An Integrative Review of Team Nursing and Delegation: Implications for Nurse Staffing during COVID-19

Delegating care as a double-edged sword for quality of nursing care: a qualitative study

BACKGROUND

Considering the significance of care delegation in enhancing the quality of nursing care and ensuring patient safety, it is imperative to explore nurses' experiences in this domain. As such, this study aimed to explore the experiences of Iranian nurses regarding the delegation of care.

METHODS

This qualitative study was conducted between 2022 and 2023, employing the content analysis method with a conventional approach. The study utilized purposeful sampling method to select qualified participants. Data collection was carried out through in-depth and semi-structured interviews utilizing open-ended questions. The data analysis process followed the steps proposed by Graneheim and Lundman (2004) and involved the use of MAXQDA version 12 software. To ensure the trustworthiness of the data, the study employed the four rigor indices outlined by Lincoln and Guba (1985).

RESULTS

In the present study, a total of 15 interviews were conducted with 12 participants, the majority of whom were women. The age range of the participants fell between 25 and 40 years. Through qualitative data analysis, eight subcategories and three main categories of "insourcing of care", "outsourcing of care" and "delegating of care to non-professionals" were identified. Additionally, the overarching theme that emerged from the analysis was "delegation of care, a double-edged sword".

CONCLUSIONS

The results of the study revealed that the delegation of care occurred through three distinct avenues: to colleagues within the same unit, to colleagues in other units, and to non-professionals. Delegating care was found to have potential benefits, such as reducing the nursing workload and fostering teamwork. However, it was also observed that in certain instances, delegation was not only unhelpful but also led to missed nursing care. Therefore, it is crucial to adhere to standardized principles when delegating care to ensure the maintenance of high-quality nursing care.

Impact of Povidone Application to Nares in Addition to Chlorhexidine Bath in Critically Ill Patients on Nosocomial Bacteremia and Central Line Blood Stream Infection

Nosocomial Methicillin-resistant Staphylococcus aureus (MRSA) bacteremia results in a significant increase in morbidity and mortality in hospitalized patients. We aimed to analyze the impact of applying 10% povidone iodine (PI) twice daily to both nares in addition to chlorhexidine (CHG) bathing on nosocomial (MRSA) bacteremia in critically ill patients. A quality improvement study was completed with pre and post-design. The study period was from January 2018 until February 2020 and February 2021 and June 2021. The control period (from January 2018 to May 2019) consisted of CHG bathing alone, and in the intervention period, we added 10% PI to the nares of critically ill patients. Our primary outcome is rates of nosocomial MRSA bacteremia, and our secondary outcome is central line associated blood stream infection (CLABSI) and potential cost savings. There were no significant differences in rates of MRSA bacteremia in critically ill patients. Nosocomial MRSA bacteremia was significantly lower during the intervention period on medical/surgical areas (MSA). CLABSIs were significantly lower during the intervention period in critically ill patients. There were no Staphylococcus aureus CLABSIs in critical care area (CCA)during the intervention period. The intervention showed potential significant cost savings. The application of 10% povidone iodine twice a day in addition to CHG bathing resulted in a significant decrease in CLABSIs in critically ill patients and a reduction in nosocomial MRSA in the non-intervention areas. Further trials are needed to tease out individual patients who will benefit from the intervention.

An exploratory study of the practical impact of the COVID-19 pandemic on nursing tasks in clinical settings

AIMS

To identify and compare new or increased nursing tasks in South Korea during the pandemic, categorized by hospital type and department.

BACKGROUND

Although COVID-19 is no longer considered a global public health emergency, the threat of novel infectious diseases remains. Reflecting on the COVID-19 pandemic is essential to prepare effectively for future outbreaks.

METHODS

This cross-sectional exploratory study, following the STROBE checklist, included 948 registered nurses with more than a year of clinical experience currently working in various hospitals. Questionnaires gathered demographic data, work characteristics, and the frequency of nursing task performance. Statistical analysis encompassed descriptive and inferential methods.

RESULTS

The most common new or increased nursing task across all hospital types was 'Access control for family caregivers.' General wards prioritized tasks related to family caregivers, while specialized units like ICU and ER focused on infection control.

