MedSurg - Team Nursing

[RNSuzq1, RN]

Hi All,

Just heard last night from my Charge Nurse that as of Sept. 1, my floor and most of our hospital is going to "Team Nursing". It's taken most of us off guard since they didn't send out anything in writing and only a few people were told about it. From what I understand, it's a very different way of Nursing than what we're doing, so I can't believe they didn't have some hospital-wide Nursing conference to let everyone know what's going on.

Admin is doing some very strange things - last month they forced a new dress-code on all Nurses - either all white or white top and blue bottoms. Most Nurses had spent a fortune in colorful scrubs/shoes, etc., so not too many happy campers when they heard the news. Strangely, the housekeeping staff can continue to wear colorful scrubs.

So, now this Team Nursing. The Charge said, as far as she knows - our floor will be broken up into 2 groups - each group will have 2 Nurses and 1 CNA. 1 Nurse will do meds, procedures, the other will do all the assessments, charting, etc. and the CNA will help them both out. The Charge said, when it's done right, it works really well, but she's not sure how it'll go on our floor since we're always "short-staffed".

When I take report, I'm assuming total responsibility for my assigned pt's - assessments, meds, procedures, chart checks, etc. I don't give any meds to a pt until I've assessed them and checked their chart for orders. I just don't understand how this Team Nursing will work. If 1 of us is doing the assessments, chart checks and the other is passing meds, seems like you'd have to continuously be giving each other "mini-reports" and updates and we sure don't have time for that. I'm really "Anal", I know if I'm the one doing the med passes, I'll still want to do assessments and chart checks before I pass out the first Aspirin.

I work with a fantastic group at night - we all help each other out, but ultimately, we're each responsible for our own patients and we like it that way. I'm hoping for some input from others that have Team Nursing at their hospitals - I'd like to know how it works and if you like it. Thanks, Sue

[suanna]

I've been a nurse for 20 years and "team" vs "primary" nursing has come and gone over and over. Personaly I prefer "team" nursing on the floors since it allows me to focus on the care that requires an RN and directs the support staff to do thier job without "its not my patient" attitude. This is especially true on a busy floor with short staffing- the critical tasks get done and if there is time left the less vital interventions can be worked in.

[meownsmile, BSN, RN]

I agree, my facility has done team nursing since the early 90's and it works well. Each "team" is comprised of 1RN, 1LPN, 1CNA. The RN can focus on assessments, orders, calls, teaching and more technical issues and the LPN gives meds and treatments, the CNA of course does baths and answers call lights, but we are all responsible for the lights as needed. It makes delegation of tasks that the RN doesnt need to be busied with easier. If i had to do total patient care on 5 patients, with meds and treatments, assessments, dr rounds, orders, I&0's, charting etc etc id never get done.

If it is done and they let you have the right combination of members on the team it works wonderful. Not really sure how the 2RN thing will work out. You would almost be better off doing TPC with 2 RN's on a team of 8 or 10. Why not just split it up to 4-5 TPC?

Also it is not cost effective to have a RN doing tasks that can be legally delgated to a LPN as a team member.

[I<3H2O, BSN, RN]

I started a post about team nursing just before this one but since it has more replies, I will post here. I am FLOORED at the amount of pts you get for a "team" that has RN, LPN, and CNA. For example, yesterday we had 3 RNs(1 was charge nurse),1 LPN, and 2 CNA. The LPN started the day with 6 patients. At my hospital, the RN has to do the shift assessment (head to toe) so someone had to assess those 6 patients. Each of the 2 RNs had 6 patients and had to assess 2 of the LPNs patients. The charge nurse had 4 patients and had to assess 2 of the LPNs patients. At one point, I got a new admit and had to admit them plus care for my other 6 patients. This is: assessments, meds, procedures, IVs, new orders, and charting (all while making q1h rounds), oh and we help pass all meal trays-feeding pts as necessary. The CNA gives baths, does vital signs, collects I & O and charts them. The CNA also toilets, turns, ambulates but I also help out with that when the CNA is busy. We are a for profit hospital, if that makes any difference. We had a float nurse from ICU yesterday and she was FLOORED at how busy we were. Other floors just don't get how we do it. There are days that we only have one CNA (which could have been the case if we hadn't gotten an agency CNA) and the CNA does baths only and we do our OWN VS, toileting, turning, cleaning incont. pt, plus all our other duties. In my hospital, RN and LPN are = except LPN does not do head to toe assessment and cannot d/c subclavians,PICC, central lines, etc.

I think team nursing would be DREAMY!

[MedicalLPN, LPN]

On my unit we do Primary Care. It works a little better because we LPN's are allowed to assess and admit patients, give IVPB and IVP meds, etc. just can't hang blood and give certain IV drugs unsupervised. However me and one of RN's I work with have been known to combine our pt loads and work as a team when we have either a lot of pts or just busy pts. She'll do chart checks, rounds, and I/O's and I'll do meds, IV's, and tx and then we both do our own VS and accuchecks. It works really well but then again she and I work well together.