Changes in delivery system

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    Our Med-Surg. unit is looking at changing the care delivery system in our facility. We are a 32 bed med-surg. unit and want to improve the quality of care we deliver to our patients. We are trying team leading, but are getting alot of slack from staff. We were doing primary care, but found it too be very stressful for both staff and pt. as well as MD's. Primary care for us consisted of 8-9 pt. doing all cares as well as vs and meds. any suggestions would be appreciated.
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    We went through that a few years back in the hospital I worked in before I moved. We also had a 32 bed unit. we were doing like a modified primary care. no charge nurse, and two nursing assist. to help with some of our worse pts. we also had a load of 7-9+ pts. Hard work let me tell you. Management tried to get us to change to team nursing but failed to give us adequate staffing. Frustrated us all. But people in general dont like change. You may just ahve to put your foot down and say this is the way we are doing it!! In my new job I am amazed at how much smoother and easier life is. I have a section of 8-10 pts with an aid and a charge nurse.Even at that load and an admission here and there I really dont feel overwelmed(Most of the time!!!) If your hospital can afford it a good aid and a charge nurse make all the difference. The most important thing is a good attitude!!! Good Luck terri
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    When I worked in the hospital my unit used the primary model which worked out well with the patients that we had (it was an oncology unit). When I would float to other floors, various models were employed. One unit in particular used what we called "mini-team". This meant that the RN who had a load of 7-10 pt. would give up about half to an aid and primary nurse the other remaining pt. that she did not give up. The aid was split between several nurses on the unit. For obvious reasons the RN would give up the harder of her pt. load. What I mostly remember about all the different models of nursing is that teamwork is necessary, even in primary nursing. We all worked together to get the job done and this fostered a real sense of comraderie and affection between us nurses. Good luck in implementing the new delivery system.
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    Our unit is med only and has 24 pts each end with pt:staff ratio of 12:2. weekdays we have an educator, clinical coordinator and a charge on duty. They are present 50% of time due to meetings etc. weekends we are on our own. Our workload includes all patient care, bedmaking and cleaning pans, bowls etc and computer input data and the usual written report and taped handover. We combine team nursing and primary nursing as the ward work load dictates. As with most workplaces overtime is "poor time management" and extra staff is "just not possible as I have no one I can call".
    I do indeed wish you luck. Team nursing works only if all concerned are willing to work with another jointly.
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    We did modular care up until 3 years ago, that was we had one cct for the whole unit and the Rn/lpns had the floor with ratio of 4-5 pts days,5-7 pms and 10 pts on nights. we now have teams, with the number of staff based on census. The team ususlly consists of an RN and then a cct or lpn. Days team has a ratio of mx 6, pms 7-8, and nights max 11 pts. Works well because you have your own team memeber to utilize to your best ability
    Hope this helps


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