Team Nursing Versus Workplace Transformation Models

Healthcare is a challenging market that has been facing a dramatic increase in cost and controversy over the last decade. The Alberta Health Service organization is responsible for the health and well-being of the population of Alberta and provides health services as mandated by the Department of Health. Alberta Health Service’s Workplace Transformation model is the center of recent controversy as Alberta Health Service works to balance the cost efficiencies of managing a large healthcare system with the traditional high standard of patient care for which the organization is best known.

There are several reasons why Alberta Health Services is moving towards the Workplace Transformation model but the primary motive is financial. In the 2009-2010 Annual Report, Alberta Health Services reported earnings of $10.2 billion and expenses of $10.4 billion (2010). This poor financial performance of the company is the focus of the change as the organization looks to reduce one of its largest expenditures: payroll costs. Indeed, payroll costs are at the center of the controversy as the Workplace Transformation plan will reduce the number of registered nurses (RN) on staff and replace those positions with licensed practical nurses (LPN), certified nursing assistant (CNA), and Healthcare Aides (HCA). Proponents of the plan believe that this strategy will reduce waste and increase the amount of time that registered nurses can spend interacting with patients. To do this, many of the administrative burdens placed upon registered nurses would move to licensed practical nurses and healthcare aides. In addition to balancing skills across the workload, the Workplace Transformation plan includes recruiting the right mix of staff and working with educational institutions to ensure a continuous supply of qualified applicants (Alberta Health Services Annual Report, 2010, p. 49). With the proposed changes in the balance of the workforce, the leaders at Alberta Health Services will provide a self-sustaining business model and still provide quality care for patients.

Opponents to the Workplace Transformation plan are concerned that the reduction of registered nurses will have a negative impact on the quality of patient care. Donna Wilson, University of Alberta Nurse Researcher, provided an interview where she stated, “hospitals that have a higher RN staff have better outcomes. Less patients die, less mistakes are made, people are not re-admitted back to the hospital, and people go home healthier because they have been better educated on how to look after themselves” (Wilson, 2011). To address these arguments, representatives from the College & Association of Registered Nurses of Alberta (CARNA) met with representatives from Alberta Health Services to discuss the concerns of registered nurses. The results of the meeting were posted in an open letter to the members of CARNA and the letter responded to the concerns regarding quality care under the new system. Several of the strategies AHS is employing to maintain the level of quality care with less RN’s includes a patient safety net with a floating RN on staff during the shift to handle concerns and active reporting of patient safety concerns (Eagle & Gordon, 2013). In addition, AHS promised to stagger the implementation of the plan and increase opportunities for feedback and discussion (Eagle & Gordon, 2013). Alberta Health Services has also incorporated ‘Care Transition’ into the new strategy and this includes increased education for discharged patients as well as transitional hospital beds and care for patients prior to discharge (Alberta Health Services, 2013). The Workplace Transformational model involves placing less skilled healthcare workers like LPN’s and HCA’s under the direction of highly skilled RN’s and reduces the overall amount of RN’s. While this will have the overall effect of reducing the cost of healthcare, it is unsure whether this will also reduce the quality of patient care.

Another highly popular model of healthcare management is the team-nursing model. Team-nursing came into popularity during World War II and was designed to help manage the shortage of skilled nurses during the conflict (Marquis & Huston, 2003). With team-nursing, small groups of five workers oversee a case load of 10-15 patients (Marquis & Huston, 2003). The teams have mixed levels of skills and experience by are led by an experienced RN who coordinates the team efforts and reports up to the charge nurse (Marquis & Huston, 2003). Team-nursing has been proven to reduce wait times for patients by up to 90% (Subash, Dunn, McNicholl, Marlow, 2004). According to the article, “The Trials and tribulations of team-nursing,” the implementation of a team-nursing strategy has its challenges as well (O’Connell, Duke, Bennett, Crawford & Korfiatis, 2006). “Its smooth application is further affected by the uncertain and changing conditions on the wards, which are difficult to control and impact on the smooth delivery of patient care. The findings revealed strengths and weaknesses in teamwork and communication, documentation and discharge planning” (O’Connell et al, 2006). While team-nursing has a strong following and evidence to support quality patient care, successful implementation requires strong team leadership and administrative support.

