Patient care delivery systems

[LadyZad]

I have been asked to chair a committee at my hospital to research patient care delivery systems (ie team nursing, primary nursing, buddy systems, etc) to explore different ways that nursing care is done. I am looking for imput/resourses about what methods other hospitals are using, what works and what doesn't. Right now each floor does it differently, some have team nursing, others all primary and some and primary with a charge nurse.

I appreciate your imput and responses!

Jennifer :roll

[P_RN, ADN, RN]

I think each floor might do it differently because their needs are different. On our 30 bed ortho unit team nursing with a charge nurse (RN) did the best (IMHO). RN/LPN/Tech for each 10 patients. In the 700 bed hosp. we were the only floor that did this. I still wonder why.

[Tweety, BSN, RN]

It's very difficult to get a unit to change how they do things. We tried the team thing, with RN/LPN/CNA, but what happened was the RN's on night shift were too inexperienced, mostly new grads, and the LPNs had many years of experience and knowledge. Expecting an RN who can barely give an IM shot to be a "team leader" was a bit tough. Eventually, quietly the unit went back to primary, with the Charge Nurse "responsible" for the LPN, and the CNAs with an assignment all of their own.

It takes management commitment and team commitment to change.

[Audreyfay]

Name the nursing system, I worked it. I think the absolute worst one was the team nursing. The team consisted of 3 members. It was always 1 RN, who was the leader. Her job was to assess the pts, keep on top of the orders, and MD calls. The 2nd person passed out all the meds and helped with treatments. (Might be an RN or LPN.) The last person was the caregiver (an RN, LPN, or CNA.) The caregiver did all of the patient care, asked for help, when needed, did all the I&O's. I found that type of care to be very fragmented. The patients were so confused when 3 people were providing the care. Also, the work load was so uneven that when the person was anything but the leader, they were exhausted by the end of the shift.

I think the one I enjoyed the most was a modified primary. Again, 3 caregivers for up to 15 patients. Everybody did their own everything. If there was a CNA, they took an extra patient and the RN or LPN passed their medications. The RN did the orders for the team. It just seemed that it was more cohesive and the work got done better.

As most veteran nurses will say, they keep trying to find a better way, but all that ever ends up happening is recycling the old ideas, that didn't work before.

[LadyZad]

Thank you everyone for your imput. On my floor we do tean nursing (RN/LPN/CNA) for about 11 pts. It works okay, but it is a lot of work for the RN. Other floors in my hospital do primary nursing (5-7) pts a piece.

I was wondering if anyone has any resourses (websites, books, magizines) on reseach of the different methods of delivery systems. I need information on paper to take back to the hospital to discuss the different methods. Anyone know where I could get that info? (I am not having any luck researching this, hard to find any articles or research done.)

Thanks!

[DIPLOMATICRN4HIRE, MSN, RN]

We always did Primary with a charge nurse at the desk reading the orders and calling for the hyrogliphics team to decyfer what the drs wrote. A unit sec is a must(god love em) we had 4 Rn's including a charge, maybe 3 Lpns, and 2 cna's. We had a always full or loaded up 40 room floor. Our floor had 4 wings, 10 rooms per wing. Rn's always took the fresh cabgs, and caths, and Lpns took the generals, unless it was a mandated Rn care. It worked well, we had a great team that covered each other.

Zoe