Switch to team nursing and boost staff morale

Do you want to increase satisfaction scores, improve patient care, and boost staff retention all in one shot? Consider switching to a team model of nursing.

"There is a growing trend toward team or zone nursing in the ED," reports Lisa DiMarco, RN, BSN, MBA, CEN, administrative director for emergency services at Edward Hospital in Naperville, IL. Morale of nursing staff has dramatically improved since the team model went into effect in August 2000, she reports.

If you are planning to switch to team nursing, consider these significant benefits:

• Nurses help one another more readily.

Previously, attitudes such as "it’s not my patient" were all too common, notes DiMarco. "There wasn’t as much ownership of what was happening in the ED," she says.

With the team model, if a nurse is caring for a trauma patient while assigned to two other patients, another nurse automatically steps in to cover these rooms for them. "Or a nurse may be precepting that day and is tied up," says DiMarco.

Nurses are more eager to assist their peers without being asked, says Randy Schmidt, RN, charge nurse for the ED. "Often, you will hear a nurse say, I’ll take that patient,’ only to hear another nurse say, No, I can take them, you already have three,’" he says.

Now, every nurse knows at least something about all the patients, says Schmidt. "This makes it easier to assist a patient or answer questions when you might not be their primary nurse," he adds. "Assistance is generally acknowledged with a sincere thank you,’ which is in itself a great morale booster."

• Employee satisfaction scores increase.

Staff satisfaction is measured by South Bend, IN-based Press-Ganey Associates every other year, and an internal survey tool is used during the off years, reports DiMarco. "After we get the results, we sit down and have sessions with staff to talk about problems," she says.

Employee satisfaction ratings for the 2002-2003 year scored in the 58th percentile, a significant increase from two years earlier when it was in the 22nd percentile, reports DiMarco, who attributes this to the team nursing model being implemented.

However, about 10% of nurses still are resistant to the team model, DiMarco acknowledges. "You will always have a handful that never will buy into this, and they do create a lot of stress for the group," she says.

To combat this, insist that resistant nurses be included in any decision-making process, advises DiMarco. "They are not allowed to just complain. If they are going to complain, they have to give a suggestion to fix it."

For instance, several ED nurses complained about doing the lion’s share of the workload, and were told to share their concerns directly with their colleagues. "Their tendency is to avoid confrontation and just complain to the management. But we just keep sending them back to the team," says DiMarco.

• Patients are more satisfied.

Although average length of stay has remained stable at 2.5 hours from arrival to discharge, arrival-to-physician times have decreased significantly, says DiMarco. "We were creeping up to 45 minutes, and patient satisfaction at that time was in the 75th percentile," she says. The average time to see a physician now is down to 31 minutes, she reports.

This is because the team model ensures that delays are followed up on, Schmidt explains. "Medications and discharge instructions have been much more timely," he says. "Patients are better informed about their care, plan of further care, and delays."

The ED now boasts three consecutive quarters of patient satisfaction scores in the 98th percentile. "The challenge now is: How we do maintain this and not let it fall back to where it used to be?" says DiMarco.

• The system provides additional mentoring opportunities.

The team concept pairs expert nurses with novice nurses, notes DiMarco. "The thing we were most surprised about was that retention is so much better," she says. "I believe that speaks to the mentoring atmosphere of the team model."

Previously, if a novice nurse needed help but didn’t go out of her way to ask, experienced nurses weren’t necessarily going to jump in and offer assistance, notes DiMarco.

Now it is much easier for new nurses, interns, and transitional nurses new to ED nursing to approach more experienced nurses, she says. "The preceptors are typically assigned to a new hire and follow that person’s schedule."

Having the correct skill mix on each team is key to success, says DiMarco. "The nurse manager does the scheduling and considers individual unit clerks, technicians, nurses, and doctors to make sure there is the right combination of skill mix on the team," she says.

Many of the ED’s less experienced nurses have gained significantly in self-confidence, patient care skills, and efficiency, notes Schmidt. "They have been less hesitant to ask questions, and the more experienced nurses have been less reluctant to offer assistance," he says.