CONCLUSION

Understanding how COVID-19 has impacted nursing tasks is crucial for gaining insights into efficient resource allocation, targeted education, and policy formulation during similar public health crises. The pandemic has given rise to new family caregiver-related tasks in the nursing profession. Consequently, continuous nursing research is essential for establishing guidelines and fostering a supportive work environment, which is crucial for the successful implementation of these tasks.

Reimagining America's Rural Health: Challenges and Opportunities

OBJECTIVES

The objective of this inquiry was to identify (a) rural health challenges in the United States, especially in the context of the COVID-19 pandemic and (b) to identify opportunities within the disruptions caused by the pandemic.

BACKGROUND

Rural healthcare challenges in the United States are not the same as those faced in urban and suburban communities. Nor are rural hospitals a miniature version of larger urban hospitals. Urban healthcare and hospital-centric policies and solutions, hence, do not help address or optimize the unique health challenges of rural communities. Furthermore, the challenges previously faced by rural hospitals were further exacerbated by COVID-19.

METHODS

Key points from public deliberations among experts in a 1-day symposium on rural health, attended by 65 professionals representing 18 west Texas institutions, were captured by the authors. The data were subsequently analyzed to identify common areas of information.

FINDINGS

Four clusters of challenges and opportunities were identified: healthcare delivery, healthcare infrastructure/building, community health, and public administration.

CONCLUSIONS

Symposium data suggest that rural health faced numerous unique challenges, which were further compounded by the COVID-19 pandemic. However, the pandemic also helped discover the resiliency of clinicians working in rural areas. For rural health optimization, rural health buildings also need to be flexible. While funds are not easily available, some innovative community collaborations with healthcare institutions may generate novel solutions. In the meantime, telemedicine promises a radical change in rural community health services in the future.

Evaluating the Effect of TeamSTEPPS on Teamwork Perceptions and Patient Safety Culture among Newly Graduated Nurses

BACKGROUND

Quality healthcare delivery is contingent upon effective teamwork and a patient safety-focused culture. TeamSTEPPS offers an evidence-based framework that enhances these competencies. However, the impact of TeamSTEPPS on newly graduated nurses, who undergo a significant transitional phase, has yet to be comprehensively explored. Consequently, the objective of this study was to assess the influence of TeamSTEPPS on perceptions of teamwork and patient safety culture among newly graduated nurses.

METHODS

This study employed a quasi-experimental pretest-posttest design with a single group, utilizing a convenience sample of 132 newly recruited nurses from a university hospital. The participants completed the hospital survey on patient safety culture and the TeamSTEPPS teamwork perceptions questionnaire at three different time points.

RESULTS

The impact of the TeamSTEPPS training program was found to be significant, as indicated by the substantial improvement in the mean scores of nurses' perceptions regarding teamwork and the culture of patient safety across multiple assessments (p < 0.001). The effect size (η2p ≥ 0.14) suggests a large effect, further emphasizing the meaningful impact of the program on the measured outcomes.

CONCLUSIONS

The study underscores the effectiveness of TeamSTEPPS as a valuable framework for facilitating the seamless transition of newly graduated nurses into the healthcare field. Integrating TeamSTEPPS into nursing training programs can significantly enhance nurses' perceptions of teamwork and the culture of patient safety. Therefore, it is crucial for nurse managers to implement TeamSTEPPS systematically, aiming to improve teamwork perception and cultivate a patient safety culture among nurses. Furthermore, they should establish mechanisms to ensure the consistent application of these skills over time.

Hospital Adaptions to Mitigate the COVID-19 Pandemic Effects on MARQUIS Toolkit Implementation and Sustainability

OBJECTIVE

To explore the perceived effects of COVID-19 on MARQUIS toolkit implementation and sustainability, challenges faced by hospitals in sustaining medication reconciliation efforts, and the strategies used to mitigate the negative effects of the pandemic.

DATA SOURCES AND STUDY SETTINGS

Primary qualitative data were extracted from a Web-based survey. Data were collected from hospitals that participated in MARQUIS2 ( n = 18) and the MARQUIS Collaborative ( n = 5).

STUDY DESIGN

A qualitative, cross-sectional study was conducted.

