Team Nursing Vs. Primary Nsg

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    need input, please need input, please

    i work in a small community hospital on a med- surg floor where our total capacity for pts is 26. our nurse manager wants us to change our nursing model from primary nursing to team nursing. she is looking for a model and i have been selected to research what works. i am originally from ma where a small community hospital consisted of 240 beds (this hospital consists of 40 beds). anyways, from my understanding ma is struggling and i want to submit info on a team model that works. i am looking for teams of 13 patients a piece -- need numbers that work as well as how tasks are delegated among the team. we have a rate opportunity in that it will be the staff nurses that make the determination (within reason) so i want to submit information for success. thanks for all who can help.

    nurse on a mission
  2. 17 Comments so far...

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    Hi there!wavey:
    I work on a med-surg floor which utilizes team nursing. I love it this way. The way it works is this:

    Day & evening shifts: One RN and One RPN for apprx 10 pts, the pts are divided up between the RN and the RPN, the RN takes the more complex and acute pts, where the RPN gets the less acute, stable pts. The RN monitors all telemetry and IV's for all 10 pts, and does rounds and assessments on all of them as well. The RPN does all the rest for his/her pts: meds, all care treatments etc.
    Night shifts: same as above, but apprx 16 pts are divided up between the RN and RPN.

    It's simple, and it works. Everyone helps one another if things get to be too much. Good luck with your research
    Patti
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    Thank you so much for responding. Is an RPN like an LPN? Sounds like it, I just wanted to be sure. Also, one more question, do you have LNAs or CNAs at all in this mix? Our meeting is Wednesday. Thanks again for your input and I'm encouraged to hear that you like the Team approach.

    NurseGr39
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    I will give you my opinion as an RN. If you want this to work and do not want to have alot or errors you will need to supply an adaquate amount of aides and have the floor well stocked with supplies. Is the RN also responsible for all the next days med sheets? Do you have an IV team or is the RN responsible for starting all IV's? Does lab do the blood draws? Many times an RN will come in and be faced with IV's that are no longer patent, new admits, and panic labs. To do the job effectively the RN will need all the support that is available. Does the LPN look at the care plan and treatments? Will they have to be told who needs PAS stockings and whose stools need to be hemmocculted?

    How is the leadership of the unit? Does the RN and LPN know their responsibilites? Does the RN get support when delegating responsibilities ?. Team nursing is ineffective on my unit. Many errors are made because of the lack of support staff and ineffective leadership. Also there were and are financial problems. Many nurses left, many bullies stayed. There is also an abuse of informational power.

    Another hard question is how does your hospital guage success? If it is on patient satisfaction and lack of errors then you will know in a short time if team nursing for your unit is successful. If the success is measured in dollars saved then the results will be very subjective. Good luck on this approach. I hope it works for your unit.
  6. 1
    Originally posted by Rapheal
    I will give you my opinion as an RN. If you want this to work and do not want to have alot or errors you will need to supply an adaquate amount of aides and have the floor well stocked with supplies. Is the RN also responsible for all the next days med sheets? Do you have an IV team or is the RN responsible for starting all IV's? Does lab do the blood draws? Many times an RN will come in and be faced with IV's that are no longer patent, new admits, and panic labs. To do the job effectively the RN will need all the support that is available. Does the LPN look at the care plan and treatments? Will they have to be told who needs PAS stockings and whose stools need to be hemmocculted?

    How is the leadership of the unit? Does the RN and LPN know their responsibilites? Does the RN get support when delegating responsibilities ?. Team nursing is ineffective on my unit. Many errors are made because of the lack of support staff and ineffective leadership. Also there were and are financial problems. Many nurses left, many bullies stayed. There is also an abuse of informational power.

