NURSING MANAGEMENT: TEAM VS. PRIMARY

Hospitals address nursing care of ward patients in several ways. The two most common nursing management styles are Team Nursing and Primary Care Nursing. Each type of nursing care management has its own pro’s and con’s with respect to both nurses and patients. Both systems were devised in order to improve the quality of care given to patients, while considering the abilities, capabilities, and limitations of nurses and other health care providers in the ward.

WHAT IS PRIMARY NURSING AND TEAM NURSING?

Primary Care Nursing is a system in which one nurse is caring for all the needs of a patient or more within a 24 hour from admission to discharge. He or she is responsible for coordinating and implementing all the necessary nursing care that must be given to the patient during the shift. If the nurse is not available, the associate nurse responsible for filling in for the nurse’s absence will provide hospital care to the patient based on the original plan of care made by the nurse. This type of nursing care can also be used in hospice nursing, or home care nursing.

o The advantage of promoting primary nursing in hospital practice is that the patient is able to build trust and confidence on the abilities of the nurse assigned to him. This in turn can lead to fast recovery and improved nurse-client relationship.

o The disadvantage of promoting primary nursing is the high cost setting, especially in specialized units such as the ICU where one nurse is assigned to the total care of a single patient. It is also important that the assigned nurse will be highly knowledgeable about the patient’s condition and how to properly plan and implement the right nursing care. Also, if the right patient-nurse mix is not achieved, the patient may deteriorate in condition and even reject the nurse totally.

Team Nursing, on the other hand, is a system developed in the 1950’s to answer the need of more nurses in a hospital. This is where one nurse is in charge of leading group comprising 4-6 different members such as nursing aids and unlicensed assistive personnel to care for a group of patients equating to 15-20. Patient care is delivered through the coordination and cooperation of each team member through delegation of assignments with respect to the team member’s level of responsibility and accountability. Delegation of patients and duties are done at the beginning of the shift, while a summary of care given and outcomes resulting from patient care is conveyed at the end. Any action that is done by unlicensed assistive personnel, nursing aid or nurse volunteer is the responsibility and accountability of the team leader, the registered nurse.

o The advantage of team nursing is that the total number of absences and leaves related to over-work and medical conditions related to stress and fatigue is lessened. This is due to the sharing of workload between each team members, enabling them to do a huge amount of work in such a short time without undue exertion. This delegation of duties will also enable team members to hone their skills in different nursing tasks, and also improve their ability to communicate and coordinate. Each can also learn from each other during team conference while discussing on ways how to go about in caring for different patients. Once the team has established themselves as members and not as individuals each would feel that they belong thereby increasing nurse morale. This in turn would improve the quality of care each would give to the clients, leading to better patient satisfaction. Each will realize each team member’s role in caring is important for the client, minimizing the barrier between each profession.

o One major disadvantage of team nursing is lack of team effort and inability to communicate. Pooling people together in order to work does not necessarily equate that each team will work as a group. Time must be given in supervising the team to help each member act as part of a group. Communication barriers may cause some problems in rendering patient care. If team members are constantly being re-shuffled, the continuity of care can be interrupted, leading to patient dissatisfaction.