Team Nursing Model/Approach During A Pandemic Crisis Team Nursing .

Team Nursing Model/Approach During a Pandemic CrisisTeam Nursing OverviewTeam Nursing model is based on philosophy in which groups of professional and nonprofessional nursing personnel work together to identify, plan, implement and evaluatecomprehensive client-centered care. The key concept is a group (team) that works togethertoward a common goal that is, providing high quality, safe and comprehensive nursing care.Image 1: Team Nursing Structure ExampleSource: Marquis, B. & Huston, C. (2021). Leadership roles and management functions. Chapter 14: Organizing Patient CareThe Team Nursing model is employed due to the COVID-19 pandemic crisis. Health careworkers (HCWs) who have useful skills but lack experience in a specific areas can work in teamssupervised by those with relevant experience. Instead of individual HCWs caring for one or twopatients, a team of HCWs, who amongst them possess a complete skill set and relevantexperience, collectively care for a group of patients. To ensure high quality and safe patientcare delivery is maintained throughout the team nursing model approach, based oncompetency level and scope of practice, team members to complete competency validationtools (CVT) as appropriate [CVT & education materials & resources are available on the RegionalCOVID-19 SharePoint: KPSC COVID-19 Regional EducationSuccesses within team nurses have noted that extensive team communication, both formal andinformal, is essential and may include communication between the team leader and individualteam members as well as regular team planning communication via frequent team huddles,frequent rounding, consistent communication, etc. to ensure high quality and safe delivery ofpatient care (Marquis & Huston, 2021). Team leaders should use consider each member’sabilities for patient care when making patient assignments and allow autonomy for teammembers to promote high functioning teams (Marquis & Huston, 2021). Each Team Leadshould engage in continual communication with the Unit Charge RN to ensure team membershave appropriate breaks and respite care during their shift.1

Team Lead works with a team ofnurses and ancilary staff toprovide care for a group ofpatientsHigh quality and safe patientcare through team collaboration,team communication, and teammembers practicing at the top oftheir scope of practiceTeam leads use knowledge of skilllevel, education, qualification,and competency of every staffmember to deliver high qualityand safe patient careReference: AONL (2020). Team Based Nursing: Advocate Aurora Health.Team Nursing Considerations: To ensure high quality and safe patient care delivery is maintained throughout the teamnursing model approach, based on competency level and scope of practice, teammembers to complete competency validation tools (CVT) as appropriate [CVT & educationmaterials & resources are available on the Regional COVID-19 SharePoint: KPSC COVID-19Regional Education Unit manager or designee assigns a group of patients to a team; The composition of the team will vary depending on level of care and acuity of patients; An RN is the leader of each team; Each Team Lead should engage in continual communication with the Unit Charge RN toensure team members have appropriate breaks and respite care during their shift; Assignment of care and care team huddles: RNs assign duties to members of the care teamand teams meet (“huddle”) regularly throughout the shift to reassess the plan for the day; Bedside shift report: RNs report to each other at each patient’s bedside at every shiftchange and conduct a number of safety checks. This time is also used to allow patientsand families to ask questions or raise concerns; Patient whiteboards: Each patient has a whiteboard near his or her bed with provider andcare team members names, a list of the day’s appointments, care goals, anticipated dateof discharge, and space for patients and families to leave messages for staff; Every provider in contact with a patient introduces him- or herself, states their role, andstates the duty they are to perform for the patient; Patient shift assessment: An RN or licensed vocational nurse conducts the shift assessment; Initial patient assessment and orientation: A Registered Nurse (RN) or Licensed VocationalNurse (LVN) conducts a patient assessment within 60 min of arrival to the unit andprovides verbal information about various aspects of unit functioning; LVN/PCT reports to RN: assessments, vital signs values, I/O values, responses tocare/treatments2

Roles and Responsibilities in Team and Functional NursingIntensive Care Unit (ICU)Team Leader Nurse (ICU RN)Team consists of:[based on scope of practice and competency level]: ICU RN Team Lead with: RNs Licensed Support Pt Care team membersICU RN Team Lead can oversee up to 8 – 10 patients per teamTeam Members RN or LVN: Non-critical patient assessment to include vital signs,input/output and drain management Administration of non-critical medications Intravenous care & maintenance Catheterization insertion/care/maintenance (CAUTI Bundle) Enema Administration (Fleets, Oil, Tap Water) Specimen Collection Assist with patient mobility to include range of motion(ROM) exercises, ambulation, turning/ repositioning Assist with patient hygienic care (i.e. Bathing and toileting) Assist with patient meals and feeding Retrieval of medications from Pyxis Glucose Accu Check (obtaining sample and documenting) Observer of PPE donning and doffing (Spotter) IV Start (Nurses with current competency) IV fluid bag replacement Other duties as assigned (within scope and competency) Hourly rounding Answering call lights Respiratory Managemento Ventilator/Trach Managemento Oxygen Delivery Systemso Incentive Spirometer Medication Administration Blood & Blood Products AdministrationInvasive Monitoring and Management: PA Catheter / Arterial Line External PacemakerTeam Nursing ModelICU ExampleCharge NurseTeam Leader:ICU RNUp to 8 – 10 ptsRN TeamMemberRN TeamMemberUp to 4 – 5 ptsUp to 4 – 5 ptsLicensedSupport TeamMemberLicensedSupport TeamMemberCertified NursingSupportEach Team Lead should engage in continual communicationwith the Unit Charge RN to ensure team members haveappropriate breaks and respite care during their shift.3