DATA COLLECTION/DATA EXTRACTION

Qualitative data were extracted from a Research Electronic Data Capture survey databased and uploaded into an Excel data analysis template. Two coders independently coded the data with a third coder resolving discrepancies.

PRINCIPAL FINDINGS

Thirty-one team members participated, including pharmacists ( n = 20; 65%), physicians ( n = 9; 29%), or quality-improvement (QI) specialists ( n = 2; 6%) with expertise in medication reconciliation (MedRec) (14; 45%) or QI (10; 32%). Organizational resources were limited, including funding, staffing, and access to pharmacy students. To support program continuation, hospitals reallocated staff and used new MedRec order sets. Telemedicine, workflow adaptations, leadership support, QI team involvement, and ongoing audits and feedback promoted toolkit sustainability.

CONCLUSIONS

COVID-19 affected the capacity of hospitals to sustain the MARQUIS toolkit. However, hospitals adapted various strategies to sustain the toolkit.

Medication Safety Event Reporting: Factors That Contribute to Safety Events During Times of Organizational Stress

BACKGROUND

Incident reports submitted during times of organizational stress may reveal unique insights.

PURPOSE

To understand the insights conveyed in hospital incident reports about how work system factors affected medication safety during a coronavirus disease-2019 (COVID-19) surge.

METHODS

We randomly selected 100 medication safety incident reports from an academic medical center (December 2020 to January 2021), identified near misses and errors, and classified contributing work system factors using the Human Factors Analysis and Classification System-Healthcare.

RESULTS

Among 35 near misses/errors, incident reports described contributing factors (mean 1.3/report) involving skill-based errors (n = 20), communication (n = 8), and tools/technology (n = 4). Reporters linked 7 events to COVID-19.

CONCLUSIONS

Skill-based errors were the most common contributing factors for medication safety events during a COVID-19 surge. Reporters rarely deemed events to be related to COVID-19, despite the tremendous strain of the surge on nurses. Future efforts to improve the utility of incident reports should emphasize the importance of describing work system factors.

The impact of the COVID-19 pandemic on hospital-acquired infections at a comprehensive cancer center

BACKGROUND

Robust infection prevention and control (IPC) measures were deployed across health care institutions at the start of the COVID-19 pandemic, resulting in increased use of personal protective equipment, enhanced contact precautions, and an emphasis on hand hygiene. Here, we evaluate the effect of enhanced IPC practices on the occurrence of various hospital-associated infections (HAIs) in a comprehensive cancer center.

METHODS

From September 2016 through March 2022, we calculated the incidence rates (IRs) of HAIs for C. difficile infection, multidrug-resistant organisms, respiratory viral infections (RVIs), and device-related infections. We analyzed the incidence rate ratios for all HAIs during the periods before the pandemic, during the pandemic, at the time of the surges, and in COVID-19-designated wards.

RESULTS

When comparing the prepandemic to the pandemic period, the IR across all MRDOs was similar. We observed a decrease in the IR of central line-associated bloodstream infections and a stable IR of catheter-associated urinary tract infections. A significant decrease was observed in the IR of C. difficile infection. The total IR of nosocomial RVIs decreased, as did for each respiratory virus. A similar IR of nosocomial RVIs between COVID-19 community surge versus nonsurge periods was observed except for SARS-CoV-2, RSV, and influenza. multidrug resistant organisms were 5 times more likely to occur on the COVID-19 wards compared with the non-COVID-19 wards.

CONCLUSIONS

Implementing strict IPC measures during the COVID-19 pandemic in a cancer hospital led to a significant decrease in many HAIs and a reduction in nosocomial RVIs.

Evaluation of lay health workers on quality of care in the inpatient setting

AIMS

To evaluate the impact of a lay health worker support role in the inpatient setting.

BACKGROUND

Healthcare systems are facing critical nursing and nurse assistant staffing shortages. These disciplines can be challenging to recruit and retain, leading healthcare leaders to identify innovative staffing models. Whereas lay health workers have been used in the community and low-income setting, there is scant evidence of their use in the inpatient setting. We implemented a lay health worker role, called Patient Attendant Service Aides (PASAs), on two medical/surgical units at a community hospital.

