Team nursing has been around since 1953, and on Monday, November 26, 2007, the model was instituted at the John F. Andrews Family Care Center (FCC) for the nursing staff, physicians and patients.

The Team Nursing model marks the dawning of a brand new day in addressing the needs of the patients and the staff. Traditionally at the FCC, each physician was assigned one nurse. In time, this nurse would know all of her physician's patients and a bond would be created with them. Each nurse was able to interpret the doctor's writing, answer questions, and handle prescriptions and refills.

Under the Team Nursing model, the nurses care for all the FCC's patients, they are not exclusively the nurse for Dr. Barker or Dr. Benoit. As a patient comes in to be seen, each nurse, in turn, cares for them prior to seeing the physician.

Why the change? Practice Manager and Registered Nurse, Jen Barron and Clinical Coordinator and Registered Nurse Tom Beard see it as the means to providing the best quality care where patient needs are met.

In addition to the "un-assignment" of nurses to specific doctors, one nurse will be designated the information resource. She

answers patient questions, listens to concerns, and handles all of the prescriptions and refills.

"We want to make sure the patients are contacted in a timely fashion, that they are followed up with, and receive, the appropriate answers to questions they have," Barron said. "Having one person specifically for these tasks will facilitate this."

The other nurses need only concern themselves with taking care of the patients that are coming in - regardless of which doctor the patient is scheduled to see.

"This way we will come to know all the patients because today the nurses who were the medical assistants are beginning to meet the patients of all the doctors in that day," Beard said. "We are a family taking care of family."

The familiarity this situation will create will have a positive impact on the continuity of care patients receive.

For example, under the former "one doc - one nurse" model, if the nurse was out on vacation or ill, or both the doc and nurse were out, a patient may call in because they need to speak with that nurse about an ongoing condition, or some other reason, but, the staff on duty is not familiar with the caller and/or her situation.

As the nurses become familiar with more of the patient population, that Barron estimates to be 5,000, the better prepared they will be to address patient needs.

This continuity of care will be further strengthened when the FCC begins using EMR, electronic medical records, instead of charts. EMR, combined with the information nurse, will facilitate quick patient response.

Many medical offices throughout the state have already adopted EMR, the FCC will have desktop PCs in the exam rooms, where all patient records are kept; all information from each visit is in that patients EMR file.

When all records are kept in an EMR system, a nurse would only have to type in the patient's name to bring up their record and assist that patient immediately.

In the past a nurse was responsible for her doctor's patients, handle all script refills, triage, all prior authorizations for medications and calls from patients concerning long-term care or ongoing care.

"There are not enough hours in the day," said Barron.

"Now the nurses on the floor will able to completely focus on the patients they are seeing, take care of a need a physician may have; they can give focused care," said Barron.

"This model really helps nurses feel like they are giving that time and attention to the patient - without the worry about 12 other things they need to do because the "information/nurse in the box" is handling those other tasks," Barron said.

Although patients will not always have the nurse they are most familiar with caring for them during a visit, patients will still be seeing the doctor of their choice.

But, during those times when patients become ill when their doc is out, these patients will be encouraged to come in and see another doctor if they have something that should probably not wait until their doctor returns, such as strep throat or intense ear pain and the like.

Barron and Beard also stressed that a patient with an ongoing medical situation that has been speaking with their doctor's nurse long term should not feel as though they will not be allowed to do so now.

Both Barron and Beard are acutely aware of the life of an R.N. and have worked together at other medical facilities - including one where they implemented the Team Nursing model.

They have observed the closeness of the community with the hospital and the family care center that exists on a far different scale in a larger community.

So, how do nurses feel about the change? Doris Burnham has been a nurse at the FCC for "forever" according to Barron.

Burnham says that when they move into the new facility they will have to deal with many changes such as the physical plant, computerized prescriptions and computerized records - and that learning this method now is for the best - in the long run.

"We are just in our second week, but we are getting a better understanding of the method that we are told will save time," said Burnham.

"I have already noticed that team nursing does allow more time for the task at hand," Burnham said. "We all want the best care for our patients in the quickest manner."

Burnham said that after these first two weeks the nurses, Barron and Beard are meeting to discuss what was going well, where the kinks were and how everyone feels about the progress.

She cites one of the reasons the nurses are open to this method is because both Barron and Beard are R.N.'s as well as administrators.

"They know what it is like to be out on the floor, and Jen (Barron) is very approachable and encourages critiquing of the new system," Burnham said.

"We certainly understand, after being on the floor here ourselves, how stressed out our nurses can be," acknowledged Barron. "We feel it is a better concept that will work better with an EMR system."

"It's about best practices; what is best practices to bring quality, patient satisfaction and efficiency," Barron said. "Larger practices, like this one, benefit from this model."