Team Nursing-

RNPATL, DNP, RN · Oct 22, 2004

Our hospital has recently decided to go to "team nursing" on all medical-surgical floors. I was interested if anyone else is participating in this type of patient care. Any helpful hints, I have found that it is taking some getting used to!

Team nursing use to be the model of choice for care .... as health care changed and reimbursement decreased (or at least changed also), hospitals discovered that they could combine the team's tasks and assign these task for one nurse to perform and primary care was born. Most acute care facilities use a primary care model for the delivery of nursing care.

Team nursing focused on assigning a group of patients to a team .... generally, this team consisted of an RN - the team leader .... this individual would complete all the assessments, deal with the physicians, orders, and tasks that other members on the team could not take care of (i.e central line dressing changes, IV push medications, etc.) ..... the next member of the team was generally an LPN. The LPN would be responsible for completing the medication pass, treatments and if time permitted, would assist with providing basic care. The last member of the team was a nursing assistant. The NA would be responsible for providing basic care, answering call lights and dealing with issues that the nurses did not have time for. Most of the time, the team would have any where from 12-14 patients.

When I first entered nursing, in the very early 80's .... team nursing was still the delivery model that most hospitals used .... as time passed, many hospitals went to primary care. Today, I think most hospitals are still using a primary care model, although we are seeing many more unlicensed assistaive personenl in place and in some cases, taking the place of the nurse. LPN's are not hired as much in the acute care side as they use to be. I remember a day when there were as many LPN ads in the classified ads as RN ads .... today, it just is not the case.

As we move into the future, I am sure there will be new and different models of nursing care delivery. Hope this helps.

kellye · Oct 23, 2004

Our floor has team nursing consisting of an RN, LPN and MA. pt load is usually 11 pts per team, LPN takes 6, RN 5 and the MA all 11. The RN takes report on all 11 and is responsible for them (the LPN reports to the RN) she also does any of the procedures for the LPN (pushes, central line stuff etc..) it works out really well and has been on this floor for quite a while. i am a baby nurse, just passed boards 10/04 and am in orientation. it is overwhelming right now, so much to do and chart and there is so much that i haven't done or learned in nursing school! i know it will be awhile (at least a year i am told before i am comfortable) so how do i know when i am ready to be on my own? the usual time frame is 8-12 weeks. when i have four or more pts it feels like i am treading water to keep from getting too far behind!! help!

barefootlady, ADN, RN · Nov 7, 2004

You have gotten the description of team nursing from Pat, but I really felt this type of nursing was productive and efficient. The team took report where I worked and the assignment was made according to accuity of patient, as an RN, I took all pts needing blood, complex IV's, and vents. Yes, this was when vents were on the floor, the LPN took complex dressings, did po meds, I covered pushes, and pain meds, expecially IV ones, and CNA did baths, and beds, simple dressings, and we all fed patients. I know this sounds overwhelming but a good team could manage 12 patients, get lunch and chart. It was demanding, but we all knew who was in danger of coding, the FS were done and covered everyday, and meds, IV's and dressing were done routinely. Patients had issues addressed when they happened. Not hours later. The charge nurse was there as backup, called MD while you did what you needed to do for patient, the doctor was used to dealing with one team for weeks at a time and felt better about the care his patient was receiving.

I miss team nursing. Some of the smaller hospitals here still practice it. They are the ones patients have fewer complaints about and seem to have good morale with staff and less turnover with staff.

mattsmom81 · Nov 7, 2004

Barefootlady, my experience in team nursing was good as well...of course I learned how to do it in nursing school...our hospital based program practiced it and did it right. Most younger nurses do NOT know how to work team nursing succesfully and unfortunately this includes many managers today. Unless their managers are older and worked with it personally.

I too feel its an efficient and rewarding way of providing good care...if its done right with sufficient, capable people who will work as a team.

Many facilities today confuse team nursing with functional nursing which is a misnomer.

Getting everybody on board with the concept is the first hurdle...I have seen major problems in achieving this first step. good luck to you...it can work well with all the right ingredients. Primary care is verrry expensive.....and IMO is not necessary in every setting. Not all nurses agree however.

fergus51 · Nov 7, 2004

I learned it in school too, and I still consider myself pretty young;) I think the most important thing is that every staff member knows what is and is not expected of them. Clear communication and an atmosphere of good teamwork can make team nursing great. If members don't communicate or work together well, it will be bad (I think this is the reason some of us prefer primary care).

