HealthJune 06, 2022

Team nursing: New strategies for nursing orientation

By: Katie Manoy, MSN, RN, CPNP
Team nursing is back! Many facilities have moved away from a primary nursing model and into a team nursing approach in response to the staffing challenges presented during the COVID-19 pandemic.

Team nursing models focus on assigning nursing staff to a team to provide care for a shared group of patients. Each member of the team performs specific duties appropriate to their role to provide total patient care. Teams may include licensed practical nurses (LPNs) and unlicensed assistive personnel (UAP) that are supervised by a registered nurse (RN). Less experienced, or non-critical care RNs, may be assigned to a team in a critical care unit led by an experienced critical care RN.

Each team member plays a vital role. UAP staff often provide personal care, measure vital signs, distribute meal trays, and perform other duties. LPNs administer medications, perform technical tasks such as urinary catheter insertion, and assist the UAP or RN, as needed. The RN functions as the team leader, completes assessments, coordinates the plan of care, and in many cases also orients new graduate nurses.

Where does the new graduate nurse fit?

Numerous new graduate nurses are entering the workforce at this critical time in healthcare history. In many instances, they lack essential skills to take on full assignments of their own or function as a team leader. Their final clinical rotations may have been limited due to restrictions placed upon nursing schools during the pandemic. The amount of actual patient contact they experienced may have been minimal, and they may have only had a few opportunities to perform essential nursing skills on real life patients.

In some cases, simulation or virtual reality may have been substituted for in person clinical experiences. Therefore, even after the completion of standard orientation programs, many new graduate nurses are struggling with performing assessments, prioritizing care utilizing critical thinking, and performing essential nursing skills like urinary catheter insertion or safe medication administration.

Benefits of team strategies for nursing orientation

Given the challenges faced by new graduate nurses and the increase in utilization of team nursing models, innovative ideas are needed to facilitate effective nursing orientation programs. Exclusively pairing the inexperienced, new graduate RN solely with another RN may lead to feelings of failure and frustration for both the preceptor and the orientee.

Conversely, developing team strategies for orientation may lead to achieving competency in the new graduate nurse at a faster pace, with less burnout and work fatigue experienced by all participants. Using the knowledge and skills of the LPN and UAP to facilitate the new graduate’s transition to practice, can lead to increased success by allowing the new RN the opportunity to practice and refine essential skills that weren’t solidified in nursing school.

Orientation can be tailored to the needs of each orientee, and if needed, the new graduate RN can be paired with other team members, such as an LPN or a nursing assistant, to practice and refine their nursing skills at each level. With a team orientation model, new graduate nurses can experience success at each stage of orientation. Spending time with each team member can help to develop relationships and foster an overall team approach to achieve positive morale on the unit.

If your unit or floor is experiencing increased turnover, ineffective nursing orientation, or other challenges, it may be time to consider revamping the way new graduate nurses are trained and the team members that are used for this process.

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Katie Manoy, MSN, RN, CPNP
Clinical Editor, Lippincott Solutions, Wolters Kluwer Health
Katie is a nurse with 17 years of pediatric nursing experience, including 10 years of pediatric intensive care experience, and five years in nursing education. She develops and edits clinical content for Lippincott Procedures.
  1. https://journals.lww.com/nursing/Fulltext/2017/10000/Team_nursing__A_collaborative_approach_improves.6.aspx#:~:text=Team%20nursing%20is%20defined%20as,and%20supplement%20to%20patient%20care.
  2. https://aacnjournals.org/ccnonline/article/doi/10.4037/ccn2022399/31710/Rapid-Deployment-of-Team-Nursing-During-a-Pandemic
  3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8450812/
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