Why and How Team Nursing is Here to Stay
Implementing a Team Nursing Model: A Successful Blueprint for Long Term Acute Care Hospitals
A shift in nurse staffing practices that started at CHC ContinueCARE Hospitals in response to COVID-19 is proving to be not just a temporary adaptation to the pandemic but an evolution that optimizes staff resources over the long-term.
Of the various nurse staffing models, the nurse-to-patient ratio model was the favored approach pre-pandemic. However, at many healthcare facilities, maintaining normal staffing ratios in the midst of the pandemic simply wasn’t possible. In response to the influx of COVID patients — and in recognition of trends shaping the healthcare industry more broadly — CHC ContinueCARE Hospitals switched to a team-based model.
ContinueCARE Hospital at Baptist Health Corbin, a long-term acute care hospital in Corbin, Ky., exemplifies how team staffing can optimize human resource management while maintaining quality patient care. Implementation consisted of several stages aimed at one overarching goal: to reduce overreliance on registered nurses by enabling all nursing and non-nursing bedside staff to practice at the top of their licenses and scope of practice.
Team Staffing Isn’t New, So Why Now?
Prior to the pandemic, the healthcare industry had been braced for a cohort of 1 million nurses to retire by 2030. Because of COVID, many retired earlier than anticipated. The pandemic also brought radical changes to education as well as healthcare, so while it was once common for retired nurses to go into teaching, fewer have elected to do so. The decrease in faculty numbers means that fewer nursing graduates will be joining the workforce. Those who do enter the field may lack clinical experience due to COVID restrictions. Despite these challenges, ContinueCARE Hospital at Baptist Health Corbin has created unprecedented learning opportunities for nursing students by implementing a staffing model that’s been around for decades: team-based staffing.
Team Staffing Defined
Team staffing differs from other models in that nurses, aides and ancillary staff with varying skill sets work collaboratively to provide patient care. As opposed to assigning a small number of patients to one RN, several staff members are assigned to groups of patients. By combining skills, the team can deliver quality care to a larger group of patients than one RN could do alone. At the same time, team staffing alleviates pressure on RNs and allows them to dedicate more time to the tasks that require their specialized training.
Team staffing reemerged during COVID to meet staffing demands and better support those providing patient care. Hospitals cross-trained, repurposed and upskilled existing staff, and set aside siloed views of responsibility.
At ContinueCARE Hospital at Baptist Health Corbin, staffing challenges during the pandemic led to a strategic implementation of a team staffing model for long-term success. The first step was taking stock of the staff’s collective skills, identifying any gaps as well as development opportunities. The goal was to strengthen and diversify the workforce. Respiratory therapists, for example, are adequately prepared to take over certain patient care responsibilities, such as administering infusions. Specially trained certified nursing assistants and patient care technicians also gain clinical skills that are within their capabilities.
Where there were skill gaps, though, the hospital faced the formidable challenge of finding, attracting and retaining health workers. By cementing a formal affiliation with Cumberland University, the hospital began onboarding nursing students prior to graduation and preparing them to provide critical care as part of a team. Key to the program’s success was the creation of a new position, a clinical educator retentionist who develops professional development programs and recruitment pipelines.
Finally, there’s the technology piece. The hospital is implementing an acuity tool to ensure team assignments match the collective skills to patients’ needs. An acuity tool demonstrates when a care team can be safely assigned to a larger number of patients; evaluates patient outcomes; and can support a shift in culture when staff still cling to the nurse-to-patient ratio model out of habit.
Metrics, including employee and patient satisfaction levels, suggest that team staffing is working. The model’s underlying philosophy underscores one of the positive takeaways of COVID: Working together, we are stronger.