Roles and Responsibilities in Team and Functional NursingStep Down Unit (SDU)Team Leader Nurse (SDU RN)Team consists of:[based on scope of practice and competency level]: SDU RN Team Lead with: RNs Licensed Support Pt Care team membersSDU RN Team Lead may oversee up to 12 patients per teamTeam Nursing ModelSDU ExampleTeam Members RN or LVN: Non-critical patient assessment to include vital signs,input/output and drain management Administration of non-critical medications Intravenous care & maintenance Catheterization insertion/care/maintenance (CAUTI Bundle) Enema Administration (Fleets, Oil, Tap Water) Specimen Collection Assist with patient mobility to include range of motion (ROM)exercises, ambulation, turning/ repositioning Assist with patient hygienic care (i.e. Bathing and toileting) Assist with patient meals and feeding Retrieval of medical from Pyxis Glucose Accu Check (obtaining sample and documenting) Observer of PPE donning and doffing (Spotter) IV Start (Nurses with current competency) IV fluid bag replacement Other duties as assigned (within scope and competency) Hourly rounding Answering call lights Respiratory Managemento Ventilator/Trach Managemento Oxygen Delivery Systemso Incentive Spirometer Medication Administration Blood & Blood Products AdministrationCharge NurseTeam Leader:ICU RNUp to 12 ptsRN TeamMemberRN TeamMemberUp to 6 ptsUp to 6 ptsLicensedSupport TeamMemberLicensedSupport TeamMemberCertified Nursing Support: Hourly Rounding Perform/report vital signs (BP, heart rate, resp rate, tempand O2 sat) to SDU nurse Answering call lights Assist with patient meals and feeding Assist with patient mobility to include range of motion (ROM)exercises, ambulation, turning/ repositioning Other duties as assignedCertified NursingSupportEach Team Lead should engage in continual communicationwith the Unit Charge RN to ensure team members haveappropriate breaks and respite care during their shift.4

Roles and Responsibilities in Team and Functional NursingMedical Surgical Telemetry (MST)Team Leader Nurse (MST RN)Team consists of:[based on scope of practice and competency level]: MST RN Team Lead with: RNs Licensed Support Pt Care team membersMST RN Team Lead may oversee up to 16 patients per teamTeam Members RN or LVN: Non-critical patient assessment to include vital signs,input/output and drain management Administration of non-critical medications Intravenous care & maintenance Catheterization insertion/care/maintenance (CAUTI Bundle) Enema Administration (Fleets, Oil, Tap Water) Specimen Collection Assist with patient mobility to include range of motion (ROM)exercises, ambulation, turning/ repositioning Assist with patient hygienic care (i.e. Bathing and toileting) Assist with patient meals and feeding Retrieval of medical from Pyxis Assist with patient hygienic care (i.e., bathing, toileting, etc.) Glucose Accu-Check (obtaining sample and documenting) Observer of PPE donning and doffing (Spotter) IV Start IV fluid bag replacement Respiratory Managemento Oxygen Delivery Systemso Incentive Spirometer Medication Administration Blood & Blood Products Administration Other duties as assignedCertified Nursing Support: Hourly Rounding Perform/report vital signs (BP, heart rate, resp rate, temp andO2 sat) to MST nurse Answering call lights Assist with patient meals and feeding Assist with patient mobility to include range of motion (ROM)exercises, ambulation, turning/ repositioning Transport of specimens to lab Other duties as assignedTeam Nursing ModelMST ExampleCharge NurseUp to 16 ptsTeam Leader:ICU RNUp to 8 ptsUp to 8 ptsRN TeamMemberRN TeamMemberLicensedSupport TeamMemberLicensedSupport TeamMemberCertified NursingSupportEach Team Lead should engage in continual communicationwith the Unit Charge RN to ensure team members haveappropriate breaks and respite care during their shift.5

Roles and Responsibilities in Team and Functional NursingInpatient Perioperative Nurses and StaffTeam Nurse: PACU NursesTeam Nurse: OR NursesTeam Nurse: Pre/Post NursesBased on competency levelPACU nurses will beassigned to work in criticalcare setting/ EmergencyDepartment as an RN inthe Team nursing model.Based on competency level OR nurses willbe assigned to the medical surgical/stepdown setting as a RN in the Team nursingmodel.Based on competency level Pre/Postnurses will be assigned to the medicalsurgical/step down or critical caresetting as a RN in the Team nursingmodel.PACU RN: PACU nurses can assistin the ICUs (Teamapproach)OR nurses with recent critical careexperience (within 3 years), and existenceof current ACLS certification may beconsidered for possible assignment to thecritical care setting/ EmergencyDepartment as a RN in the Team nursingmodel based on competency level.OR RN: Helping hands in Inpatient Setting orEmergency Department based oncompetency level and medical centerneeds Manual ProningPre/Post nurses with recent critical careexperience (within 3 years), andexistence of current ACLS certificationmay be considered for possibleassignment to the critical care setting/Emergency Department as a RN in theTeam nursing model based oncompetency level.Pre/Post Nurses: Mixed skills Helping hands in Inpatient Settingor Emergency Department basedon competency level and medicalcenter needsAncillary staff, OR tech, Anesthesia tech, Scrub tech Helping handsManual ProningRunnersAmbulation & MobilityEach Team Lead should engage in continual communication with the Unit Charge RN to ensure teammembers have appropriate breaks and respite care during their shift.6