METHODS

A pre/post-implementation design was used for this study. An online survey was provided to nurses, nursing assistants, and PASAs on the two medical/surgical units to assess their satisfaction and perceptions of the role. Nursing quality metrics, patient satisfaction, and nursing and nursing assistant turnover were evaluated before and after implementing the role.

RESULTS

The online survey showed that nurses and nursing assistants felt that PASAs helped offload their workload, allowing them to focus on nursing-related tasks. PASAs felt supported by the team and believed they were making a meaningful contribution to the unit. There were slight improvements in patient satisfaction, although not significant. There was a significant improvement in nursing turnover on Unit A, from 71.1% to 21.6% (p = 0.009).

CONCLUSIONS

This is one of the first studies to evaluate the use of lay health workers in the inpatient setting; we found this role to be a feasible way to offload tasks from clinical staff. This role may serve as a pathway for workforce development, as several PASAs are now enrolled in nursing assistant training. Nurse managers may consider using lay health workers in the inpatient setting as they face severe clinical staff shortages.

A Current State Assessment on Nursing Work Activities: An Observational Study

BACKGROUND

Nationwide nursing shortages have led to higher patient-to-nurse ratios, nursing burnout, and decreased quality of care.

LOCAL PROBLEM

Staffing challenges and nursing burnout were becoming growing concerns and success was contingent upon efficient use of existing resources.

METHODS

Direct observation current state assessment was completed on medical-surgical specialty units to better understand work activities of registered nurses (RNs) and unlicensed assistive personnel (UAPs).

RESULTS

RNs spent more time performing indirect care (eg, documentation) than direct patient care. Interruptions and problems consumed 17.4% and 5.6% of their time, respectively. UAPs performed more direct patient care but had a higher proportion of downtime. RNs underdelegated nonclinical tasks.

CONCLUSIONS

Direct observation current state assessment offers a better understanding of workflow and workload inefficiencies. This information is critical to provide informed, evidence-based recommendations to develop future patient care models with more capacity to deliver high-quality care with greater efficiency and lessen nursing burden and burnout during the nursing shortage crisis.

The association of the emergency department work environment on patient care and nurse job outcomes

Objective

To determine the association between emergency nurses' work environments and patient care quality and safety, and nurse burnout, intent to leave, and job dissatisfaction.

Methods

Cross-sectional study of 221 hospitals in New York and Illinois informed by surveys from 746 emergency nurses and 6932 inpatient nurses with linked data on hospital characteristics from American Hospital Association Annual Hospital Survey. The RN4CAST-NY/IL study surveyed all registered nurses in New York and Illinois between April and June 2021 about patient safety, care quality, burnout, intent to leave, and job dissatisfaction and aggregated their responses to specific hospitals where they practiced. Work environment quality was measured using the abbreviated Practice Environment Scale of the Nursing Work Index. Generalized estimating equations were used to determine the relationship between emergency nurses' work environments on patient care and nurse job outcomes.

Results

A total of 58% of emergency nurses reported high burnout, 39% reported job dissatisfaction, and 27% indicated intent to leave their job in the next year. Nurses in hospitals with good (vs mixed) or mixed (vs poor) emergency work environments were less likely to report unfavorable patient care quality and hospital safety grades, and were less likely to experience high burnout, job dissatisfaction, and intentions to leave the job, by factors ranging from odds ratio (OR) 0.21 (95% confidence interval [CI], 0.16-0.29) to OR 0.46 (95% CI, 0.34-0.61).

Conclusions

Given the complex and high stakes nature of emergency nursing care, leaders should place a high priority on organizational solutions targeting improved nurse staffing and work environments to advance better patient and clinician outcomes.

A scoping review of registered nurses' delegating care and support to unlicenced care and support workers

AIM

To scope the international literature about registered nurses delegated models of care to unlicenced workers, identify gaps and reflect upon how the evidence relates to nursing in multiple contexts.

DESIGN

Scoping review of the peer reviewed literature from the year 2000 onwards, using the PRISMA-ScR checklist.

METHODS

The study searched the following databases in February 2022: CINAHL, Medline, ProQuest, and SCOPUS, and included keywords, Boolean operators and subject headings relevant to registered nurses delegating the provision of care to unlicenced workers.

