Authored by: JoAnn Lazarus, MSN, RN, CEN, FAEN, Senior Vice President, Training and Development
How many times have we heard there is a nursing shortage? This is a reoccurring theme we have heard repeatedly over the last 90 years. While the specific causes and severity of nursing shortages vary over time, several factors have contributed to this ongoing issue. These factors include an aging population, retiring nursing workforce, insufficient nursing school capacity, and work environment challenges. These factors impact all specialties of nursing, including emergency nursing.
Efforts to address the nursing shortage have included increasing funding for nursing education, expanding nursing school capacity, offering incentives such as scholarships and loan forgiveness programs, improving working conditions, and implementing policies to enhance the recruitment and retention of nurses.
In the aftermath of the pandemic, nursing shortage has been exacerbated. Many nurses chose to leave the profession, leaving hospitals to find creative strategies and processes to provide quality patient care and improve or maintain nurse engagement. One such strategy is team nursing. Team nursing is not a new concept. It was first introduced after World War II because of the nursing shortage and advancements in medical technology and remained popular into the 1960s. This model involved dividing
patient care responsibilities among a team of healthcare professionals, including registered nurses, licensed practical nurses, nursing assistants, and support staff. The team worked collaboratively, with each member contributing their skills and expertise to provide comprehensive care. This model enhanced efficiency and allowed nurses to focus on more complex patient needs. Team nursing essentially disappeared in the 1970s when primary nursing model gained popularity because of the perceived fragmentation of care related to team nursing.
It is important to learn from the past success and failures of the team nursing model. During the pandemic the team model of patient care enabled hospitals to redeploy, restructure, or reorganize staff from other areas of the hospital to assist in providing care to patients throughout the hospital.
“To effectively implement the team nursing model, buy-in at all levels of staff is crucial.”
Using the same team model in the emergency department (ED), when staffing is a challenge, may offer benefits that contribute to more effective and efficient patient care. Here are some of those benefits:
- Collaboration and communication – Care teams in the ED bring together healthcare professionals from different disciplines, such as physicians, advanced practice providers, RNs, LPN/LVN, paramedics, patient care technicians, social workers, and case managers. This interdisciplinary collaboration improves communication and coordination among team members, leading to better patient outcomes. Team members can share information, discuss treatment plans, and address any concerns or questions in real-time.
- Specialized expertise – In an ED care team, each member has their own area of expertise. This enables the team to provide specialized care for a wide range of medical conditions and emergencies.
- Reduced waiting times – By utilizing care teams, EDs can optimize the patient flow and reduce waiting times. Since multiple team members can work simultaneously on different aspects of patient care, such as triage, assessment, treatment, and discharge planning, the overall process becomes more streamlined. This helps minimize delays and ensures that patients receive timely care.
- Enhanced patient safety – Care teams improve patient safety by promoting error detection and prevention. With multiple healthcare professionals involved in the care process, there are more opportunities for cross-checking and verifying critical information. Team members can catch and rectify errors or oversights, such as medication errors or missed diagnoses, leading to improved patient safety.
- Comprehensive and holistic care – ED care teams take a comprehensive approach to patient care, considering not only the immediate medical needs but also the broader context. Social workers and case managers, for instance, can address social determinants of health, facilitate care transitions, and connect patients with necessary resources or follow-up care. This holistic approach ensures that patients receive appropriate care and support beyond the ED visit.
- Professional development and learning – Working in a care team environment fosters continuous professional development and learning opportunities for all team members. They can exchange knowledge, share best practices, and learn from one another's experiences. This collaborative environment encourages professional growth and improves the overall competency of the ED staff.
To effectively implement the team nursing model, buy-in at all levels of staff is crucial. Involving staff members in the design and implementation process enhances the potential for success. Clearly defining roles and ensuring effective communication through frequent huddles and various communication strategies are essential. Developing contingency plans for surges, increased boarding, or staffing shortages within the team is also necessary. Moreover, strong leadership support is vital, as visible
and engaged leadership drives and sustains success.
Will the team care model work in all emergency departments? It is important to note that the effectiveness of team nursing may vary depending on factors such as team composition, communication processes, and the context in which it is implemented. As the field of healthcare continues to evolve, ongoing research and studies may provide additional insights into the impact of team nursing on patient care.
In a constantly changing healthcare environment, where the search for innovative solutions is ever-present, sometimes the answer lies in revisiting and learning from the past. The team care model, with some adaptation to modern healthcare settings, has the potential to make a significant difference in improving patient care and addressing the ongoing nursing shortage in emergency departments.
References
- Boston-Fleischhauer, C. (2020, April 15). How Baylor Scott & White Health restructured its care team model to prepare for the COVID-19 surge. The Advisory Board. https://bit.ly/45431nN
- Brown, H., Carerra, B., & Stanley, L. (2021). Optimizing nurse staffing during a pandemic. Journal of Continuing Education in Nursing, 52(3), 109–111. https://bit.ly/3OwJS8M
- Cross, K., Bradbury, A., Burnham, N.,Corbett-Carbonneau, D., Peterson, K., Phelan, C., & DeSanto-Madeya, S. (2021). A nurse staffing model for an unprecedented event. Nursing Management, 52(3), 34–42. https://bit.ly/47b8AD2
- Dempsey, C., & Batten, P. (2022). Outcomes-based nurse staffing during times of crisis and beyond. The Journal of Nursing Administration, 52(2), 91–98. https://bit.ly/43Jw7rK
- Endacott, R., Pearce, S., Rae, P., Richardson, A., Bench, S., Pattison, N., & The Seismic Study Team. (2022). How COVID has affected staffing models in intensive care: A qualitative study examining alternate staffing models (SEISMIC). Journal of Advanced Nursing, 78(4), 1075–1088. https://bit.ly/3q81eiW
- Patel, S., Hartung, B., Nagra, R., Davignon, A., Dayal, T., & Nelson, M. (2021). Expedited cross-training: An approach to help mitigate nurse staffing shortages. Journal for Nurses in Professional Development, 37(6), E20–E26. https://bit.ly/3YbnaWQ
- Sherman, R. (1990). Team nursing revisited. The Journal of Nursing Administration, 20(11), 43–46. https://bit.ly/3O7lvNs
- Skene, I. (2021). The complex issues that lead to nurses leaving the emergency department. In E. Murray & J. Brown (Eds.), The mental health and wellbeing of healthcare practitioners: Research and practice (pp. 88–99). Wiley Blackwell. https://bit.ly/3OzpLXp