Team Nursing

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    Hello fellow nurses. I've been informed of imminent plans to return to the "team nursing" model at my current job on an acute med/tele floor. I suspect this "change" is more budget inspired than it is regarding quality care.

    Currently, RNs have a full pt load & "cover" 1/2 of LVN's load with another RN(to include IV meds, assess all pts, direct care, update careplan, etc).Soon, it will be one RN and one LVN w/ one Nurse Assistant to a "bigger team of patients." I am feeling like the demands to be placed on RN will be overwhelming, unrealistic, and unsafe. I don't care what your hourly wage is- there is only so much you can do in one shift.(Thank goodness the LVNs at my work are top notch!!!! Otherwise this change would be unbearable).

    I am curious about what experiences others have found in the team approach? For those utilizing team nursing, what are your nurse pt ratios (shift & unit?); devision of tasks & nsg role, etc.? It has been suggested to have LVN pass all po meds & do dsg changes & tx; RN do assessments, careplan,admits, IV meds & direct pt's care. It seems very heavy for both RN & LVN. Any suggestions,reccommended reading? LVNs & Rns please give me your input...

    I suspect management won't be offering suggestions on how to best implement this change, so am hoping for suggestions from real life nurses. Thanks in advance for your reply!
    ~Kona2
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    I was curious to what your patient load is? I'm not in the hospital setting at this time, I work in a prison, and from my nick I guess you can see it's a prison with death row inmates.
    When I did work in the hospital setting I work Med/Surg with patient load of 10-12 pts at the most. We had 1 RN, 2 LPNs and 1 CNA on days and evenings, 1 RN, 1 LPN and 1 CNA on nights. The state I worked in allowed LPNs to do IV meds as well as injectables and PO meds. On days there was also an Med Nurse (LPN) she was responsible for giving the scheduled meds (all routes) and the LPNs assigned to the floor gave only PRNs. RNs were mostly responsible for the paper work, like care plans, admissions, taking orders off the charts, etc. Of course we were avialable when needed by the LPNs or CNAs, for advice or help with the patients. RNs made rounds with the doctors, and handled the pt's families. The CNA's helped pts with baths and other dailey living skills needing assistance by the pts and take VS. CNAs were also able to help the nurses as they needed assistance in any procedure such as catherization, NG tubes, etc. The LPNs were able to do any skilled procedure as the RNs with the exception of hanging blood. Thus the reason for 2 LPNs on days & evening shift when most admissions and procedures were done.
    The RNs weren't required to co-sign any documentation by LPNs. I don't understand the rationale for this. You also mentioned assessments were made by RNs only, why? In my state LPNs learn how to make assessments in nursing school and can do this very well. LPNs can start IVs and push meds such as antibiotics, after going through training provided by the hospital.
    The team worked well for us and we worked well as a team. Even were i work now we have team nursing and it works well for us. Of course there's days when everyone is overwhelmed, I think that's just part of the job. When duties are allocated properly, and utilizing each nurse properly I feel it's the only way to work.
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    Thanks for your input! Our "team" is said to consist of 8 patients for a day shift acute floor. This includes one RN, one LVN, and one nurse's aid. I'm not sure what pms and nights will have for skill mix. The floor is pretty heavy & acute- even if the numbers sound reasonable.In answer to your question about LVNs doing assessments:I live in Calif., where our nursing practice act states that the LVN's scope of practice is "data collection" or basic assessment. In my state, RNs have to "directly observe the patient" and are responsible for the "synthesis of data collection," direct assessment,careplans, and directing overall care of patient.We cannot simply take the LVN's "assessment" and sign off on it. We are required to do our own focused assessment as well, and monitor all labs, hx, tx, and care. (This is not to say that I agree with the nursing practice act). LVNs here can do everything but; hang blood, give IV med/IV push, central line care, or do admission assessments. We do have to "cosign" all LVN charting & note if we agree or disagree w/ the LVN's data collection (based on our assessment) which I feel is redundant, but the law nonetheless.I'm skeptical as to how this "change" will benefit patient or staff.However, I appreciate your comments (and any others who care to chime in- hint, hint). Thanks again.
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    I have worked in team nursing with anywhere from 10-25 patients, 1 RN, maybe a LPN, and 1-2 aides. With the nursing shortage and the increased patient acuity, I can see no other reasonable alternative. As RN's we know that our giving direct patient care is more cost effective and better for our patients. It also lowers our liability by not having to supervise unlicensed personnel. But we cannot do it all. Most of us do not want to return to team nursing, but do we have any alternatives?
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    I'm not sure what the laws are in Cali, but here in MD patients need to be assessed by an RN once in a 24 hr period. This means that an LPN (or in your case LVN) can take care of a patient for a shift provided that the pateint is cared for by an RN on the next shift. This way you could split your team in half and only have four patients...and cover the other four for things like IVP and blood transfusion.

    At my hospital we have LPN's carry a team of their own. The charge nurse is normally assigned to cover them for IV meds, blood, admission assessments, etc. We normally carry about 24 patients, have two RN's one LPN and one or two techs on the floor.

    We tried the team nursing thing and it failed in a matter of months. One team of 10-12 pts was assigned an RN and a tech, while the other had an RN and an LPN (and sometimes a tech) I was normally in the RN/tech team. I barely knew my patients and found myself doing tech duties more often than not. The LPN's on the other hand where reduced to techs/medicine aides. It was insulting to them.

    Hope things work out a little better for you!



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