Nursing teams caring for hospitalised older adults.

AIMS AND OBJECTIVES: To offer an explanation of how registered nurses' are providing care to hospitalised older adults in nursing teams comprised of a variety of roles and educational levels.

BACKGROUND: Around the globe economic pressures, nursing shortages and increased patient acuity have resulted in tasks being shifted to healthcare workers with less education and fewer qualifications than registered nurses. In acute care hospitals, this often means reducing the number of registered nurses and adding licensed practical nurses and care aides (also referred to as unregulated healthcare workers) to the nursing care team. The implications of these changes are not well understood especially in the context of hospitalised older adults, who are complex and the most common care recipients.

DESIGN: Thematic analysis of data that were collected in a previous grounded theory study to provide an opportunity in-depth analysis of how nurses provided care to hospitalised older adults within nursing teams.

METHODS: Data collected in western Canada on two hospital units in two different health authorities were analysed in relation to how nursing teams provide care. Hand coding and thematic analysis were employed.

RESULTS: The themes of scrutinised skill mix and working together highlighted how the established nursing value of reciprocity is challenging to enact in teams with a variety of scopes of practice. The value of reciprocity both aided and hindered the nursing team in engaging in team behaviours to effectively manage patient care.

CONCLUSION: Educators and leaders could assist the nursing care team in re-thinking how they engage in teamwork by providing education about roles and communication techniques to support teams and ultimately improve nursing care.

RELEVANCE TO CLINICAL PRACTICE: The value of reciprocity within nursing teams needs to be re-examined within the context of team members with varying abilities to reciprocate in kind.