RESULTS

A total of 49 articles met the eligibility criteria for this study, and relevant data were extractedThree models of delegation were highlighted within the literature: direct, indirect and a mixture of both. The data highlighted that direct delegation mainly occurred in acute contexts, with delegation decreasing with increasing patient acuity and/or complexity but the threshold of when this would occur was not clear. There was one intervention study that measured patient outcomes which could aid in the determination of what is effective delegation. For studies that did report on it (n = 6), there were few examples of better patient outcomes in cases where care was delegated from registered nurses to unlicenced workers.

CONCLUSIONS

The scoping review highlighted heterogeneity in practice areas and methods of delegation practice. A key gap in literature is the absence of studies focusing on patient outcomes, with a clear baseline to measure and identify effective delegation practices. Additionally, the legal and logistical implications presented in both direct and indirect delegation practices is not evident in the literature.

IMPLICATIONS FOR THE PROFESSION

Decisions related to delegation are often made at the service level and prescribed to those who work within the service, suggesting that models of indirect delegation are in fact not delegation at all, rather a re-distribution of nurses' work.

RELEVANCE TO CLINICAL PRACTICE

Delegation is a vital component of the scope of practice of registered nurses. This review has highlighted unique differences in delegation by practice context, where the proliferation of unlicensed workers in certain contexts places a vastly different professional and legal burden on the registered nurse.

Priority Nursing Populations for Mental Health Support Before and During COVID-19: A Survey Study of Individual and Workplace Characteristics

BACKGROUND

Nursing is a high-risk profession and nurses' exposure to workplace risk factors such as heavy workloads and inadequate staffing is well documented. The COVID-19 pandemic has exacerbated nurses' exposure to workplace risk factors, further deteriorating their mental health. Therefore, it is both timely and important to determine nursing groups in greatest need of mental health interventions and supports.

PURPOSE

The purpose of this study is to provide a granular examination of the differences in nurse mental health across nurse demographic and workplace characteristics before and after COVID-19 was declared a pandemic.

METHODS

This secondary analysis used survey data from two cross-sectional studies with samples (Time 1 study, 5,512 nurses; Time 2, 4,523) recruited from the nursing membership (∼48,000) of the British Columbia nurses' union. Data was analyzed at each timepoint using descriptive statistics and ordinal logistic regression.

RESULTS

Several demographic and workplace characteristics were found to predict significant differences in the number of positive screenings on measures of poor mental health. Most importantly, in both survey times younger age was a strong predictor of worse mental health, as was full-time employment. Nurse workplace health authority was also a significant predictor of worse mental health.

CONCLUSIONS

Structural and psychological strategies must be in place, proactively and preventively, to buffer nurses against workplace challenges that are likely to increase during the COVID-19 crisis.

Focusing on fundamentals of care in an ICU setting during a pandemic

AIMS

This manuscript aims to describe one acute care hospital's ICU journey during the COVID-19 pandemic and how fundamental care was central to the implementation of team-based models of care.

BACKGROUND

Over the course of the COVID-19 pandemic, team-based and alternative models of care are being employed to manage and address global shortages and surge capacity. Employing these alternate models of care required attention to ensure fundamental care needs of patients were being met.

DESIGN/METHOD

The following paper describes an ICU's journey of focusing on the delivery of the fundamentals of care through the implementation of team-based models of care to address the surge in patient care demands experienced in response to our global pandemic.

CONCLUSIONS

The implementation of an evidence-informed approach to optimizing models of care and staffing in the ICU amid the evolving COVID-19 waves in one acute-care hospital is provided. This local approach focused on meeting patients' fundamental care needs throughout the necessary introduction of team-based care models and staffing changes and drew from evolving evidence, the ILC Fundamentals of Care Framework, and regulatory guidance.

Nurses' Work Methods Assessment Scale: a study of content validation

OBJECTIVE

To develop and validate the content of the Nurses' Work Methods Assessment Scale.

METHODS

Methodological study conducted between January and February 2022, based on the Quality Standards for Nursing Care and Imogene King's framework. A literature review was previously undertaken to design the scale. The content validation was carried out by 23 experts.

