Team Nursing vs Primary Nursing

tonchitoRN · Sep 7, 2001

Because everyone who has posted prefers the team nursing concept I have a question. Is the RN legally responsible for the LPN/LVN i.e. cosigning her MAR's etc, making sure the patient got her meds, reporting abnormal labs etc.? I have only worked in primary care where every patient got an RN and CNA. Therefore, I was totally responsible for the care of that patient. It was explained to me that in team nursing I would be responsible for the work of the LPN/LVN even if I was not there to witness the work done. Under those circumstances I always refused to cosign for the LPN/LVN under the rationale that I can only be responsible for the work I do. Please comment on the legality and accountbility of the team concept. :cool:

leesonlpn · Sep 7, 2001

It always goes back to the fact of where you live doesn't it. In BC licensed practical nurses are responsible for their own scope of practice. We do not need RN's to co-sign.

fergus51 · Sep 7, 2001

I think that team nursing depends so much on what the LPN role is/can be. Our facility does not allow LPNs to dispense medication, monitor IVs, do dressings etc. They do baths, ambulation, basic needs flow sheets, i&O and hat type of thing. A lot of the floors don't even have LPNs anymore. I loved working with LPNs because I just didn't have the time to do everything, and a good LPN is an EXCELLENT resource if there is something I am questioning with a patient. Knowledge is not limited to those with RN behind their name.

I like primary nursing though, because it allows me to spend more time with each individual patient and because I can combine tasks (like bath and assessment) better and feel more comfortable getting information for myself rather than asking someone else.

capgirl · Sep 19, 2001

Last year I was working in a major teaching hospital on the Peds floor. Our model was team nursing : 2 RNs, 1 LPN, 1 PCA for 13 patients. Our kids had very high acuity, chemo, etc. I really loved the team nursing model in THEORY. However, in REALITY, in the 9 months I worked there, we only had all the pieces of the team in place 1 time. Always worked without someone.....I didn't stay because these kids were just too sick, I wasn't comfortable always working short. Now I work Peds in a very small community hospital, Primary nursing, good pay, low acuity. I couldn't be happier !

Janice8551 · Sep 19, 2001

On the floor I work on, a busy acute medical floor, we follow the "paired caring" model. Here we work in pairs- 1RNand 1LPN. They work TOGETHER to provide care to patients. As our skills and scope of practice overlap as much as 70% in some cases, we SHARE the duties whenever possible. Not so much delegation as there is discussion about who'll do what. The only way to make it all work is to talk and work out your care plan together for the shift. The best thing is is that you have a regular partner and you get to know each other very well. You get to know how each other work, and in some cases, you can almost read each others' minds. My Rn picks up on things I might have missed, and I pick up on things my RN might have missed! It has worked well for us. We always seem able to adapt because we can pick up the slack as needed. WE MAKE IT WORK, AND WORK WELL!!!:)

EXOTIC NURSE, RN · Sep 19, 2001

I am totally against team nursing......I am dealing with team nursing now where I work on a extremely busy tele unit and some of the team leaders I have to work with or very very lazy and they do not like to leave the nursing station and they constantly call your name to do simple tasks that they can do; they pile IV bags on my med cart because they do not want to hang them and any small task they are constantly calling your name. It is disgusting and I think that primary care nursing is better. Half the time we do not have a full team to work with so it really isn't team nursing at all.

nsmith_rn · Sep 24, 2001

Not my cup of tea

Can be great if you have a good team but how often does that happen.... not very often where I am at. Therefore I end up taking more patients and doing allot more

tobias fonge · Sep 24, 2001

I work in a unit where we do team nursing however we are changing to primary nursing because our kind of pts are going to change in the near future. We are going to have a chest pain observation unit on our floor and other kind of cardiac pts as well. Because of this, the Rns will have to take care of less pts and have more one to one with the pts. The lpns will take take of the less acute pts. The CNAs are going to float and help out every body.

While the team nursing approach lasted, we really enjoyed it. It can work only in a unit with enough work available for everybody. For example, our floor has high acuity pts. They get lots of meds, accucheks, wound care, some on frequent VS, lots of turning and repositioning, lots of prn meds etc. The team comprise of about 12-13 pts. The Rn does all the assessment, make calls to the doctor, sign doctor's orders, give central line meds, and some iv meds which the lpn cannot give like iv ativan, or iv cardiac drugs.

The lpn does the meds, accucheks, prns, help the cna with pt care, does wound dsgs, etc.

The cnas does pt care and vs, pass ice and every other things that may come up.

Some times when it not too crazy, all three actually get to give baths, do dsgs etc.

The advantage to this system is that there is a greater continuity of care. The pt gets seen all the time. One of the team members is always in to do something. If you have one of the pts going bad, some times the pts don't even notice because that might tie down one or two nurses but the pt still gets attention from the other members of the team. Besides, there is the charge nurse who is always willing to jump in and help in crisis situations.

The only short coming to this system is a team is as good as its members. If you have a lazy crew, you better say your prayers. While the Rn is ultimately in charge of the team, every licensed member of the team is responsible for what they do. Another advantage is when you are on lunch break, you are on lunch break. Nobody disturbs you except there is an emergency because you have other members of the team covering. There are pros and cons to every system. Every floor does what is comfortable for them to get the job done.

OneChattyNurse · Sep 24, 2001

Fergus...it really suprises me that your facility "does not allow" LPN's to do what they went to school, studied, did clinical and were trained to do. I am not usually one to get on the "poor me LPN" bandwagon, but it is places like your facility that facilitate this attitude. I am an LPN and have worked hard both in school and on the job to be the best nurse I can be. I am constantly striving to add to my knowledge. Everyone is always talking about the terrible nursing shortage, but maybe the problem would not be so great if the nurses that are out there were utilized to their full potential. I am not saying that I can do everything an RN can do. There are certain things that the State Board does not permit an LPN to do. This is acceptable and understandable as we do not have as much educcation as an RN. I just do not understand the theory behind not allowing a competent LPN to do a job which she carries a license to do. Sorry if I got defensive...just felt I had to give my two cents worth!

Thanks!

Shari