Do you like team nursing? - page 2

i'm still a student (one semester to go), but there are hospitals in my area w/ & w/out team nursing. should i stay away from the ones w/ team nursing?...opinions?....the good & the bad?... Read More

  1. by   EmerNurse
    Eek - I worked at a hospital that went to Team Nursing. They went bananas on the day shift. On nights, we pretty much split up our team and the RN and LPN were "primary" to "their" patients.

    Things I didn't like:
    1: Having to do all the assessments - I felt I didn't have enough time to really, thoroughly go over my patients and know them well.

    2: Sad but true, there ARE nurses out there that get by doing the least they have to - if one of those nurses is your "team mate" you either let it go, or (me) feel that I have to ride herd to make sure MY standard of care was met, since I was responsible. And then they get mad at you, no matter how diplomatically you try to couch your requests.

    3: related to #2, I felt I had to check behind everything to see it was done, and done right. Sure, I had some LPNs I knew well and trusted, in those cases, I could relax a little in the knowledge that this nurse always did a good job.

    Incidently, at this hospital (where I no longer work), team nursing lasted about a year - that was all.

    Where I am now, there is one "zone" which is usually teamed - and the same, very same, problems crop up. HATE it - if my new hospital went completely to team nursing, I'd quit in a heart beat. Give me my OWN patients, that I can care for, know well and bond with, and I'm happy. Please don't make me have to check over others' stuff just cause it's on me if they don't do things that're supposed to be done.

    Bah sorry - can you tell I had a rough time recently, related to a team-nursing situation?

  2. by   MedSurgeMess
    In my hospital, med surg floors have 1 RN and 1 LPN for 5-6 pt team. RN does assessments and vitals and dressing changes, LPN does all meds, IVs and I & Os. It works out good on my floor, as long as you don't get stuck with a slacker. They stopped hiring CNAs, and are replacing them with LPNs. We have a capacity for 24 on each of the floors and usually not totally full, and there are usually 4 teams, unless census really drops.
    Last edit by MedSurgeMess on Oct 12, '06
  3. by   cocco
    There are a few floors at my hospital that do team nursing. I have never floated there but I think it is ridiculous. To have to float an LPN, RN or PCNA from our floor to their floor even though they have enough staff to run but they don't have 1rn to 1lpn to 1pcna is so stupid. I agree "I" want to care for "my" pts. Not rely on somebody else to maybe tell me something valuable that I need to know. If they forget to tell you then you're still held responsible.
  4. by   Tweety
    I like the Nurse/CNA team, because that's two people taking care of the patients. We used to have that were we worked, but recently to save money the increased the CNA workload, so we now have to share the tech with other nurses. Still that's better than being totally on my own.

    I haven't really worked with the RN/LPN/CNA team but when you start adding more people into the mix you run into the problem of not everyone pulling equal weight, and resentment breeds. Also you run into the LPN/RN dynamics when you have a new grad RN trying to run a team that includes an LPN whose been doing it for 30 years. I can see it working if there are specific roles (like stated above the RN assesses, etc.)............AND people work together for the good of the patient, rather than worrying about what the other one is doing.

    Here, we just ignore the nurse practice act and let the LPNs on their own assignment without direct RN supervision, with an RN on paper beside their name.
    Last edit by Tweety on Oct 13, '06
  5. by   Tweety
    Quote from strong_willed
    In my hospital, med surg floors have 1 RN and 1 LPN for 5-6 pt team. RN does assessments and vitals and dressing changes, LPN does all meds, IVs and I & Os. It works out good on my floor, as long as you don't get stuck with a slacker. They stopped hiring CNAs, and are replacing them with LPNs. We have a capacity for 24 on each of the floors and usually not totally full, and there are usually 4 teams, unless census really drops.

    That's a very excellent ratio. I think I could manage that.
  6. by   Mulan
    Quote from strong_willed
    In my hospital, med surg floors have 1 RN and 1 LPN for 5-6 pt team. RN does assessments and vitals and dressing changes, LPN does all meds, IVs and I & Os. It works out good on my floor, as long as you don't get stuck with a slacker. They stopped hiring CNAs, and are replacing them with LPNs. We have a capacity for 24 on each of the floors and usually not totally full, and there are usually 4 teams, unless census really drops.
    that's a good ratio, with 10 patients though it's a different thing, and team is much harder than primary
  7. by   melsch
    Our hospital does mostly team nursing on all the floors except the critical care areas. I love it.