RN8 · Nov 8, 2004

We too just implemented team nursing on our surgical unit. I am looking for help from anyone who will give me advice as to how to make this work. I am the manager of the unit. It is a 36 bed surgical unit. Teams consist of 12 pts with an RN, RN, NA. Sometimes a team may have an RN, LPN, NA. When we are full we have a prn person on 7-3. We have 3 teams. THis is our 3rd week of implementation. I need some advice because it doesn't seem to go well. Staff states they don't know their patients, its too busy, etc. How do other places do this. ALl staff went through a mandatory 4 hour training session to start--more planned. What to do?? Any advice would be helpful. I feel team nursing will provide a more supportive environment than primary nursing. Who does what on your teams?

THanks for you input!

barefootlady, ADN, RN · Nov 13, 2004

Wow!! Four hours of orientation for team nursing, how generous, most of us older nurses practiced it for a year or more in training before we could master all of the ins/outs of it, but here goes. The whole team must listen to report, since you have 2 RN's and a CNA to the teams most days, there is not need for switch off of med duties, who is team leader, what does the charge nurse do, is the CNA getting help with 12 baths? In team nursing the charge nurse listened to report on the whole floor, noted which patients may need closer eye and was ready to aid nurse with problems if need arose, The RN team leader would assign patients/duties to team members, If there are 2 RN's then are they going to work with the CNA on the difficult baths? The RN's can each do the po,IVP, and IV's for 6 patients but are they going to assign the CNA all of the VS? This would be unfair. Each member should do 4 pts VS's, hopefully the RN would take the most problem patients VS's . It may take all 3 team members to get a pt oob in a chair, who does the dressing

changes? As above the RN can do 6 each or it can be split to 4 each if the CNA is allowed to to simple dressings. Is the CNA aware of what is needed to report to RN on the patients on the team? Who does F.S.? Who covers them.

Who does I&O? Is the team leader responsible to call labs to MD or will charge nurse do this? Is the charge nurse going to do rounds with the MD or is each team leader going with the MD, or is the RN going to cover her assigned pts only? Who does the feeding of the patients who need fed? Is that assigned fairly? Are every 2 hour notes required or are flow sheets being used or are they going to be used. Flow sheets save lots of time and allow charting by exception, which is great. Does the CNA have a place on the flow sheet to chart? I hope team nursing comes back in a big way. It was great. I can agree that it takes time to work out the kinks in team nursing, some teams just work better together than others. I do know that many doctors here are beginning to want team nursing to come back. They are tired of having a different nurse every day for the same patient and each day they have to re-educate the nurses on what they want do and how they want it done. I hope this gives you some idea on what to look for with team nursing. As a manager, I hope you take the time to say a kind word to your staff when they have done a good job and mastered team nursing. Once they get the hang of it, I think they will like it.

SweetnurseS · Nov 16, 2004

Years ago the small rural hospital where I've worked for 15 yrs. did team nursing. About 8 years ago they changed to primary nursing with a charge nurse. I prefer primary nursing as I usually have 4-5 patients, I am responsible for baths, feeding, meds, etc. I know what is going on with the patients and am not constantly asking if something was done or having to check with the other team members about different things. Our charge nurse notes the orders, deals with the doctors, makes the calls to wherever, does the assignments, helps us out if needed, etc. We have one charge nurse who works 7-3 mon. thru fri. The primary nurses work 12 hrs. We don't have a big turnover of staff, most of us have been here for more than 5yrs. I'm not sure if it's the change but I feel my coworkers are just as happy as I am about primary nursing.

allnurses Guide · Nov 16, 2004

We don't do team nursing - except when the other nurse is a LVN. Then I do all the assessments on, at the most, 12 patients. After that we split the patients 6:1 or whatever the patient load is. I'm still responsible for making sure all 12 patients are getting their needs met. I also have to check the charting to see if I agree with what the LVN has written. I trust the LVN's I work with and hate that their role is so limited.

I like having my own patients at the 6:1 ratio (which changes to 5:1 in January). I think something gets lost in communication when you do team nursing.

steph