A Push for the Return of Team Nursing in Medical-Surgical and Telemetry/Step-down Units
Imagine arriving on your Medical-Surgical unit one morning to find that you can share the burden of work with another nurse? Busy in an isolation room and can’t answer the phone? No problem! It will go to the other nurse’s phone. Busy passing meds and don’t want to disturb your concentration by helping the patient next door to the bathroom, but the tech is caught up doing vitals? Call your fellow nurse.
SpecialtiesMed-SurgArticle
Welcome to the world of team nursing, where two nurses and a nursing assistant share the burden of a larger assignment but have the advantage of teamwork. As a nursing student and new nurse, I heard about team nursing from some of the more experienced, seasoned nurses. They spoke about team nursing with nostalgia, not because of the larger assignment, but because everyone worked together as a team, because they had too.
I was thinking about team nursing today and its advantages. For one, it is great to have an extra nurse around when you are dealing with a psych patient, even on a non-psychiatric unit. Psychiatric patients and even those without diagnosed psychiatric disorders may practice splitting, which means attempting to turn staff against each other in order to manipulate a particular staff member. One common example of this is when a patient tells a particular nurse that they are much "nicer" or a "better nurse" than their nurse last shift or that the CNA "isn't very friendly." What they are saying may be true, but it could be an attempt to win your favor. Psych patients may also attempt to manipulate staff by making requests and then undoing them. If you call them out on their behavior, they will deny it at times. For example, I had a patient in the ER who had documented psych issues last week. She was very selective about when she spoke or answered my questions. She kept pushing the call bell and when I asked her what she needed, she didn't answer. Finally, after the 3rd time, she said "I need a blanket." I got her a blanket and spread it out on her, and they she took it off and said "I don't want this." This is an example of classic manipulation. Having another nurse there would help curb these behaviors.
It can also be helpful for patient compliance because a united front is a stronger front. If you patient is insisting on leaving the unit to smoke for example or doesn't want to ambulate in the hall, having two nurses educating the patient about the healthier choice may encourage them to choose the option that is best for them. When the nurse is sharing your assignment and is therefore in close proximity it is easier to get this kind of help and support when you need it.
I think it can also make the shift go much more smoothly. For example, one nurse can focus on doing assessments on the eight, nine, or ten patients assigned to them, while the other nurse can focus solely on passing medications. Nurse #1 who did the assessments will pass off relevant information I.e. abnormal finding in her assessments to Nurse #2 before Nurse #2 starts his med pass. If he gets a phone call, he can safely ignore it and it will go to the other nurse's phone. This can decrease medication errors because the nurse feels less rushed and can focus on the task at hand without interruptions. The CNA can hover between the rooms the nurses have not yet reached to document vital signs and or help patients to the bathroom (to avoid such requests when the nurse comes to pass meds or do an assessment as so commonly happens). An alternative would be the nurses going in together to do assessment, one doing the assessment and the other nurse documenting for her. The nurse doing the assessment would take a quick look at what was documented prior to signing the assessment. This would also help both nurses be informed about each patient's assessment findings.
Having another nurse available can also help nurses deal with the emotional and physical parts of the job. By sharing patients, both nurses feel vested in their assignment. When the CNA is busy in another room, one nurse can call the other to help turn or toilet a patient or even to do wound care. When you need a break or a hug, there is always someone there to back you up and support you.
Team nursing can also be a good way to help new nurses acclimate to nursing once they are off orientation. Being teamed with a more experienced nurse can be a great learning experience. If there is a problem, the more seasoned nurse can step in and offer a solution. If the novice nurse has questions, there is a more experienced colleague close by to answer questions. However, if tasks are divided and the newer nurse is assigned to do the assessments and the more experienced nurse questions her assessments it can create resentment even if her concerns are legitimate. There has to be a great deal of trust in this arrangement.
Team nursing requires trust in another nurse's abilities as well as the ability to get along. A toxic nursing environment that uses team nursing can be detrimental. An industrious CNA make it or break it in primary or team nursing. There would have to be a lot of thought put into the assignment regarding which nurses and CNAs work best together and to make sure skill level is compatible. For example, it would be better to avoid having two nurses fresh off orientation working together.
Team nursing can make shifts go more smoothly by minimizing interruptions and helping patients behave better. It can help with the emotional and physical burdens of the job. To me, the challenges seem easy to overcome and a good tradeoff to reap from the many benefits. Post your thoughts below.