    Our floor is one of the heaviest in the building and we have 8 patients with 1 RN and 1 LPN and the floor has a float LPN and float care aide. The RN and LPN work together to get care and assessments done. The RN usually does all the meds, but the LPN will jump in and help if the RN gets behind due to a sicker patient etc. We really work together as a team to get the work done and I have never worked with someone who didn't pull their weight.

    Having never worked anywhere where there was primary nursing I have never understood how it worked. Where do you get help to turn or feed patients as you can not be in 4 places at once? Sometimes not safe to ambulate or even reposition the patient in bed with out a second person. Do you have float LPNs or aides to grab or do you have to pull someone from their 4 patients to help you?
  8. by   Nurse`Chief~Chickie
    bleecckk!
    i have a prn job at a facility that does the rn/lpn/cna bit. i despise it. my main job is great for the fact that i am the nurse that cares for the team. i have a cna or tech with me and we do what needs to be done. i do my assessments. rounds with drs meds and all of it. thus i know what is going on without having to get it second hand. someone elses " iv patent and unremarkable" may be my "need to d/c due to increased inflammation and decreased blood flow to distal extremity. " this iv was in a pt foot. toes were literally white, no cap refill, no pulse present and above the ankle, the leg was red and hot. every other body part was fine and other leg was normal! i'm glad i do my own assessments, even though there the rn is who really does them. no other contact than the initial one and ivps but they are responsible for all charting and rounds? whatever! if i'm competent enought to take care of 7 pt on my own at one place, i shouldn't be just a med-tech at the other!
  9. by   am17sg05
    it depends on the area where you are working.with me, i work is psychiatric nursing and i believe team nursing works for us.when i worked in er, we did team nursing although sometimes if the cna's are very busy, we just do some of their work like vital signs,collecting specimen,etc. in telemetry, we used primary nursing and i believe it works better than team nursing.
  10. by   bugalug_nurse
    I love team nursing. I'm an EEN (I think that's an LPN overseas) and I really enjoy working with an RN throughout my shift. There are no 'set' jobs that we each have to do - we plan our shift and help each other out with whatever is needed. It also means that if a particular patient requires monitoring (ie for chest pain etc), or if a patient needs to be taken to surgery, the other patient's aren't without a nurse.
  11. by   ashleyjean3
    My hospital just switched to team nursing, as much as i thought i would hate it I love it. The team leader (RN 1) assess and charts, RN 2- pass meds, admits, and d/c, CNA does her thing. We have a wound team to change all dressings. The ivs are started by whoever has time. Each team gets 13 patients
  12. by   sweetielin
    team nursing is the only thing i've done but i like it. i have the suspicion that if our hospital went to primary nursing, they would routinely saddle us with 10 patients each. on average, an rn-lpn team has 15 pts. one team can have up to 17 though. if census is low, they will cut an lpn or move her er. this leaves one lpn for 18-23 pts. the rns split those. so if i have 20 patients, each rn has 10 of those. it's overwhelming to be responsible for all meds except iv, dressing, accuchecks, tube feedings, checking orders, checking the night work. then sometimes you have to call the docs. the aides are usually busy turning so i have to interrupt my med pass to take people to the bathroom. thankfully, the rns do help or else i would quit asap. usually the rn will ask what you need or she will say what she will do to help. i think a lot of times, they don't really understand why it is so overwhelming but at least they do try to lighten the load. i look forward to getting to sit and chart. luckily we don't have that many pts too often. it's nice to have a partner to help each other out. the rns are usually done with their med pass before the lpns and free to start opening charts. we don't keep track of who does more charts because there are times when one person opens more than the other then it may be different the next time. we do what we can. we are all busy and just get it done instead of worrying who did what. as long as it gets done. there's not much than lpns can't do at our hospital, so we can help out a pretty good bit as time allows.
  13. by   wmsclan
    right now i work on a "modified team nursing" unit. each nurse, both lvn and rn have 5-6 pts on day shift. we work primary care for those pts and the rn's are there as a "resource" for the lvn's. care plans, hang blood etc. the only thing that lvn's can't do in the hospital is those things outside the bne scope and admission assessments. so the "team nursing" concept works, just in a different way.

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