Team model shaken, showered, shifted & survived

1 May 2014

There are probably fewer more challenging tests of teamwork than a 6.3 magnitude earthquake turning your ward into an indoor waterfall, followed by having to evacuate patients on mattresses down a sodden stairwell in ongoing aftershocks.

Donna Galloway took up the post of charge nurse manager of the then-Ward 30 in the fourth floor of Christchurch Hospital’s Riverside building in 2010. The team model – initially called the practice partnership model – was introduced across the medical cluster of wards soon after and was just bedding in prior to Feb 22 turning the ward literally into a disaster zone.

For Galloway, it was not so much the initial post-quake days that was a test of her nurses and the new model, but the years to follow.

“I think people forget what some of these nurses have been through.”

The ward staff were initially dispersed for three months across the hospital before setting up a new temporary, medical ward across town in Princess Margaret Hospital in mid-2011, and then finally returning to their old building Riverside – third floor this time – in September last year.

It was the shift to Princess Margaret where the new team model with its enhanced communication – both verbal and visual – truly came into its own, says Galloway. “It was a saviour.”

Along with the physical shift the ward staff had to shift its mode of working to include taking GP admissions straight from the community.

“So the fact that we had good communication skills and good team work set us up in good stead for that, I believe,” says Galloway.

The model also drew on releasing time to care initiatives like the patient status white board and wearing medication jackets during drug rounds to stop nurses being interrupted by doctors or others while holding a kidney dish of morphine.

It also has meant a structured role for hospital aides in the team who – though not at present expected to have any set qualifications – can be allocated to tasks like showering patients at the discretion of the team leader.

Galloway is aware that some nurses are reluctant and concerned about giving up showering to unregulated staff, fearing that HCAs or aides might not pick up skin or other issues.

“That’s funny because I find hospital aides pick up more things than some of the nurses sometimes,” says Galloway.

“Because the nurses are so busy that if a hospital aide is taking a patient to the shower, or washing them, they report directly back to the RN. And they say ‘I washed Mr So-and-So and his sacrum is very red’. They are very, very good at reporting things – trust me – they certainly don’t let things slip by.

“The hospital aides really like it (team nursing) as they are part of a team, they are communicated with, they feel supported … and as long as everybody is communicating, everybody seems to be happy.” ✚

Christchurch Hospital Ward 27: Team nursing model of care

  • General medical ward.
  • Charge nurse manager
  • Donna Galloway.
  • 30-bed ward with five beds to a room and some single side rooms.
  • Two teams (‘wine’ and ‘cheese’).
  • Each team = 3 nurses and 1 hospital aide (one RN is designated team leader).
  • Plus senior RN co-coordinator working across the ward floor.
  • Ward chose approximate patient load of five patients per RN (i.e. one nurse to a room) rather than four patients so it could have RN coordinator.
  • Bedside handover between morning and afternoon shift with all team (including HCA) present.
  • Other nursing support includes CNS and nurse educator working across medical wards plus across hospital specialist nursing services and other services including ‘transfer of care’ nurse and resource nurse and services bridging the gap between hospital, community, and home-based care like Acute Demand and Crest.