Team-Based Nursing Care – Getting Started

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

In a study released by Incredible Health, 94% of health executives outside of nursing now describe the nursing shortage as critical, and 68% note they would now be unprepared to handle another health emergency like COVID. Their data indicates that 53% of nurses working in health systems now have five years or less experience, and the priorities and needs of the nursing workforce are rapidly shifting. 75% rely heavily on travel nurses (for up to 25% of staff). This data and other recent studies demonstrate a high priority to innovate how care is delivered.

Yet, redesigning a care delivery model to use a team approach to care which could include virtual nursing staff can seem like an overwhelming challenge. It was refreshing to hear about a success story now two years in the making. Community Health Systems (CHS) has implemented a team-based care model (RN-LPN-PCT) in its medical-surgical units in 62 of its 78 hospitals across 15 states. They have nearly two years of data and workflow analysis to study the outcomes of a massive yet highly successful undertaking. Their experience was recently showcased at a Press Gainey Client conference with a packed audience in attendance.

I recently spoke with Senior Director of the Patient Experience Jerry Painter and Senior Vice President and Chief Nursing Officer Pam Rudisill( who also happens to be a former AONL president)  about their experience in the successful implementation of team-based care where so many others have struggled.  Some lessons learned from their experiences are essential:

1. It began as a pilot on medical-surgical units in a few hospitals and later rolled out across the system.
2. Senior leadership is very hands-on in their communication, discussion of implementation plans and iterations of the model.
3. Weekly calls about the model are held with CNOs at all the facilities.
4. Staff input and concerns about the model are encouraged and acknowledged using techniques like town halls and polling.
5. Implementing a new model of care is not one and done but rather, it needs ongoing guidance and monitoring.
6. Workforce and performance analytics are carefully tracked on an ongoing basis.
7. It was not assumed that nurses would know how to lead or delegate in the new model – education was provided.
8. Teamwork skills are an essential part of a team-based model of care.
9. Scopes of practice differ widely for LPNs across states, and this needed to be considered as new roles were designed.
10. Getting the buy-in of finance executives was critical, as paying PCTs a living wage is vital to the model’s success.

The leadership at CHS clearly understood from the beginning that a change in how care is delivered is a massive undertaking that takes a village (well beyond nursing leadership) to ensure success. Interestingly, there was little pushback from RNs, who quickly began to see improvements in med-surg unit staffing. Building a strong teamwork foundation and maintaining open and ongoing communication are critical success factors. Results from their pilot are showing positive results across patient experience, quality, safety and efficiency. Their advice is get started with pilots in hard to staff areas like med-surg and be prepared to pivot and change as needed.

© emergingrnleader.com 2023

 

 

 

 

 

 

 

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