3 women in masks
“Providing quality care, in times when it seems almost impossible, requires a team effort,” says registered nurse Myla Santos, pictured here in the middle with physiotherapist Meghan Marcil, (L), and occupational therapist Amy Cockburn. Together with registered practical nurse Lani Denila, the colleagues participated in a team-nursing dry-run. (Photo: UHN)

When four colleagues on Toronto Rehab's Specialized Dementia Unit (SDU) participated in a mock team-nursing exercise, it allowed them to flex skills, gain a greater appreciation of other roles, and feel ready for a real-life scenario.

They recognized the uncertainty of the impact of COVID-19 could lead to unprecedented patient surges and staff shortages requiring an immediate pivot to a team-nursing approach.

Knowing they'd have little time to prepare in a real-life scenario, registered nurse Myla Santos, registered practical nurse Lani Denila, physiotherapist (PT) Meghan Marcil, and occupational therapist Amy Cockburn organized a dry-run.

"Providing quality care, in times when it seems almost impossible, requires a team effort," says Myla.

"We wanted to make sure our colleagues had the confidence they'd need to step into our shoes, if the situation required it."

'There are concentrated times of the day where everyone needs something at the same time'

In a team-nursing scenario, Allied Health professionals are redeployed to provide basic care, such as dressing, feeding, toileting, and ensuring a patient's comfort. That frees nurses up to focus on more complex tasks, such as medication administration, wound care, reviewing lab values, and entering vitals into the electronic patient record.

"I've worked on the unit for many years, so I didn't expect to feel so fresh that first morning," Meghan recalls. "It was similar to how some of our students must feel, when joining a new clinical environment."

That's because there's nothing basic about basic care. It requires efficiency, responsiveness on your feet, and the ability to stay organized, despite being pulled in different directions.

From coordinating tray deliveries around medication schedules, to ensuring they always had the right supplies on hand when giving bed baths, by mid-morning, Meghan and Amy determined they'd work a lot better by caring together for their combined 10 patients.  

"There are concentrated times of the day where everyone needs something at the same time," says Meghan. "We realized it would be a lot more efficient, and safer for patients, if we teamed up to share these responsibilities."

Another surprise was the physicality of the role, says Meghan, a PT who is used to being on her feet.

"The amount of running around I did on the unit, from patient rooms, to supply closets, to care stations, probably tripled my daily steps," she laughs.

'Two-way communication is essential to feeling comfortable and being useful'

While the dry-run served to increase confidence, it also reinforced the importance of teamwork.

"When staff are stepping out of their usual roles, two-way communication is essential to feeling comfortable and being useful," says Meghan.

"The way we kept talking to one-another, knowing we could speak up when we needed help, and stepping in when someone asked for it, is what made this exercise work."

Myla agrees, adding that, most of the time, her Allied Health colleagues already knew what to do, but just needed a little affirmation before doing it.

"We know each other and we trust each other," Myla says. "Even without a practice, Meghan and Amy would have done great.

"They already know the patients, and have a good sense of what patients need and how our unit operates."

A more personal take-away for Meghan has been the ability to apply to transfer some of her experience to her PT role.

"I was already trying to do more functional assessments – seeing how long a patient can stand, lift their arm, or bring their leg up – using everyday activities on the unit," she says. "But now I feel even more confident moving away from a standardized PT assessment, and gathering that information while helping with dressing or toileting."

It's also renewed her appreciation for her nursing colleagues.

"When we talk about going over-capacity, or being short-staffed, I used to think, 'yes, I can see how it be challenging to take on extra patients,'" she says. "But when you think about it on a per-hour basis, it becomes increasingly challenging to stay organized and on time.

"I already held my colleagues in high regard, but it reinforced to me that they're the ones here 24/7, keeping everything covered. The rest of us are critical to the team as well, but nursing really is the backbone of the healthcare system, and it can't function without them."

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