Team: What’s Your Definition?

Writing a job description was not exactly what I imagined myself to be doing in the first week of a clinical immersion. (To many, this might not sound too interesting or even relevant to clinical as a nursing student.) However, it proved to be an extremely valuable experience and inspired a new thought process on defining roles among health care staff.

The task for the meeting was to draft a clear description and distinction for both the nurse and medical assistant. It turned into 2.5 hours of constructive debate about how to word the already understood roles so that they would be concise, clear, and representative of the values of the medical home – a team-based health care delivery model.

What stuck with me the most from participating in the composition of the job descriptions was the meaning of the word “team.” In the medical home model, an interdisciplinary team approach is critical. (In fact, there is even a position for a Team Coordinator.) During the meeting, we were contemplating changing the name of the job title of a Registered Nurse to Team Nurse and from Medical Assistant to Medical Team Assistant. What would be the implications of renaming the role? What does the word “team” really mean?

As I am sure many of you are familiar with, the word “team” is used endlessly in coursework. My field of study, clinical nurse leader, in fact, represents and advocates the importance of an interdisciplinary team. But does everyone think of the word in the same way? This idea was discussed and will be revisited in an upcoming meeting. In the meantime, I asked around at the center, inquired with fellow peers, family, and friends to compile a mix of perspectives on how to define the word “team.” Here are some of the responses I received:

• “A group of individuals working cohesively in order to achieve a common goal”
• “A team is people who make each other better than they can be alone”
• “A group of people working together toward a common goal, sharing resources, skills, and responsibility”
• “A group of individuals working toward a common goal with various different perspectives and approaches to reach that goal”
• “A group of people working for a common purpose”
• “A group of peers working together”

Key words in these definitions were “together,” “achieve,” and “goal.” I was pleased to see how many people chose to use those exact words or something very similar. I think the members of this task force will agree the word “team” will be well received and a positive addition to the job title and description at the center.
I’d love to hear from some of you. What does the word “team” mean to you? Does your clinical site or past sites use the word “team” in everyday practice?

- Jessica Hatch, Clinical Nurse Leader Student, University of New Hampshire

Editor's Notes: Learn more about Jessica—and her clinical nurse leader role—in her interview from the 2011 IHI Open School Student Quality Leadership Academy.

From the Vineyard to the Bedside: A Clinical Nurse Leader's Journey

Clinical Nurse Leader is the first professional designation added to the American Nurses Association in the last 35 years. So, what is it?

In an effort to begin blogging about becoming a Clinical Nurse Leader (CNL), I should first share a tidbit about who I am. My name is Jessica Hatch. I am 24 years old, and I am not yet a CNL but on the progressive pathway toward this exciting designation.

Upon graduating from the University of New Hampshire - having obtained a B.S. in Nutritional Sciences with a minor in Healthcare Management and Policy - I dabbled for a number of years in viticulture and enology (aka grape growing and winemaking) in New England. Since the owner of the winery is a retired ER physician, his wife is a visiting nurse, and I was a student of nutrition, none of us had strayed too far from our respective health care fields. (What occurs in the wine cellar is biochemistry at its best; we had just extended our scientific knowledge into another interesting area of study.) As much as I enjoyed the wine world, I realized my true passion was to work with patients and that winemaking would instead become a hobby.

Nursing was always in the back of my mind, but I had never committed to the idea. Then I came across the Direct Entry Masters Program at UNH, which allows students of all undergraduate fields to become a Registered Nurse, and earn their CNL certification, in just two (very accelerated) years. The role was new to me, having only heard of it from an acquaintance studying in the program. But as I learned about the program, it was clear I could finally combine many aspects of my diverse educational background while growing into a prominent and needed leadership position as a nurse.

The hope is that, collectively, CNLs can guide all other professions to alter the path our stubborn healthcare system continues to follow. The role of the CNL is not to put innovative ideas that have never been considered into play, but instead to place a higher value on the key patient-care components that are often overlooked. A re-evaluation of pre-existing ideas that date back to Florence Nightingale and assigning more appropriate value to these ideas is a reoccurring theme throughout the literature that demands one thing: viewing the patient as a whole.

This will be accomplished through a redesigning of the system, incorporating the expertise of all disciplines to form a strong collaborative team that the CNL will guide. From pharmacists to school systems, social workers to surgeons, the CNL will empower all members of the team to transfer knowledge, constructively debate, collectively plan, and deliver care representative of the patient's values and goals. The hope is that ideal patient care is delivered.

It is important to note that the CNL works with other nurses, including Clinical Nurse Specialists, reports to the same nurse manager, involves all other disciplines to coordinate care, but at the same time, takes a leadership role.

This is what sets the CNL apart.

Through a strategically designed education and practice curriculum, the CNL is well prepared upon graduation to assume this role. (I believe a few years of work experience are also necessary.) Other staff members have been spread so thin that the CNL will be able to oversee direct patient-care, which should be the main concern. Still, the CNL will be sure to delegate appropriately and distribute equal loads across the partnership so there truly is a team effort in working with the patient. This is key to the success of the CNL, as it is clear other disciplines have become worn out due to overload. Furthermore, the CNL will reduce fragmented care, which results in errors - system errors, not staff errors.

I hope my introduction was interesting and helpful. In future posts, I will begin to shed more light on the role of the Clinical Nurse Leader. Stories from students, examples of practicing CNLs, and much more is on the way.

In the meantime, feel free to share your comments and questions!

- Jessica Hatch, Nursing Student, University of New Hampshire