Read Part V of Institutional changes in hospital nursing
Team nursing was also inefficient because much of the RNs’ time was spent managing members of the team. This quasi-management role was problematic for several reasons. First, the use of RNs as managers of the team had effectively moved the most highly skilled nursing personnel out of direct patient care. Additionally, it led to widespread job dissatisfaction of RNs. This job dissatisfaction arose from the fact that under team nursing, RNs spent the majority of their time organizing and managing the team and documenting the team’s work.
Additionally, RNs who were members and managers of the team had limited authority in determining the direction of patient care, which was left to the discretion of the head nurse. Widespread job dissatisfaction led to greater turnover among RNs. One coordinator of nursing services discussed the relationship between dissatisfaction and turnover in the following manner.
Nurses are becoming disenchanted and are leaving the nursing profession because they are not being allowed to practice as professional nurses in the hospital setting . . . To check this exodus from our profession, a modality of care which encourages creativity, innovation, and self-satisfaction in the professional practice of nursing must be developed.
Employers in the hospital industry responded to these growing signs of job dissatisfaction and turnover of RNs because it was in their interest to minimize attrition. RNs were integral to the delivery of nursing services. Moreover, the absence of attenuated job ladders offering promotional opportunities, coupled with the fact that wages did not increase significantly with tenure on the job, meant that hospitals had to rely on other incentives, such as job satisfaction, to induce RNs to continue to work.
While the nursing literature contains numerous anecdotal references to increased job satisfaction associated with the implementation of primary care nursing, studies that are more quantitative in nature have also addressed this issue. In particular, Patricia A. Prescott studied the relationship between nursing turnover and primary care nursing using data from the early 1980s.
She concluded that “the use of team or functional rather than primary nursing is associated with high vacancy and high turnover . . . . “Hospital management was amenable to the reorganization of nursing services in the form of primary care nursing because it offered the possibility of eliminating this inefficiency.(6)
The move to primary care nursing also moved RNs back into bedside care and increased their stability as hospital employees by creating the environment where professionalism became a workplace reality. Professionalism was promoted in training and embodied in the move to primary care nursing. It emphasized autonomy, accountability, and the meeting of patient needs as the appropriate goals for the RN. Gwen Marram sums up this philosophy:
Continue reading Part VII of Institutional changes in hospital nursing
