Building An Infrastructure for New Models of Care Delivery

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

Virtually every health system in the country is either considering or in the pilot phase of testing new nursing care delivery models. This is not surprising. Outside of a few specialty areas, future care delivery models will necessitate a team-based approach with professionals and support staff working at the top of their scope of practice. A growing gap exists between the number of nurses needed and those available. While we once had the luxury of assigning nurses to non-nursing tasks, the situation has changed, and we no longer can.

Every proposed model, from adding virtual nurses to adding new roles such as mobility techs, mental health techs, or on-unit tech support, has two commonalities. They are intended to be nurse-led and team-based. There is an underlying assumption in the pilots I have reviewed that a strong culture of teamwork is already in place. Just as you would not build a house without a strong foundation, we should not create new models of care without ensuring that nurses are ready to lead others and that there is a strong culture of teamwork.

The last six months and more than 30 virtual workshops on Rebuilding Nursing Teams: Coming Together after Falling Apart with thousands of nurse managers have made me realize this infrastructure is not in place for most health systems. Over the past two years, core teams have fallen apart. We have a new generation of nurses who place less value on teamwork and are less inclined to provide team back up to others. Nurse managers tell me it is almost impossible today to find nurses who will take charge nurse roles, let alone lead teams. Teamwork in nursing is not in a good place, and we need to be willing to admit it.

We also have two generations of nurses who have spent their careers in a primary care delivery model. It is all they have known. I was not surprised by the recent findings of the Models of Care Insight Study that indicate 63% of RNs don’t support the addition of LPNs to a care delivery model in their organization. This addition is a significant change to the models of care currently in place. Few nurses are now educated about the supervision and delegation of care to healthcare staff other than RNs. There is great fear about this as nurses are asked to assume more leadership at the frontline of care. It will also require a change in mindset among nurses from thinking about “my patients” to “our patients” as nurses co-manage more patients.

So why does this matter? History provides some lessons about why it is essential to have a robust infrastructure in place if new models of care are to be successful. Team-based care is not new in nursing. Most hospitals used a team approach to care from World War II through the early 1980s. Beginning in the 1980s, primary nursing care models replaced team nursing. The team nursing delivery system was studied in the late 1940s and early 1950s by Dr. Eleanor Lambertsen at Teachers College Columbia University with a Kellogg Foundation grant. Her research found the team approach to care was efficient and effective in producing good patient outcomes. Dr. Lambertsen’s work attracted nursing administrators nationwide who sought to reorganize their nursing staff. A guiding principle of team nursing is that multiple healthcare professionals working together can provide a higher level of care than any single professional working alone.

So why did it fail to take hold? Thirty years ago, toward the end of her life, Dr. Lambertsen mentored me at Teachers College, Columbia University, as I did my dissertation research on the team-based approach to care used in the Department of Veterans Affairs. Team nursing had fallen into disfavor at that time as most systems adopted a primary nursing care model. I interviewed her several times about what led to the demise of team nursing. She attributed it to a lack of leadership education provided to nurses about how to lead teams and the lack of infrastructure to support and encourage strong teamwork. The notable exceptions in her mind were the military and the Department of Veterans Affairs, both of which continue to use it even today. Dr. Lambertsen’s ideas are as true today as 30 years ago. As we design new models, we must consider the foundation we build them on.

It is why I wrote my new book released last week, A Team Approach to Nursing Care Delivery. We can’t afford to make the same mistakes today. The stakes are too high.

© emergingrnleader.com 2023

 

 

 

 

 

 

 

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