Nursing care delivery is defined as the way task allocation, responsibility, and authority are organized to achieve patient care. Tiedeman and Lookinland (2004) suggested that systems of nursing care delivery are a reflection of social values, management ideology, and economic considerations. (Tiedeman&Lookinland, 2004) According to Fewer (2006), the quality of nursing care delivery systems affects continuity of care, the relationship between nurse and patient, morale, nurse job satisfaction and educational preparation.(Fewer, 2006) Nurses are essential human resources to provide medical services with professional knowledge and skills in the healthcare setting. However, the registered nurse turnover rate has increased in recent years resulting in lowering morale and quality of patient care in the U.S. Various models of patient care delivery have been introduced. They include, total patient care and functional nursing, team nursing, primary nursing, nursing care management and transforming care at the bedside. These models vary in clinical decision making, work allocation, communication and management, and model choice is driven by differing social and economic forces.(Tiedeman&Lookinland, 2004) This paper examines the description and effects of the team nursing model.
Description of the Team Nursing Care Delivery Model
Research by Tiedeman, Lookinland (2004) illustrated in team nursing that the healthcare workers consist of a diversity of education, skills, licensure, professionals (RNs), technical personnel (LPNs), and ancillary staff (nurses’ aides). The team model allows the utility of nonprofessional nursing personnel such as LPNs and nursing assistants, through delegation and observation by an RN while holding a team leader accountable.( Tiedeman&Lookinland,2004) The focus is to work collaboratively and cooperatively with shared responsibilities, and to some extent accountabilities, for assessment, planning, delivering, and evaluation of patient care. ( Tiedeman&Lookinland, 2004)
In this type of nursing care model, the RN team leader has the responsibility to supervise a group of patients. The team leader assigns team members with task allocations to personnel according to roles, licensure, education, ability and the complexity of the care required. (Tiedeman&Lookinland,2004) Therefore, the team leader also needs to be aware of the legal and political limits of each role. Yoder-Wise(2011) explained that another crucial role for the team leader is to improve patient satisfaction by planning the care, delegating the work, and following up with members to evaluate the quality of care for the patients assigned to the nursing team.(p. 255) It is extremely essential for team leaders to practice effective clinical leadership in the model. Therefore, team leaders must have necessary experience, excellent nursing skills and in-depth knowledge to perform patient care and to communicate clearly with the team members. Also, the team leaders are required to be effective decision-makers and have conflict management capabilities. For the staff RN`s role and responsibility, according to Yoder-Wise(2011), ‘the staff nurses, as members of team, develop expertise in care delivery. The most educated staff is required to supervise less skilled workers, rather than providing direct care themselves.’ (p. 255) In explaining this role, staff nurses progress responsibility for significant care giving and identify nursing situations to provide support and assistance to unskilled workers especially for new graduates. As a result, nurses working in a team can better improve relationships.
In team nursing, each team member delivers and provides patient care through the coordination and cooperation by delegation of assignments accordingly to the team member’s level of responsibility and accountability. For example, the RN performs the assessment and administers intravenous medications and handles the admission. Hence, LPNs may give oral medications and collect data. Nursing assistants are delegated minor duties such as hygiene tasks or personal care.
In terms of reporting relationships, according to Yoder-Wise(2011), ‘the member of a team reports directly to the team leader, who then reports to the charge nurse or unit manager hierarchically.’ (p. 254) Thus, the team leader must be higher skilled and well-trained in order to communicate between team members.
In spite of the model of care, all team members need to work within their scope of practice and be aware of the scope of their colleagues’ practices in the group.
Cost, quality of care and patient satisfaction in a team nursing care model
According to Tiedeman and Lookinland (2004), ‘the team model is viewed as one of the most expensive models of patient care delivery because more personnel are needed. It is a less efficient model because of time spent in coordinating, delegating, and supervising leads to a loss of productive work time.’ In contrast, the functional nursing care model is more cost-effective. The model defines that fewer RNs with unprofessional workers can deliver care to a large group of patients. In spite of the financial benefits, the functional nursing model has been criticized due to crucial problems such as poor quality of care, low patient satisfaction, increased omissions and errors. Not surprisingly, nurses are enabled to provide a high quality of care to patients in team nursing. Tiedeman and Lookinland (2004) reviewed that ‘quality of care is higher with the model because the nurses have responsibility and accountability for fewer patients. The nurses know the patients better and can make assignments that best match each patient’s needs with staff abilities and skills, and provide more direction, coordination, and supervision.'(p. 294) Each member is able to approach and coordinate patient needs as well as improve continuity of care in team nursing.
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