Crew resource management (CRM) is about managing resources effectively, so it makes complete sense that when task load is high, as it is on most patient care units, the work should be strategically divided among the team. Dividing up the workload ensures two things: 1) Individuals are not placed at greater risk for low SA due to task saturation and depletion of the attention resource, and 2) everyone on the team is not focused on the same thing (attention narrowing).
This is the premise from which I strongly advocate a team approach to nursing care. By this I specifically mean that more than one staff member is assigned to the care of a patient, and each staff member is responsible for different tasks. This, in my view, is preferable to primary nursing which, for the sake of this discussion, means a model of care where on licensed nurse carries out all aspects of the patient’s care on the unit: custodial care, medications, care planning, treatments, assessments, and communicating with physician providers. Primary care has its merits and is appropriate in certain conditions, but one must consider the fact that on many medical-surgical units, nurse-patient ratios are simply not conducive to sustaining this type of model. Without getting into extended discussion about nurse staffing ratios, I will asset that when human resources are challenged within a primary care model, the natural limits of our cognitive resources are easily exceeded. The result is low SA and the potential for poor decisions, increasing the risk for poor patient outcomes. Dividing the task load can take many forms such as designating a specific nurse(s) to:
- Administer medications
- Admit patients
- Discharge patients
- Review orders, complete assessment, and communicate with physicians
- Accomplish all IV site, tubing, and dressing changes (often overlooked)
- Perform treatments
- Obtain scheduled blood glucose measurements and administer insulin products
It is important to note that preserving the SA of each individual nurse on the unit is a precursor to the development of heightened overall team SA.
Gary L. Sculli, RN, MSN, ATP
David M. Sine, MA, CSP, ARM, CPHRM