In acute care wards, there is a continuous need for specialists that want and able to work together as a team, because coordinated interventions save lives. In that setting, a team nursing care delivery model was observed. Developed as a substitute for a fragmented and poor-performing functional approach, team nursing imbued the idea of meaningful cooperation and evolved to be rather popular among U.S. hospitals (Dickerson & Latina, 2017).
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There are also other prominent nursing care models such as nursing-managed care that are also worth reviewing. Thus, due to the paramount nature of nursing care models as catalysts of hospital patient treatment quality, this paper will review the literature on team nursing and nursing-managed care and discuss practical observations and suggestions on their implementation.
A recent study conducted by Dickerson and Latina (2017) observed the use of the team nursing paradigm within multiple hospital environments. The study employed an experimental design to assess and evaluate the effectiveness of this approach. Within the 18-bed transitional care unit, a team of nurses performed various procedures on patients collaborating meaningfully to fulfill their daily duties.
The experiment was conducted for 90 days, and interviews were conducted to assess the nurses afterward. The authors document an 11% increase in perceived levels of support among nurses and a 20% boost in self-reported accountability for one’s actions (Dickerson & Latina, 2017). Thus, the study demonstrates that the team-nursing model appears to be rather instrumental for nurses in regard to their psychological stability, which is known to positively correlate with the quality of service.
Another study on the team nursing paradigm was initiated by King, Long, and Lisy (2015). This group of scientists undertook a systematic review of papers that tested this care model in acute care settings. They aimed to observe how this approach performs in relation to nurses’ wellbeing in comparison to the total care model of nursing. The authors identified 40 peer-reviewed studies and reviewed the findings in each of them using standardized data extraction tools.
The results revealed that there is no statistically meaningful distinction in stress levels or staff turnover between the two models. However, job satisfaction was found to be higher in nurses engaged in team nursing. The authors conclude that economic analyses should be conducted in the future to further test the model for effectiveness in an acute care setting.
Nurse-Managed Care Model (250)
Nurse-managed care is a specific alternative model of care delivery that presupposes the whole range of treatment and management operations in the hospital performed by qualified nurses. In their study, Holt, Zabler, and Baisch (2014) explore this innovative model from the standpoint of evidence-based practice. They employ an integrative review to identify the characteristics of nurse-managed care and processes the acquired knowledge via quantitative analysis techniques developed by Donabedian.
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In the course of the study, the authors identified 59 articles devoted to the model in question. The analysis revealed a range of positive outcomes in the individual, community, health care system, and academic spheres. Significant changes in health and wellbeing, health knowledge, and quality of services were registered in hospitals managed by nurses.
Another study that identifies the positive qualities of a nurse-managed care delivery model was conducted by Pron (2013). This research sheds light upon the relationship between the nurse-managed care model and nurse job satisfaction. The author surveyed 99 completed the survey designed in accordance with the nurse practitioner job satisfaction scale. The gathered data was then analyzed quantitatively and discussed in relation to theory and practice.
As such, the research found that in nurse-managed clinics nurses have meaningfully high job satisfaction rates as well as positive regard for their role as autonomous. The study in question appears to confirm the beneficial nature of this care paradigm. The author also proposes that employment in such clinics may positively influence nurses’ well-being and career perspectives (Pron, 2013). Yet he identifies that such a model may face certain difficulties with implementation pertaining to the patient perceptions and the nature of the health care market in the U.S.
Team Nursing Implementation Observations
The team nursing care delivery model observed in the acute care setting appears to be positively influencing the members of the team as well as the patients’ perceptions of their care process. The in the hospital where observation took place nursing teams were formed by pairing 1 experienced nurse practitioner with several years of clinical experience and academic degree and one or two nursing students or interns. During the shift, they performed daily patient care tasks where the professional NPs observed, instructed, and helped their trainee colleagues in practice.
This system has been in operation for several years and, as reported by NPs and managers, yields great support from young nurses. The latter notice that they feel elevated confidence about performing their daily duties as they always have a colleague that can lend their assistance in times of critical need.
However, NPs note that this system appears to be a burden for them as certain interns rely on their help excessively which results in their impaired practical learning outcomes. This model, as some of them admit, prolongs the education process in young nurses and to a certain extent forms a careless attitude towards the job as some students tend to fake their inability to perform an operation and have their patrons do it for them.
Yet, it was observed that patients’ interests under the team nursing model are better met due to the quality of care they are provided even though inexperienced care providers are involved in the delivery process. Thus, despite the existence of certain issues, the paradigm appears to work rather well for both nurses and patients.
Nursing-Managed Care Implementation Alternative
As an alternative to the existing models, many academics suggest nurse-managed care due to the multiple positive influences it has on the patient’s health, quality and safety of service, and job satisfaction among staff (Holt et al., 2014). Nurses as field professionals who devote their skills and knowledge to the continuous provision of care to a variety of patients are therefore excellently suited to organize the plethora of clinical issues. In regard to the quality of care, nurses, who are daily engaged in servicing patients, have the opportunity to refine and polish their skills and, therefore, represent the clinical staff that knows all about it.
Thus, giving them the leading role in the process of treatment, will with a high degree of certainty yield better results. Given the current innovations and quality improvements in nursing education and the introduction of new levels of academic expertise, nurses have become proficient in all questions concerning patients’ health and procedural safety. This new role means that such professionals can undoubtful manage all such issues.
On the other hand, in academic literature, there are concerns that a nurse’s role is not suitable for management and governance. Pron (2013) states that proponents of such considerations doubt nurses’ ability to administrate financial, organizational, and otherwise systematic issues pertaining to the hospital organization. Yet, empirical studies and the existence of more than 250 nurse-managed clinics prove that such concerns lack evidence basis (Holt et al., 2014).
In regard to staff satisfaction, the evidence also suggests that the practical implementation of nurse-managed care demonstrates a substantial increase in job satisfaction and positive role perception. It appears that being empowered and surrounded by colleagues, nurses are motivated to perform and commit themselves fully to their duties. Overall, the academic and practical evidence suggests that this care model is capable of significantly improving the quality and safety of patient care as well as boost the mental wellbeing of the nursing staff.
Summary and Conclusion
The experience of observing the team nursing model in action gave me a sense of belonging to a profession and a deeper understanding of the mechanics which guide the process of care. The knowledge of different care models that I gained while reviewing academic works had a significant impact on the perception of my role within the clinical setting. I learned that there are a plethora of models that are implemented across the U.S. Model-specific studies mostly identify their effectiveness, yet there is still a concern that the specificity of each setting favors one or another model and there are no universal solutions. The knowledge gained in the course of this study will be implemented into practice where it would be appropriate.
Dickerson, J., & Latina, A. (2017). Team nursing: A collaborative approach improves patient care. Nursing 2018, 47(10), 16-17. Web.
Holt, J., Zabler, B., & Baisch, M. J. (2014). Evidence-based characteristics of nurse-managed health centers for quality and outcomes. Nursing Outlook, 62(6), 428-439. Web.
King, A., Long, L., & Lisy, K. (2015). Effectiveness of team nursing compared with total patient care on staff wellbeing when organizing nursing work in acute care wards: A systematic review. JBI Database of Systematic Reviews and Implementation Reports, 13(11), 128-168.
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Pron, A. L. (2013). Job satisfaction and perceived autonomy for nurse practitioners working in nurse‐managed health centers. Journal of the American Association of Nurse Practitioners, 25(4), 213-221.