Functional / Team Nursing

EMTPTORN · Feb 14, 2003

It looks like team nursing is still practiced, but is functional nursing still practiced? Where can it be used?

In most LTC facilities do they practice team nursing?

EMTPTORN · Feb 14, 2003

jax,

Do you mean that one experienced RN works with another inexperienced one on the team? Sorry to be slow... what/ who do your teams consist of, personnel wise...and if I understand corectly, on nights the team takes care of 10-11 patients, but on days since there is an extra RN is the ratio 5 patients? Five patients seems like a small amount to take care of for team nursing, from what I have read, I thought in primary nursing you often got five. anymore info is great, and thanks for your time!

jax · Feb 14, 2003

sorry I wasn't clearer. Where I work we are all RN's. On an am shift (8hrs) 2 RNs one generally experienced, one not work together to care for 10 or 11 patients - total patient care. Same goes for evening shift(8 hrs) and overnight(10 hrs) one RN cares for the same pt's. We have no auxillary nurses etc, the ward is large and is split into 5 areas, ie, there are 5 seperate teams. We have one RN in charge of the shift, who is responsible for staffing , assisting us in trouble shooting, and liases with managers re admissions , bed status etc.

I should also mention that I work in Australia, and

jax · Feb 14, 2003

my toddler just threw a sandal at the computer, and I got cut off - sorry. what I was going to say is that we call how we work team nursing, but it may be different to your definition of the same. jax

mattsmom81 · Feb 15, 2003

I trained in team nursing in the 70's and feel it works quite well if one has all the right 'ingredients'. Good solid staff who fully understand their responsibilities and limitations are essential. Good leadership is equally important.

Personally, I feel this is what RN's are trained to do...provide supervision for a team of health care providers. At least this was what I was trained for. Total patient care may be easier on the nurse (fewer patients ) but it is not really feasible ...financially or otherwise in today's shortage.

So...another 'old' idea is to be reinvented. :)

EMTPTORN · Feb 15, 2003

Jax,

My wife and I have kicked the idea around about working in New Zealand or Australia ( she is nurse already, I finish in August),

any pointers or advice? Is there a great need for nurses, does the American nursing education compare and prepare you to work in you country?

My wife is real serious about this prospect, and I am always up for something new.

EMTPTORN

RNanne · Feb 15, 2003

I trained under the old functional nursing model. There was a charge nurse, a medicine nurse and a treatment nurse. And an army of nurse's aides. (CNA's) The personal care of the patient was unsurpassed in those days, as the aides did all of that. One medication nurse passed meds to all the patients and that is all that she did. The treatment nurse did all of the treatments and IV's. The charge nurse made rounds with the MD, did all the calls, and charted. The only charting that the med and tx nurse did what the meds and the tx. It really wouldn't work very well today. In those days, the MD's did the assessments. The role of the nurse is not what it is today. I do think that a modified form of this model would work well, but unfortunately nurses do not perform well with it as they aren't trained to it. One needs to be able to lead and manage an auxillary staff. LTC functions better with this model. I have lived through functional to team to total patient care to primary care. We really never made it to true primary care though. Total pt. care, in my opinion does not work as well as it might. One nurse can not be all there is to one patient and it isolates the nurse from a "team". She is often left with no help or assistance with her patients. I bet we see some modified model of some of the "older" models come back with the shortage of nurses. Or maybe a brand new model. Who knows. If you want any specific info re: functional nursing, just ask away and I will try to answer from a first hand perspective. This model was present in the 50's and 60's. I liked it a lot as your job was well defined and manageable.

CherryRN · Feb 15, 2003

I wish my unit had team nursing. It sounds good.

I work in PICU. We do everything ourselves. We don't have an aide either. Well, we did, for a short time. She is out on leave. She wasn't very cooperative either. So, no loss.

It gets overwhelming doing everything. Especially for 12 hours. If I have a really sick child it is exhausting.

CherryRN

jax · Feb 16, 2003

EMTPTORN,

I'm not the best person to answer your queries, try posting on the australian discussion board - I'm sure you'll get helpful advice. Jax

OC_An Khe · Feb 16, 2003

Team and or funtional nursing has never worked well in intensive care units and even in the 60's I don't recall team/functional being utilized there.

To do either requires significant amount of well trained auxillary staff which doesn't exist in most hospitals any more.

Yes you did learn delegation and people skills in team and functional nursing but it came at the expense of hands on patient knowledge.

EMTPTORN · Feb 16, 2003

RNanne,

How many patients did a "functional group" take care of. If I understand it correctly, say you have a Med-Surg floor with capacity of 20 beds, then the whole floor was taken care of by the functional team. How does laboratory and xray personnel fit in? Were their roles similar to the roles they have today. With functional nursing you mentioned that the patients received very good care from the aides; one of the things that i have read about functional nursing is a disadvantage was that it did not look at the holistic picture of the patient, because everything was task oriented, and care was fragmented. Also I read that a disadvantage was Nurses felt bored with performing repetitive tasks without variation. Can you elaborate on these questions?

To Team Nursing, can you advise me how many patients a "Team" takes care of?

Let me give an example and you tell me if i am correct. Say a patient comes to the E.D. c/o chest pain. A triage Nurse initially triages patient, then patient is taken to a room where another nurse does the assessment, then a technician comes and does a 12 LD, and a PCT comes and starts an IV and draws blood. In this scenario, is this an example of functional nursing?

Another example: A LTC facility with two wings, each wing has three CNA's, two LPN's and there is one RN for both wings combined. Is this an example of team nursing? (This scenario I hope is an accurate depiction of a typical LTC facility, I have not worked in one, but I think this is typical, please correct me if I am wrong).

WHat floors or types of patients do team nursing and functional nursing work best?

Thanks in advance for any help, and anyone else who reads this feel free to kick in your two cents.

When I started this post I had basically NO info, now I have found some literature and written my essay, but I am still very keenly interested in learning from those who have performed this kind of nursing, because i want my essay and project to reflect accuracy (I know my instructors have practiced in these delivery systems).

semstr · Feb 16, 2003

Well, sorry for your instructor, but team nursing is still done here in most hospitals. And I personally like it a lot!

First of all, when your unit (up to 15 patients, depends on the speciality of course) is "done", you always look at the other units whether you can help there. And the other way round, when something comes up, there are always others of the team to back you up.

You know a lot of patients, so when you are on nightduty, not everybody is "new" to you.

Normally a unit is upped with 2 RN, 2 Lpn and a few students (we still have the "old-fashioned" diploma course too!)

I worked the functional nursing system too. Still know a few wards, where they work like that. For them it is ok. I never liked it!

One RN is on the admin. site the whole day, phoning, making appointments etc.

Another or two others do the "real nursing" on the patients, bathing, change the dressings etc.

Staffnurse is there and organizes all the other things and goes on the big rounds with the doctors.