overwhelming to complete each task assigned for every patient. Team nursing ultimately allows each individual on the team to feel empowered to use his or her best skill and feel confident about time management. When a team member is assigned a skill they are proficient in, they are able to complete more tasks in a given time frame, further decreasing patient wait times and improving outcomes. Allowing nursing staff to assume a position on the team, performing a skill they are confident in, also improves the work environment by decreasing anxiety and stress related to increased patient workload. One study found that, “ Healthcare strategies and efforts to modify adequate nurse staffing levels and better work environments of nurses are needed to improve patient outcomes” (Cho, Chin, Kim, & Hong, 2015). Reorganizing the structure of nursing care in long term care facilities allows for more patient centered care, further improving overall patient satisfaction and outcomes.

Many long-term care facilities struggle with staffing ratios, resulting in an increased nurse to patient ratio, further restricting nurses from providing adequate care to each patient. One observation that I made at a long-term care facility was that nurses were overloaded with medication passes, which impacted the amount of time they had available for patient interaction and assessment. With the team-nursing model, registered nurses would have more time to take on their specific task for the shift and complete it in a timely and professional manner.  One study found that “…traditional organizational structures, staffing levels, and resources constrain the ability of staff to provide individualized, resident-focused care…” (Zimmerman, Shier, & Saliba, 2014). Perhaps implementing the team nursing model, moving away from traditional structures, would result in increased quality of care, increased staff morale and decreased poor outcomes among residents living in long-term care facilities.

Topic Relation to My Nursing Practice

As a nursing student and soon to be new graduate, this research opened my eyes to the difficulties that are faced in many nursing facilities. I have a newfound respect for nursing managers and the role they play in staffing, organizing and leading their units. As I move forward in my career I plan to incorporate aspects of team nursing into my own practice. Although this model is not used within many hospital settings, I can see how it is possible to combine the different aspects of the nursing models, especially team nursing. Researching this specific model has provided me with a wealth of information and will ultimately guide my delegation as a newly graduated nurse. I now have an understanding of how working as a team and delegating to those who are proficient in a skill that I may not be so confident in can help boost morale among team members and further improve patient outcomes. Looking into the future, I absolutely plan to take advantage of members that are on the nursing team I work with to ensure that my patients are receiving the highest quality of care possible.

Conclusion

Research supports that team nursing promotes a work environment that allows the nursing team to provide safe, effective and quality care, further improving patient outcomes and satisfaction in long-term care facilities. To achieve an environment that promotes exceptional patient care, nursing managers have a responsibility to select a nursing care model, such as team nursing, and make use of their employees in an effective manner. With appropriate leadership and management, nursing staff is ultimately encouraged to participate and provide excellent care while working alongside other participants on the team, resulting in increased patient satisfaction and excellent medical, mental and physical outcomes.

References

Cherry, B., & Jacob, S. R. (2016). Contemporary nursing: issues, trends, & management. St. Louis, MO: Elsevier.

Cho, E., Chin, D. L., Kim, S., & Hong, O. (2015). The Relationships of Nurse Staffing Level and Work Environment With Patient Adverse Events. Journal of Nursing Scholarship, 48(1), 74-82. doi:10.1111/jnu.12183

Kojetin, L. H., PhD, Sengupta, M., PhD, Lee, E. P., PhD, Valverde, R., MPH, Caffrey, C., PhD, Rome, V., PhD, & Lendon, J., PhD. (2016). Long-Term Care Providers and Services Users in the United States: Data From the National Study of Long-Term Care Providers, 2013–2014. Vital and Health Statistics, (38), 3rd ser.

Nursing Homes and Assisted Living (Long-term Care Facilities [LTCFs]). (2017, February 28).

Yoder-Wise, P. S. (2015). Leading and managing in nursing (6th ed.). St. Louis, MO: Elsevier.

Zimmerman, S., Shier, V., & Saliba, D. (2014). Transforming Nursing Home Culture: Evidence for Practice and Policy; The Gerontologist Vol. 54, No. S1, S1-S5 . doi:10.1093/geront/gnt161

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