RESULTS

The initial version consisted of 40 items organized in four work methods identified in the literature. In the first dimension, from ten items, seven were considered, and one was reformulated. Seven of the initial ten items were considered in the second version. The third dimension consisted of seven items. In the fourth dimension, three items were reformulated, and three were excluded, leaving seven items. The final version ended with 28 items, whose Content Validity Index ranged between 0.83 and 1.

CONCLUSIONS

The involvement of experts has become pivotal in the development and validation of the items, providing confidence to the continuity of psychometric procedures.

A Fresh Look at the Nursing Home Workforce Crisis: Transforming Nursing Care Delivery Models

The current State of the Science Commentary focuses on workforce challenges in the nursing home (NH) setting that lie within the purview of professional nursing-what professional nurses can do to promote high-quality person-centered care within a context of existing resources-individually and broadly across the collective profession. Historically, three models of care delivery have characterized the way in which nursing care is organized and delivered in different settings: primary nursing, functional nursing, and team nursing. Based on the existing evidence, we call for scientific leadership in the redesign, testing, and implementation of a nursing care delivery model that operationalizes relationship-centered team nursing. This integrative model incorporates successful evidence-based approaches that have the potential to improve quality of care, resident quality of life, and staff quality of work life: clear communication, staff empowerment, coaching styles of supervision, and family/care partner involvement in care processes. In addition to the needed evidence base for NH care delivery models, it is imperative that educational programs incorporate content and clinical experiences that will enable the future nursing workforce to fill the leadership gap in NH care delivery. [Research in Gerontological Nursing, 16(1), 5-13.].

Escala de avaliação dos métodos de trabalho dos enfermeiros: um estudo de validação de conteúdo

RESUMO Objetivo: Construir e validar o conteúdo da Escala de Avaliação dos Métodos de Trabalho dos Enfermeiros. Métodos: Estudo metodológico realizado entre janeiro e fevereiro de 2022, baseado nos Padrões de Qualidade dos Cuidados de Enfermagem e no referencial de Imogene King. Para construção da Escala, realizou-se previamente revisão de literatura. A validação de conteúdo contou com 23 peritos. Resultados: A versão inicial continha 40 itens, organizados nos quatro métodos de trabalho identificados na literatura. Na primeira dimensão, dos dez itens, foram considerados sete e um foi reformulado. Na segunda, dos dez iniciais, foram considerados sete. A terceira dimensão constituiu-se por sete itens. Na quarta dimensão, reformularam-se três e excluíram-se três, ficando sete. A versão final ficou com 28 itens, cujo Índice de Validade de Conteúdo oscilou entre 0,83 e 1. Conclusões: Recorrer aos peritos tornou-se fundamental na construção e validação dos itens, conferindo segurança à continuidade dos procedimentos psicométricos.

Nurse scheduling in COVID-19-designated hospitals in China: A nationwide cross-sectional survey

AIM

This study aimed to investigate scheduling in COVID-19-designated hospitals, including working hours, rest days, adverse nursing outcomes and their relationship.

BACKGROUND

Hospitals are at the forefront of COVID-19 prevention and control, and nurses are the main force on the frontline of the epidemic. Nursing shift is one of the most relevant and pressing issues for frontline nurses. However, there is a lack of national, large-sample surveys on scheduling and adverse nursing outcomes in COVID-19-designated hospitals.

METHODS

Using a cross-sectional online survey, we used nurse-reported data to measure the characteristics of the work setting, samples and work schedule. A descriptive analysis was performed to assess the shift status and adverse outcomes of designated hospitals and frontline nurses. Logistic regression analysis was performed to determine the association between them.

RESULTS

Basic data were collected from 217 departments of 69 COVID-19-designated hospitals in 31 provinces in China. Nurses in the severe isolation ward worked mainly for 4 h per shift, whereas those in the fever clinic and observation ward worked mainly for 6-8 h. Half of the nurses had only 1 day of rest per week. Long working hours, lack of adequate rest time and overtime can seriously affect the quality and safety of nurses' work, resulting in adverse outcomes. Frontline nurses hope that scheduling guarantees the time to rest while ensuring fairness.

CONCLUSIONS

The current evidence showed that frontline nurses were faced with long working hours, insufficient rest and overtime, which has a negative impact on nurse satisfaction, physical and mental health and quality of care. The government, hospitals and administrators still face many problems to overcome in their nursing schedules.

