Does Team Nursing work? Two Views:

The polite term for task allocation

On 11 August 2006, steven222, a Health Care Support Worker, submitted his view of team nursing:

Team nursing is the polite term for task allocation. It completely destroys all lines of accountability and responsibility as no individual nurse has both control of and responsibility for the care of any individual patient.

Team nursing consists of dividing the nursing workforce into two groups and then treating one group (staff nurses ) as too important ever to do any manual labour whilst treating the other group (HCSWs) as too gormless ever to do anything else. Then we go around looking puzzled at the fact that we don't get on! It does however make for a good ideology to justify ignoring the patients call bell if you are a staff nurse.

Team nursing reminds me of the joke about the office where four people called Everybody, Nobody, Somebody and Anybody worked - Everybody thought that Somebody would do it ; Anybody could have done it but in the end Nobody did it. Each job and patient needs one nurse who IS responsible for them not four who might be.

Team nursing also means all HCSWs are permanently confined to basic tasks regardless of their level of knowledge and experience which will ensure that the good ones quit and only the timeservers remain. Team nursing does my head in. We need a national database of all wards which practise patient allocation and which practise bloody team nursing so we know which places to go and work and which to avoid like the plague!

Not a quick fix for understaffed wards

Andrew Heenan wrote this in 2004

There really is no quick and easy answer; there are so many variables; you could just as well argue "nothing works".

A better question would be "How does it work", followed by "(How) can I apply it my area.

Team nursing will not, by itself, improve morale or reduce staff turnover; but it can (applied appropriately in suitable environment) improve nursing care, which can then contribute to staff job satisfaction, then morale, then staff turnover.

If, for example, the nursing home is on two levels, then there is a good case for considering having a team for each level; staff would know where they'd be working each day, thus reducing instantly a major anxiety for some people. If one area is seen as 'harder work' then you could arrange to periodically rotate staff, or adjust staff numbers in each area. Such increased stability would lead to better staff understanding of the need for flexibility in the case of sickness, for example, rather than (for them) a random allocation with no continuity for them or the residents.

'Geographical' division is just one perspective; are there any other ways the resident group naturally divides?

There are other issues, such as skill mix and leadership - could it be practical to have two teams, but one leader (it would need to be a good leader!)

That's just one scenario; it all depends on your local situation.

To me, primary nursing is the ideal, as I believe it offers the patient the best continuity and least potential confusion; team nursing - in practice - has almost always been about stretching resources, not really about improving anything.

In recent years, team nursing has increasingly involved RNs leading a team of untrained staff, whose 'care' the RN is accountable for. This means (of course) that the one person with nursing skills cannot actually use them, because of admin and safety responsibilities. The end of Real Nursing as we know it.

But primary nursing (in my view) cannot work in an under resourced unit, as the primary nurse and the relationship stand to 'take the blame' for the failings of the organization.

Personally, I prefer a 'group nursing' system; smallish teams, with primary nursing within the group - each member being associate nurse for the other nurses' patients. This can reduce the number of individuals involved in each patient's care, and can allow for mentorship and teambuilding within the group.

In fact, I don't know of any system that is safe when nursing is under resourced - but while nursing models have had their reputation blackened by a plethora of time wasting jargon-ridden twaddle based on poorly researched undergraduate course work, promoting independence and involving significant others remains a "least worst" option.

When planning a system of nursing, there is never - ever - a 'quick fix'.

Team Nursing CAN Work:

Ari Haytin, Student Nurse, UCSF, Submitted this 7th April 2007:

I would like to respond to the article that took the perspective that team nursing was more detrimental than beneficial. First the author believed that team nursing “destroys all lines of accountability and responsibility.” This can be the case if the unit is not a well-organized team. There are teams that people are enthusiastic and committed to being a part of and others where the morale is low and the members are not satisfied to be there.

The author’s experience of team nursing has been one of hierarchy and division, which is one way of organization, but it is important to be aware that there are other ways to organize teams. I am currently a nursing student that came from a counseling position in a community oriented public health clinic and never planned on working in a hospital partly due to the organization of many hospital units that lack a true team environment.

When I say true team environment I mean one that values all of the players on the team, that gives them all a voice and opportunities to grow and expand in their position. I have had the opportunity to observe many different units and truthfully to my surprise found that there are some units in the hospital that have amazingly well-organized teams. My first day observing at the Emergency Department the MD’s introduced themselves to me and welcomed me. The staff gave each other a lot of respect, trust and were there to assist one another when they needed it. I think this organization especially common in ICU and ED departments that have a high rate of success with their patients’ outcomes. I hope that some of the teams with low morale would look for ways of reorganizing their team instead of giving up on the team.

© July 2004, revised February 2005, June 2007