The Medical/Surgical Unit Team Nursing model is based on a nursing team of one RN, one LPN, and one CNA that manage the care of eight patients on a medical/surgical unit. Banner Estrella Medical Center (BEMC) clearly defines the roles of each team member and ensures that all team members and other health care professionals understand the delineation of the roles. The LPNs are required to have IV certification, and the scope of their practice duties adheres to the standards defined by the Arizona State Board of Nursing.

While the team model increases the size of each RN’s patient panel, the RNs are able to manage the increased load because s/he can delegate tasks to other members of her/his team. The model encourages teamwork and creates a safety net of having three individuals responsible for a patient. BEMC is developing a revised RN scope of practice policy to try and help maintain gains by the model.

Each member of the team has deep knowledge about the patients under her/his team’s care and can answer questions from other health care professionals or patients or be available for a consult. In addition, since the teams are assigned geographically, physicians and other clinicians can easily find the individuals who are taking care of their patients in a timely manner.

The Medical/Surgical Unit Team Nursing model is in place 24/7. For the night to day shift transition, the RN from the night reports out to the day team (RN, LPN, CNA), and then the night nurse does rounds with them.

New RNs can lead a team after they have completed their three-month orientation and when their preceptor says they are ready. Each new RN leading a team is assigned a peer nurse who is available for support and troubleshooting. In addition, the resource nurse serves as a valuable support for new RNs.

BEMC provides significant nurse resources for the care delivery model. Each shift has a Clinical Manager, a role that has been filled by an internal RN promotion. In addition, a SWAT nurse, house supervisor and advanced practice nurse are available as hospital-wide resources. Finally, a nursing director and three senior clinical managers provide additional support. The senior clinical managers round with each team about once a week to stay connected; they are able to give feedback to the teams and help them resolve any issues.

As a new hospital, Banner Estrella Medical Center had the benefit of beginning with an electronic medical record, and the hospital operates in a paperless environment. Everything is in the EMR in real-time. This eliminates depending on a physical chart or another caregiver for patient information. Before a caregiver sees a patient, s/he can pull up all the information they need. Also, BEMC uses Hillrom locators, so that the patient has rapid access to caregivers. BEMC also uses Voicera for specific staff to facilitate patient flow.

Rather than using traditional centralized nursing stations, BEMC provides decentralized alcoves between every two patient rooms where nurses complete computer documentation. Each alcove can accommodate two nurses or providers working on computers. In addition, each alcove has windows into each of the two patient rooms it is situated between, allowing patients to see their caregivers (for privacy, the windows have internal curtains that patients can draw).

By using the alcoves for documentation, nurses stay (physically and visibly) closer to their patients. This has virtually eliminated the use of patient call lights.

A core principle of the Medical/Surgical Team Nursing Model is to create a great experience for patients and their families. BEMC allows unlimited visiting hours and offers room service for patients. In each patient room, there is a couch that turns into a bed for visitors. Each room provides an outside view with large windows, patient-controlled light and temperature, and noise management technologies. The hospital also provides nice lounges with lockers and refrigerators.

The TVs in patient rooms run real-time surveys to allow the patient to provide feedback on things like room temperature, food, etc., and the results go immediately to the appropriate person so things can change.

In addition, BEMC hosts breakfast and dinner “town meetings” with patients and their families to get patient feedback.