IMPLICATIONS FOR NURSING MANAGEMENT

Governments and hospitals should take these factors, such as the work setting characteristics and demographic features of the frontline nurses, into account when selecting nurses to fight COVID-19. Nurses have different working hours in different types of coronavirus unit; therefore, nursing managers should consider the working environment and nursing schedule needs, and in the future, we should pay attention to the fairness of nurses while ensuring their rest.

Implementing mixed nursing care teams in intensive care units during COVID-19: A rapid qualitative descriptive study

Aims

The goal of this study was to gain insight into the views and experiences of an intensive care team working in a new nursing‐care delivery model during the COVID‐19 waves. A new model of care was implemented to augment nursing capacity and provide sufficient intensive care beds.

Design

A qualitative monocentric study using rapid qualitative descriptive methods was reported in line with the COREQ checklist.

Methods

Nurse, ward manager and physician participants were purposively recruited between January and March 2021 in a tertiary university‐affiliated hospital in the Flemish‐speaking part of Belgium. Semistructured interviews were conducted and analysed using thematic analysis methods.

Results

The participants were seventeen expert nurses, twelve supporting nurses, seven ward managers and four physicians. A central theme of ensuring safe, high‐quality care emerged from the findings. There was a sense of losing one's grip on clinical practice when working in the mixed nursing‐care teams. Different underlying experiences played a part in this sense of losing control: dealing with unknown elements, experiencing role ambiguity, struggling with responsibility and the absence of trust. Several coping mechanisms were developed by the nursing‐care team to deal with those experiences, including attempts to create stability, to strike a balance between delegating and educating, to build in control and to communicate openly.

Conclusion

In this rapid qualitative descriptive study, the implementation of a new nursing‐care delivery model during a pandemic was seen to lead to several challenges for all members of the care team. Coping mechanisms were developed by the team to deal with these experienced challenges.

Impact

When rethinking nursing‐care delivery models, the findings of this study may help guide the process of implementing mixed nursing‐care teams. Special attention needs to be paid to clarifying roles, sharing responsibility and clinical leadership. Other significant influences (such as moral distress) should also be taken into account.

Rapid Deployment of Team Nursing During a Pandemic: Implementation Strategies and Lessons Learned

BACKGROUND

The COVID-19 pandemic increased the number of patients requiring intensive care nationwide, leading to nurse staffing shortages in many units.

LOCAL PROBLEM

At the beginning of the statewide COVID-19 surge, a tertiary teaching hospital in the upper Midwest experienced a sharp increase in patients needing intensive care. To relieve the resulting staffing shortage, it implemented a pilot program to bring general care nurses into its 21-bed mixed specialty intensive care unit to free intensive care unit nurses to help staff the hospital's COVID-designated units.

METHODS

Using a team nursing model, the intensive care unit recruited, oriented, and incorporated 13 general care nurses within 4 days. Education and resources were developed to distinguish team nurses from intensive care unit nurses, introduce them to the intensive care unit environment, outline expectations, communicate between team nursing pairs, and guide charge nurses in making staffing decisions and assignments. Staff feedback identified additional resources, barriers, and successes. An adaptive process was used to improve and update tools and resources on the basis of staff needs.

RESULTS

The pilot program ran for 6 weeks. Positive outcomes included a reduced need for float nurses and self-perceived reduction in nursing workload. The principal barrier was charge nurses' challenges involving staffing-to-workload balance based on the existing staffing model. This model identified productivity of a general care nurse and an intensive care unit nurse as equivalent, despite differences in their skill sets.

CONCLUSION

Team nursing in the intensive care unit is an agile tactic easily replicated in dire staffing situations.

Is It Time to Call 'Code Blue' on Nursing Infrastructure? A Nurse's Perspective from the COVID-19 Front-line

The COVID-19 pandemic has highlighted the significance of every role within the interdisciplinary team and has exacerbated the challenges posed to every member. From the nursing perspective, many of these challenges were present before the pandemic but have become significantly larger problems that continue to demand global attention. This has provided an opportunity to critically evaluate and learn from the challenges the pandemic has both highlighted and created. We conclude that the nursing infrastructure requires a revolution in order to support, grow and retain nurses, who are vital to the delivery of high-quality healthcare.