    Another hard question is how does your hospital guage success? If it is on patient satisfaction and lack of errors then you will know in a short time if team nursing for your unit is successful. If the success is measured in dollars saved then the results will be very subjective. Good luck on this approach. I hope it works for your unit.
    In my hospital, we do not have any aids--it is a dream that we all wish was in the budget, we alas, its reality. We find that 4-5 pts each between RN and RPN is adequate. We are always fully supplied. The night shift nurses are responsible for next days med re-orders and safety checks, however, the day and evening shift nurses are to make sure to send empty med bottles and narcotics to pharmacy for the next day. The RN is responsible for starting and maintaining all IV's, however, lab draws and sends all blood for tests. The RPN does look at the care plan--at our hospital, the RN and RPN take report together side by side, and the RPN does all treatments for her own patients that are within his/her scope of practice--that includes dressings, TED stockings, and hemmocculted stools, Midstreams, etc.
    There is one "group leader" who stays at the nurses station and keeps track of all the Dr's visits, new orders, and outpatient appointments.
    We have a discharge nurse who plans and sets up home care, prepares teaching for follow-up appointments, and gets in touch with the admitting and family Dr re: new meds for at home. They also set up possible placements in long term care facilities.
    We guage success on patient satisfaction, and how quickly (or long) the patients hospital stay is. Our patients are well cared for, and are treated prompty, and with care.
    Team nursing is the best way to go. It is efficient, time saving, and all tasks between RN and RPN are equal with the only exceptions being IV's, telemetry, Central lines, etc. The RN and RPN work together as a team to accomplish optimal patient care. We share the care plan, and discuss each patients care together. This, I still believe, is the BEST way to nurse.

    ________________________________________
    if you want the rainbow, you have to put up with the rain
    tsalagicara likes this.
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    Just to clarify the last message, there are8-10 pts DIVIDED up between the RN and RPN to make 4-5 pts each.
    Yes, an RPN is like a LPN, but I do not know what you mean by LNA's or CNA's--does that mean lisenced nursing aids, and certified nurses aids? If so, the hospitals around here do not have them, but the long term care facilities do (nursing homes).
    Hope this helps!!
    Patti
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    Yes, nursing assistants. We currently practice primary nursing with usually 4 or 5 nurses and 3 or 4 aids on a 7-3 shift. This is for up to 26 pts. The problem is that patient care is often not at optimum so our nurse manager is hoping that quality of care can be increased by team nursing as opposed to primary. We only have 3 LPNs and 2 of them have completed IV training allowing them to hang IV meds as well as start IVs. They cannot hang the first med on a pt. or hang bloods or TPN. They of course cannot do IV push meds.
    I personally wonder if it is lack of communication between the LNA and nurse and often wonder if we would be better off with less LNAs. It seems to me that sometimes we spend so much time accomodating LNAs who feel they are overworked that I wonder if it is worth it. There are other times though, when I don't know how I would have survived the shift without them. Anyways, thanks for the input. I truly hope we can find a system that works for optimal pt. care.

    Nurse on a Mission
    tsalagicara likes this.
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    So let me add one more thing: Do you think it would be appropriate for 13 pts. to have 2 licensed and one aide? Or do you think we should strive for either just 3 licensed with a floater aide? I'm not sure we can supply 6 nurses for a day shift though. I think we can easily steadily get 4 with a Charge Nurse in addition. And we already have 3 to 4 aides on staff for each shift. I'm trying to present a model in which we don't have to wait for her to hire more nurses to put it in place. Since nursing is so stressful, there is always a certain amount of turnover and it seems that when someone new comes aboard, another is leaving or changing depts.

    NurseGr39
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    I've worked where Team Nursing and Primary Nursing were utilized, and I like them both when they are organized properly and professionally so as not to put too much work on any particular member of the staff.

    For Team Nursing to be most effective, staff needs to be strong in their skills and assessment abilities along with the ability to communicate well with one another. I've seen some teams not function well for this reason.

    The only team nursing I'm familiar with is an RN, LPN, and CNA working together. If one or the other is "weak" or does not pull their own weight, the team is no good.

    Primary nursing is great because the nurse is "IT". No one to look to for assessing the patient, vital signs and accuchecks, meds and IVs, and you get to know your patients better when the nurse/patient ratio is good. Yeah right! :chuckle
    Last edit by live4today on Jul 21, '03
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    So with your RN,LPN and CNA working together how many pts do they care for? And how are the duties delegated? I pesonally prefer primary nursing, but I think the nurse manager has it set to change our pattern and whatever way we work, I want pt. care first. Thanks.


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