Such a model was a response to the chronic shortage of registered nurses as it basically removes the umbrella of license differentiation which basically enables other nursing related professionals to take duties and responsibilities that was usually confined to Registered Nurses.
Several concerns arise from the primary care to team care shift especially the conflict between license types. Tensions among them could arise due to the different way they care for patients. Putting people under one roof and making them follow the lead RN's style can be counterproductive as it can result to job dissatisfaction leading to physical and psychological withdrawal from the job.
The Five South Transitional Care Center employs a care delivery system consisting of Registered Nurses, LPNs and CNAs. I belong to a team of 5 nursing staff headed by a preceptor nurse. Under the supervision preceptor nurse, we can initiate treatments or perform interventions ourselves. The nursing staff can basically assume a Registered Nurse's dependent and independent functions. The former are those that must be carried out under the orders of a licensed physician or dentist, including such duties as administering medications and changing dressings on wounds. Independent functions are those that nurses carry out based on their own professional judgment. Such duties include bathing patients, positioning them to prevent joint contractures, teaching people how best to care for themselves, and providing nutritional counseling. Supervision is necessary for the dependent part while there is much greater degree of freedom for the independent function.
The team nursing model was a recent innovation of St. Mark's Hospital management in 2003 to comply with its goal of quality improvement. The Hospital aims at enhancing services and delivers excellent patient care through a Performance Improvement system. Under this program, every employee is encouraged to utilize their acquired knowledge and skills for the improvement of work processes so that excellent patient and health outcomes are achieved. It was also a measure, to a limited extent, to address the limited supply of Registered Nurses which I have already mentioned before.
All of us, the preceptor nurse and my co-nursing staff, agree that the team nursing model is very effective because of the various positive feedbacks that we receive from the patients that we handled. These feedbacks were gathered by Patient surveys on discharged patients. The patients expressed their joy on how receptive and how rapid the nurses were on their concerns. This was due to the relatively low patient to nurse attendant ratio of 4 is to 1. It is not uncommon to find our station with flowers, cakes and cards sent by discharged patients. With regards to staff satisfaction, all of us have become friends because of the openness and the removal of license discrimination. Many of us are very glad of the learning opportunities that would have not been available to us if we were limited in what we can do. The only major concern is not on the model itself but on the attitude of some co-nursing staff to come late at work thereby delaying our much awaited rest period.
Nursing models are evaluated primarily in patient outcomes and staff satisfaction. Generally, when positive feedbacks