Team Nursing Revisited - Again - Emerging Nurse Leader

By Rose O. Sherman, EdD, RN, NEA-BC, FAAN

Nurse staffing shortages during COVID are now a national headline. This Thursday, there will be a star-studded live-stream benefit concert Nurses are Heroes to benefit nurses and provide scholarships Emilio Estefan, the event producer, noted that “I’ve had the privilege of producing some exceptional concerts, but the response from celebrities for Nurse Heroes has been extraordinary, combined they have over 450 million fans following them on social media,” Gloria Estefan’s sister is a nurse. Her sister has told her that there aren’t enough nurses to staff through this second surge. This is a noteworthy effort, but it won’t get us through the challenges that leaders will see during the next few months.

Unlike the first surge last Spring, almost every state is now impacted. Many nurses and/or family members have themselves become sick. Hiring per diem, agency, or travel nurses may not be an option as they are in very short supply. The reality for most leaders is that you can’t keep doing what you are doing. The delivery models in place may not be sustainable during this crisis, which could last several months. It may be time to revisit team nursing – once again. Some health systems have already done this.

When a crisis hits, it forces us to look at the vulnerabilities in our systems and acknowledge some practices that don’t serve us well in emergencies. It creates space to think differently in the words of the Apple corporation. Team nursing is a nursing care delivery that has not been widely practiced for decades. Many of our younger staff and probably many leaders know little about it. And yet, the COVID-19 pandemic presents a unique opportunity for nurse leaders currently struggling to staff their ICUs and other areas to try something different.

Nurse leaders are now asked to double, triple, or even quadruple their critical care beds. Using a traditional model of care delivery, considerably more critical care and COVID unit nurses are needed. Nurses are being redeployed from other specialties to lessen the impact, but it is still not enough. So at this point, nurse leaders have a choice – do you stick with our traditional model of care and RN-Patient ratios, or do we change the model and redeploy staff using a different model of care and rapid upskilling of staff. In a blog on Avoiding the Status Quo written during the first surge, I discussed the staffing tiered model recommended by the Society of Critical Care Medicine, which essentially recommended a team approach using non-critical care staff to care for ICU patients that align with a team nursing model of care delivery.

Interestingly, team nursing was originally developed during a time of crisis during World War II when there was a nursing shortage. To combat a shortage of nurses, the military began to train ancillary healthcare staff, including medical corpsmen and 91 Charlies, to work with nurses on a team. After the war, the VA Health System was the first to move to this care delivery model. Team nursing was studied in the late 1940s and early 1950s by Dr. Eleanor Lambertsen at Teachers College Columbia University with a Kellogg Foundation grant. It was found to be efficient and effective in producing good patient outcomes when executed well.

One of the most positive outcomes from this crisis has been the high level of teamwork and collaboration. Crises have a funny way of forcing all of us to focus on a purpose and work together more harmoniously. We don’t worry as much about power and control because we have so little against this virus. It could be the exact right time to revisit team nursing. I prepared a short Youtube video to help you learn more about team nursing. The video has had 2000+ views since being posted in April. There are not that many resources out there, but I had the great fortune to have Dr. Lambertsen as my mentor while a doctoral student at Teachers College, where I did my dissertation on team nursing. As I made this video – I could picture her smiling at me and reminding me, as always did, that timing is everything.

Youtube – Team Nursing Revisited During COVID-19

Read Rose Sherman’s book – The Nurse Leader Coach: Become the Boss No One Wants to Leave