Changing model of nursing care from individual patient allocation to team nursing in the acute inpatient environment

Abstract

Agreement was reached with 12 acute medical and surgical wards/units at Sydney's Prince of Wales Hospital to participate in a trial of team nursing (TN). Six units employed action research principles to undertake a change to a team nursing model and six remained with the pre-existing individual patient allocation (IPA) model. Task-based teaming was widely discarded by the team nursing units in favour of allocating patients within the team and introducing more supportive and communicative processes aimed at fostering responsibility sharing. Localised team-based models of care arose in the change wards and were outlined, implemented and refined using social action research principles. A 12-month prospective experimental comparison of job satisfaction and staff retention between the TN and IPA groups indicated statistically significant job satisfaction benefits and practically important staff retention benefits associated with moving away from an IPA model of nursing care delivery towards a team-based model of care delivery. Perhaps not surprisingly, job satisfaction gains were most marked among new graduate nurses, who reported real benefits from a teaming inspired shift in model of care in the acute inpatient environment.

Factors contributing to nursing team work in an acute care tertiary hospital

“…O'Connell et al, 2006) and enables a range of nursing skills and expertise to effectively and efficiently deliver high quality patient care (O'Connell et al, 2006;Wheelan et al, 2003). In addition team work provides adequate supervision and/or mentoring of less experienced nurses (Fairbrother, Jones, & Rivas, 2010;Ferguson & Cioffi, 2011;Nelsey & Brownie, 2012). In contrast, dysfunctional teams increase conflict, increase absenteeism, reduce performance and job satisfaction (Carver & Candela, 2008;Duffield, Roche, O'Brien-Pallas, Catling-Paull, & King, 2009).…”

“…Models of nursing care shifted from a model of patient allocation to a team nursing model of care where a small team of ward based nurses collaborate to provide all care to a patient group (Ferguson & Cioffi, 2011;Garling, 2007;New South Wales Health, 2006;Walker, Donoghue, & Mitten-Lewis, 2002. Since the implementation of team models of care limited studies have investigated which factors contribute to teamwork nursing teamwork in an acute care hospital across all specialty units (B. J. or in an Australian setting (Fairbrother et al, 2010). Most teamwork studies have investigated specialty units such as intensive care, operating theatres and emergency departments.…”

Nursing stress and satisfaction outcomes resulting from implementing a team nursing model of care in a rural setting

“…[1,2] In Australia, registered nurses find themselves in a position of supervising other registered (including new graduate) and enrolled Nurses [3][4][5] as well as other unregulated and non-credentialed health care workers. [5][6][7] In order to manage the increased demands of responsibility and supervision of this range of varied staff classifications, team nursing as a model of care was introduced in five clini-cal units medical/surgical in a rural region in Australia as a way to address this varied skill mix.…”

“…[10] This overall ratio is similar to data from previous years. [11] Adopting models of care that capitalise on the skill mix of staff available is a feature of global contemporary nursing workplaces largely resulting from workforce shortage [4,6] and desire to contain health care costs. [5,12] In Australia, there are two levels of regulated nurses; registered and enrolled nurses.…”

“…[11] Increasingly, the nursing workforce is being supplemented by non-regulated nurses, nursing assistants as a method for ensuring appropriate staffing levels within a fiscally constrained environment. [4,6] Health Workforce Australia [2014] presented options for reconfiguring the nursing workforce to ensure sustained NC. They suggested that unregulated nurses could represent 5% of the acute care sector and 70% of aged care workforce without a significant change in quality of care delivery.…”