The hospital that I work with is going to be changing it's model from primary nursing (I would get 7-8 patients per shift) to team nursing (1 RN, 1 LPN, and 1CNA) for up to 12 patients. The LPN would be doing all the medications and dressing changes while the RN would be responsible for the assessments, critical labs, doctors orders, etc.
Has anyone ever tried this type of nursing? What is your opinion? Is it manageable to take care of up to 12 patients when tasks are divided like this? Any feedback would be helpful....
Team nursing is not a new model it has been around for years and practiced in California until the ratio law was passed. There are pros and cons to the system and I have done it all team..primary...charge nurse on both systems.
It allows the RN to focus on the tasks and skill that only they can do such as the nursing process and plan of care and evaluation of that care. Administering IV therapies per licensure (varies by state) LVNs can do some of this, Calls to MD. role of team leader and setting a plan for the day and modifying the plan as needed. The RN needs to take charge of the team and needs to delegate well and know exactly what the LVN can legally do. Communication is imperative and team members must sometimes work to improve this. If you like to work somewhat independently this model can be challenging. It also can be difficult for some RNs not to see every wound and other things but it is important to get a report from the LVN in a timely manner so if there is something you need to see they come and get you. You need to communicate with your LVN what you want to be made aware of. For example ,if you a fresh post-op with a Thyroidectomy you want to be notified of any s/sx of hypocalcemia or if you may want to be notified if a patient is febrile.
You need to be good at keeping track of a lot of things so you need a really good worksheets. I think you need to see every patient especially if you are working with an LVN you are not familiar with! The IV therapy can be overwheming on some days. I usually had a team from 12-14 and I hung a lot of IV antibiotics and antifungals and other IV medications ..up to 20-40 per shift. So have a good system with a stock of all the little things you need such as IPA scrubs and flushes. Try to group your tasks b/c you will be doing a lot of hand hygiene and your hands can get really dry not to mention it is very efficient. Before you call the MD...make sure there is nothing else you need for that pt..check with the LVN...this will eliminate mutiple calls to the MDs or LPs.
If you are working several days in a row it really helps to try and keep the same general teams and try when possible to not split the the rooms too much although it is necessary to do it.
Many RNs like this model b/c the LVNs and aides end up doing most of the baths,bed changing,toileting and tasks of that nature. Sometimes because of this and the fact the model places the RN in a supervisor role the LVN and aides will develop some animosity towards the RNs. If this is not controlled it can create chaos and anger on the unit. To stop this each member must know and feel they are a valuable member of the team. Always address them with respect..remind them they are valued..thank them for a job well done (when it is so)...offer to help and pick up the slack...(very important)..comminicate your expectations clearly..provide support as needed..make sure your team members get breaks. All of these work wonders and your team will work their butts off if they feel appreciated!!!! The RN has to be the leader and the backbone of the system.
Last edit by iluvivt on Dec 26, '12