Reply To: Well stated and provocative. See this video

[Steven Watson]

This is called team nursing, or at least a version of it. I enjoyed listening to this video, the presenter brought out many good points. One of the most clinically significant points is the decreased risk for cross-infection by fewer persons crossing the infection barrier. The presenter mentioned a moral objection to the use of international nurses where this would leave one country with fewer nurses. As an international nurse, I can say this topic is much more complex than presented. Mass recruitment from other countries doesn’t deal with the issue of the clerical burden being presented.

The clerical burden on nurses is a combination of low perception of nurses by the public (and other health professionals) and the sense of self-worth of nurses. As mentioned in the video others may view nursing as an entry-level position and therefore not necessitating a secretary. Nurses, on the other hand, are trained to be highly sensitive to minute details which should be considered holistically, as such we are reluctant to give up any aspect of our role.

There is only so much we can do/control, especially in crisis situations. Team nursing is an idea borrowed from other disciplines where it has been successfully implemented. Henry Ford famously streamlined car production by introducing the production line where individuals sequentially performed tasks repetitively resulting in high quality and efficiency. This task-focused model of team nursing traditionally has not been executed well. When various assessment tasks are divided it results in the inability to easily consider the patient’s whole situation.

Team nursing can work well when duties are well allocated, like the proposal given by the presenter. This assessor/documenter form of team nursing works well in given situations, like isolated patients, recovery, and precepting new nurses for example. This form uses the TeamSTEPPS closed-loop communication tool by the assessor calling out (or dictating) assessments and the second person reading back (documenting) what is called out completing the closed-loop. The proposal in the video suggests that this second person does not need to be a highly trained RN. This process reduces the number of times a nurse goes between the patient and the recording station, improving efficiency and reducing cross-contamination.

This form of team nursing is not ideal in all situations but could definitely be expanded beyond the situations I mentioned above. The interesting part for DNP’s and Ph.D.’s will be defining the cost-benefit tipping point for this model and obtaining buy-in from nurses and administrators alike. Of course, we should also deal with the other part of the clinical burden equation by promoting the perceptions of nursing among the public and other professionals.

PS. Please don’t connect more than one patient to a ventilator, it will end up under-inflating the person with stiffer lungs and hyperinflating and potentially injuring the other.