By Phil Niles, Clinical Nurse Manager, Medical Solutions
Many of you have encountered the concept of team nursing during your travel and/or nursing careers. If you have not encountered it, you might one day hear something like, “Your assignment will have you taking a 1:10 assignment.” Then you might say, “What???” and they might reply, “Don’t worry — it’s team nursing!” Even
Team nursing is pairing nurses of varying skill sets and experience levels to care for a larger group of patients. This team can consist of an experienced nurse and a new nurse, a RN and an LPN, or either of these two with the addition of a nurse aide. The team is intended to create a collaborative, supportive environment that will collectively meet patient needs and promote improved communication between team members.
Team nursing is not meant to be an authoritarian hierarchy with one person ordering everyone else around. In fact, many factors go into determining how the workload is divided. Team members collaborate at the beginning of the shift to divide tasks amongst each other according to skill, scope of practice, and familiarity with each patient. A common misconception of team nursing is thinking you’d have to control every detail of care for all patients assigned to you. It’s difficult to get out of the mindset of primary nursing (one nurse to a group of patients) and give up a little control and the idea that you need to do everything yourself. For Travelers working an assignment with team nursing for the first time, it can be a challenge at first to adjust. So, let’s address a few questions you may have about team nursing as a Traveler.
What can my team members legally do in their scope of practice?
This is probably the most commonly asked question and an important topic to address. Scope of practice of LPNs and nurse aides varies by state, so it’s important to study up on the Nurse Practice Act of the state you are traveling to ahead of time. Each state’s Board of Nursing website is a good resource for this. You can also reference the National Council of State Boards of Nursing (NCSBN) website. Click here and you’ll find they have a drop down box where you can select your state and to generate a link to its Nurse Practice Act. You can also ask the floor manager or even the team members themselves! It is important to remember that hospitals may not allow the same scope of practice that a state lists as acceptable, so never assume anything. Even after reviewing your state’s Nurse Practice Act, make sure to ask the manager about the hospital’s specific LPN and nurse aide scope of practice.
What if something goes wrong with a patient whom an LPN or aide on my team was assigned to?
What is your accountability when delegating tasks to others? Every member of the team is accountable for their own actions. For example, an LPN may be held accountable for negligent or improper care that resulted in patient harm. However, the RN may also be held accountable for improper delegation or not intervening in the negligent care if the RN had knowledge that the care was not to standards of care. There is a balance to be struck between delegating care and assuring that care was carried out. The RN is in a supervisory role in team nursing when the other member of the team is a LPN or aide. No one in a supervisory role should ever assume when you hand off a task that it was completed without verifying this themselves. As the RN Traveler in a team nursing scenario, you will likely see the same patients throughout the day while doing separate tasks. Take this time to also verify that all care was delivered and appropriate.
What if the other members of my team do not communicate with me?
Team nursing relies on clear, consistent communication between all team members, so never be afraid to ask questions. Often, drops in communication happen because the other person assumes you already know the information. For example, a good way to approach this type of situation would be to say, “I’m going to see Mrs. X next. Did you already change her dressing? Do you have time to change it with me now, so we can both assess it?” This is a collaborative approach with clear communication. The other person will not be threatened or feel ordered around and will likely make a plan with you. On the other hand, an approach I do not recommend is to say, “Hey! When are you going to change Mrs. X’s dressing? You need to talk to me!” As you can tell, this may spark a bit of defensiveness and potentially damage your working relationship. Still, there are those that once in a while do not respond well to coaching, so you can always go to your charge for support if you feel your team is not working well together or have a concern about a particular team member.
I hope this gives you guidance and arms you with information if you ever work in a team nursing environment. I also hope you see it as an opportunity to meet your patients’ needs in a new way.