The Team Nursing model is a collaborative approach to patient care that organizes diverse licensed and unlicensed staff under the leadership of a professional nurse. This team cares for a designated group of patients. The model gained prominence following World War II due to widespread nursing shortages, necessitating new ways to provide comprehensive care. Formally introduced in 1957 by Eleanor Lambertson, the goal was to improve patient satisfaction and maximize the efficient use of personnel with varying educational backgrounds.
Defining the Team Nursing Model
The philosophy of the team nursing model centers on delegation and close supervision. Instead of assigning a single nurse to one patient, responsibility for a patient group is assigned to the collective team. This structure leverages the distinct skills of each staff member, allocating resources based on complexity and scope of practice. The goal is to provide comprehensive care by coordinating specialized tasks under a unified plan.
Care delivery is managed through a division of labor. Highly trained staff focus on complex clinical judgments and planning, while less complex, routine tasks are distributed to other team members whose training matches the required skill set. This system promotes staff efficiency while maintaining a focus on the total needs of the patient group. The team leader remains accountable for all patient outcomes, including tasks delegated to others.
Roles and Responsibilities Within the Team Structure
The successful operation of this model depends on a clear hierarchy and defined responsibilities for each member. The structure ensures patient needs are addressed based on the required level of clinical expertise. The team typically includes a mix of professional, licensed, and unlicensed personnel, each playing a distinct part in executing the daily care plan.
Registered Nurse (RN) Team Leader
The Registered Nurse functions as the Team Leader and holds primary responsibility for the entire assigned patient group. This role involves performing initial and ongoing patient assessments, developing the overall plan of care, and coordinating all team activities. The RN leader must possess strong organizational and interpersonal skills to effectively delegate specific tasks based on team members’ competency and legal scope of practice. The Team Leader is also accountable for supervising and evaluating all care provided, ensuring continuity and quality of patient outcomes.
Licensed Practical Nurse (LPN) or Licensed Vocational Nurse (LVN)
The Licensed Practical Nurse (LPN) or Licensed Vocational Nurse (LVN) works under the direction of the RN Team Leader to execute components of the established care plan. LPNs focus on providing routine care for patients whose conditions are stable and predictable. Their duties include administering medications, performing technical tasks like wound care or urinary catheter insertion, and monitoring patient status. They serve as an intermediary between the RN and unlicensed staff, ensuring the care plan is followed.
Unlicensed Assistive Personnel (UAP) or Certified Nursing Assistant (CNA)
Unlicensed Assistive Personnel (UAP), including Certified Nursing Assistants (CNA), provide basic patient care and support activities. These tasks relate to Activities of Daily Living (ADLs), such as bathing, feeding, ambulating, and repositioning patients. UAPs also gather objective data, monitoring and recording vital signs, and reporting observed changes in a patient’s condition to licensed nurses. Their frequent contact with patients makes their accurate reporting a contribution to the team’s overall assessment.
The Operational Mechanics of Care Delivery
The daily operation follows a structured cycle of planning, execution, and evaluation to ensure integrated care. The process begins with assigning a group of patients to a specific team for the shift. The RN Team Leader reviews patient acuity levels and required interventions.
A defining feature is the daily planning conference, often called a huddle, conducted by the RN Team Leader with the team. During this meeting, the leader discusses the care plan and delegates specific responsibilities to the LPNs and UAPs. This delegation is a formal process that must adhere to established guidelines, ensuring the right person performs the right task.
Following the huddle, team members execute their assigned tasks, with the RN leader actively supervising and coordinating efforts. The leader intervenes in complex situations, performs higher-level clinical tasks, and adjusts the plan as patient needs evolve. The shift concludes with a comprehensive report-out, ensuring information is accurately transferred to the oncoming team to maintain continuity of care.
Key Advantages of Using Team Nursing
The team nursing model offers several organizational and staff-related benefits, particularly in environments facing resource constraints. By utilizing a mix of personnel with varying training levels, the model optimizes the distribution of human resources. This strategic deployment contributes to cost-effectiveness, allowing licensed nurses to focus their time on complex clinical tasks only they can perform.
The model also fosters a supportive and collaborative environment, which can positively influence staff morale and reduce the workload burden on professional nurses. Junior staff members, including new graduates and UAPs, benefit from working closely with experienced RNs, creating a system for mentorship and skill development. This structure ensures every member contributes their skills fully, allowing for comprehensive attention to the patient group.
Common Challenges and Drawbacks
While team nursing promotes efficiency, it presents difficulties that can impact the quality and consistency of patient care. A primary concern is the potential for fragmentation of care, as multiple individuals manage a single patient. This distribution of tasks can lead to communication breakdowns, especially if the team leader’s supervision or the shift hand-off is inadequate.
The success of the model depends heavily on the leadership and organizational skills of the RN Team Leader. If the leader lacks delegation or coordination abilities, the team’s efforts can become disjointed, increasing the risk of missed care or errors. The delegation process also carries risk if tasks are assigned improperly or if the RN fails to correctly assess the competency of the receiving staff member.
How Team Nursing Compares to Other Care Models
Team Nursing exists as a middle ground between two other major organizational models: Functional Nursing and Primary Nursing. Functional Nursing is a highly task-oriented approach where each staff member performs only one specific function for all patients on the unit (e.g., administering all medications). Team Nursing improves upon this by organizing tasks around a specific group of patients, mitigating the fragmentation inherent in Functional Nursing.
Primary Nursing emphasizes a patient-centered approach where one Registered Nurse is wholly responsible for the total care of a small set of patients from admission to discharge. This model requires a higher ratio of professional nurses and is resource-intensive. Team Nursing blends the efficiency of using mixed personnel, similar to Functional Nursing, with the patient-group focus found in Primary Nursing, balancing economic and quality considerations.