b. Basic to team nursing are the team conference, nursing care plan, and
(1) The conference is led by the team leader, and all personnel assigned to
the team should be included. The team leader should discuss the needs of the patients,
establish goals, individualize the plan of care for each patient, instruct the team
members, and follow up on all directions previously given to the team.
(2) The nursing care plan is a written guide that organizes information about
a patient's health. It focuses on the actions that must be taken to address the patient's
identified nursing diagnoses and meet the stated goals. It provides for continuity of care
by a constantly changing nursing staff. The team leader starts the care plan as soon as
the patient is admitted to the medical treatment facility. In response to changes in the
patient's condition, and evaluation of goal achievement, the nursing care plan is
updated and revised throughout the patient's hospital stay.
(3) Three leadership styles have been described: autocratic, democratic,
and laissez-faire. The three are sometimes blended to fit the situation, the needs of the
team leader, and/or the needs of the nursing team.
(a) Autocratic leadership. The leader determines policies and gives
orders and directions to the members. Autocratic leadership often makes team
members dissatisfied. It may be a necessary style when urgent decision-making is
(b) Democratic leadership. The leader encourages team discussion
and decision-making. This supportive style increases team productivity and
satisfaction. Democratic leadership has positive connotations but requires time for
discussion. It may not always be the most effective method when team members lack
the skills to make decisions or when urgent decision-making is required.
(c) Laissez-faire leadership. The leader participates minimally and
acts as a resource person and consultant at the request of the team members. Laissez-
faire leadership is described as a "hands-off" approach. It is most effective after the
team has made a decision, is committed to that decision, and has the expertise to
FACTORS AFFECTING TEAM PRODUCTIVITY
a. Productivity implies effectiveness and efficiency in individual and group
performance. To be effective, the objectives must be achieved. To be efficient, the
objectives must be achieved with the least amount of resources. Productivity implies
measurement. Productivity involves the relative use of skills and the relative use of
knowledge. Measurement of skills work is easy, but it becomes more difficult to measure
knowledge work. The 91B10 may take and record vital signs of 20 patients in one hour.
The team leader may use eight hours completing next month's schedule, while directing