Measuring the impact of a team model of nursing practice using work sampling

Abstract

The increasing number of inexperienced graduates, as well as other levels of nurse such as the enrolled nurse and assistant-in-nursing, requires health service and nursing managers in the acute care sector to rethink the long-preferred "patient allocation" model of care provision. As well, the escalating shortage of registered nurses and subsequent low morale among those remaining in the workforce require hospitals to re-examine skills mix and staffing ratios. This paper presents the results of two work-sampling studies conducted in a major metropolitan private hospital, the first of which was to provide a rationale for changing from the patient allocation model to a team model of care. The second study aimed to evaluate and provide data on the impact of the change. Staff were heavily involved in both studies as well as the change process. The findings highlight how effective the new model has been in redistributing certain aspects of care to make better use of each nurse HEALTH SERVICE PLANNERS are responding to staff shortages and strained finances by redesigning nursing workforces. 1 Driven by such factors as the increased age and numbers of chronically ill patients, 2 increased acuity and complexity of hospitalised patients, 3,4 the continuous introduction of new technologies, 5 shortened length of stay and increased community burden with no compensatory transfer of resources, 6 health care facilities have been implementing alternative practice models. These models attempt to sustain quality patient care, assure patient safety and satisfaction and maintain budgetary efficiency. 7,8 The current shortage of registered nurses (RNs) 1,9 has compounded the problem, making the redesign of nursing work an imperative. What is known about the topic? Nursing has long advocated the "patient allocation" model of care for a professional workforce with "team nursing" generally seen as a model from the past that is not appropriate for contemporary times. However, with the protracted crisis of recruitment and retention of registered nurses (RNs), the patient allocation model has become unsustainable in many hospitals, suggesting a need to return to team nursing. What does this paper add?Work sampling methodology identified changes in the pattern of nurses' work following changes to skill mix and staffing ratios. Our findings provide strong empirical evidence that team nursing can enhance the provision of care. What are the implications for practitioners?While the transfer of nursing education to the tertiary sector enhanced the professionalisation of nursing and made possible the idea of an all RN workforce, larger social and political forces have conspired to limit this possibility. As the long-term forecast for nursing is an increasing shortage of RNs the profession has to find ways to provide high quality and safe care to its constituencies that best use the skills of an RN while deploying less educated and skilled nurses to support and complement the work of this now precious resource.

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

“…The work reported here lends support to accepting a hypothesis that teaming in acute nursing yields job satisfaction and staff retention benefi ts. Since the project's conduct, positive results associated with shifting to team-based nursing have been reported from post 2005 nursing literature in Australia (Hayman, Wilkes, & Cioffi , 2008;O'Connell, Duke, Bennett, Crawford, & Korfi atis, 2006;Walker, Donoghue, & Mitten-Lewis, 2007) and North America (Dobson, Adamson, & Drexler, 2007).…”

A shared care model vs. a patient allocation model of nursing care delivery: Comparing nursing staff satisfaction and stress outcomes

“…Although the small matched pair sample size is problematic, this study does represent a unique quasi‐experimental study comparing two models of care on job satisfaction. A search of national and international literature on model of care studies between 1996 and 2009 demonstrated that relevant published work employed a non‐experimental descriptive method, 17,34–42 or a single group pre‐test and post‐test design 43–46 . There was only one Canadian study that used a quasi‐experimental design with unrelated samples 47 .…”

Time standards of nursing in Primary Health Care: an observational study

“…However, the values presented by studies conducted in other contexts, such as surgical centers, nursing homes, and community centers in the U.S. showed higher percentages (15)(16)(17) . We also emphasize the importance of the indirect care provided to users, families and communities, reinforcing the idea that much of what is done by the nursing staff is invisible (18) . Sharing information on care provided was among the most frequent indirect care interventions, which we believe indicates a positive and important result, as it strengthens communication, work relationships between team professionals, and collaborative practices.…”