Students graduating in the next several years will be working in AHS Workplace Transformation and will need to develop advanced leadership skills in order to compete successfully in the new working environment. The reduction of full-time roles for registered nurses means that there will be a surplus of experienced and highly skilled RN’s available for jobs that used to serve as entry-level positions for recent graduates. To counter this imbalance, recent graduates would be remiss if they do not focus on the key skills that will help them to excel in the AHS Workplace Transformation model. Leadership will be a key skill for the aspiring nurse to master. In the book, “Nursing leadership from the outside in,” leaders are described as, “….caring, self-confident people who have and effectively communicate a vision to followers who plan together how to make the vision a reality by developing trust and empowering others and by creating opportunities for change for the best throughout an organization” (Glazer & Fitzpatrick, 2013, p.9). Leadership will be an important skill for a successful RN to master.

Within the concept of leadership, communication and empathy will be the two most powerful strategies needed to operate in the AHS Workplace Transformation. Communication will be a key skill due to the myriad factors involved in patient care and the fact that the tiniest detail can have dramatic implications on the health and well-being of a patient. Maintaining an open and collaborative communication channel will be the primary responsibility of the RN assigned to the group of LPN’s and HCA’s. The RN will have the responsibility of checking and doubl- checking the work of the lesser skilled employees and working to increase the knowledge and capabilities of the team to better serve the patient. Empathy will also continue to be a key leadership and nursing skill as nurses must always remember that the patient in front of them is a person first and a medical challenge second. By mastering the skills of communication and empathy, a future RN will be better able to compete against more experienced RN’s.

Much like the AHS Workplace Transformation model, team-nursing seeks to maximize the skills of the team and minimize redundancy. However, the AHS Workplace Transformation model takes the process another step further by relying heavier on lower skilled LPN’s and HCA’s to do much of the medical administration for the patient which can lead to mistakes due to lack of knowledge. Even with the oversight of a skilled RN, the AHS Workplace Transformation model is an unproven experiment and will require further research before it is proven as a successful model. In order to successfully complete in the new AHS Workplace Transformation, new graduates will need to focus on the leadership skills of communication and empathy. Combined, these skills will enable a future RN to contribute to the success of the AHS Workplace Transformation model and be an asset to the organization for years to come.

References

Alberta Health Services. (2010). Alberta Health Services annual report 2009-2010. Alberta Health Services. Retrieved from: http://www.albertahealthservices.ca/publications/ahs-pub-annual-rpt.pdf .

Alberta Health Services. (2013). Care transformation. Alberta Health Services. Retrieved from: http://www.albertahealthservices.ca/services.asp?pid=service&rid=1054602 .

Eagle, C., Gordon, D., (2013). Workforce transformation concerns: Open letter to members. College & Association of Registered Nurses in Alberta. Retrieved from: http://archive.constantcontact.com/fs176/1102266917298/archive/1114908353072.html .

Fernandez, R., Johnson, M., Tran, D. T., Miranda, C. (2012). Models of care in nursing: A systemic review. International Journal of Evidence-Based Healthcare. 10 (4) 324–337.

Glazer, G., Fitzpatrick, J. (2013). Nursing leadership from the outside in. Springer Publishing Company. New York, New York.

Heidenthal, P. K. (2003). Nursing leadership and management. 4th Edition. Thomson Delmar Singapore. p. 255-256.

Marquis, B. L. and Huston, C. J. (2003). Leadership roles and management functions in nursing: Theory and application. 4th Edition. Lippincott Williams & Wilkins. Philadelphia, U. S. A. p. 213-214.

O’Connell, B., Duke, M., Bennett, P., Crawford, R., Korfiatis, V. (2006). The trials and tribulations of team-nursing. The Collegian. 13(3) 11-17.

Subash, F., Dunn, F., McNicholl, B., Marlow, J. (2004). Team triage improves emergency department efficiency. Emergency Medical Journal. 21, 542-544.

Wilson, D. (2011). Interview: Donna Wilson on workplace transformation. Retrieved from http://www.youtube.com/watch?v=U5OsbGhdwfo.