Team nursing in ICU?

Specialties MICU

Published

I am curious to know if anyone uses the team nursing in the ICU and if so what pros and cons do you see.

Specializes in ICU.

On occasion we've had 2 nurses on one super sick patient. One nurse is in charge of care, does all the physician updates/orders, physical assessments, etc. Second nurse is the 'mechanic' - runs the CVVH, charts on the IABP, keeps up with the IV bags, changes lines when due, etc. Both can be quite busy!

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Specializes in ICU.

only time I ever did "team" approach was when working with LPNs and basically meant that I was responsible for 4 instead of 2 patients. Had times when it worked quite well, and had times when the LPN did not even assess the patient (8 hours into a shift realized the patient had scrotal edema the size of a melon and purple and calls me in freaked out to ask if this was new). Kind of scary when my only "responsibility" was to do assessment every four hours and the LPN does all care.

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Specializes in Adult ICU/PICU/NICU.
This sounds like a cool program. However, as an RN I would not be excited about taking on extra patients above the normal assignment while also supervising a student. Everything they do is on my license, so the last thing I need is an excessively busy patient load.

I also feel that team nursing is generally not practical but specifically unsafe in the ICU. ICU level care requires someone who "owns" the patient and is responsible for seeing and assessing the whole picture continuously. The same person giving sedation meds needs to be aware of the ventilation goals and be the one watching vitals. etc. etc. etc. Everything affects everything in a critically ill patient, and the possibility of doing interventions without knowing the entire picture in detail....or possibly repeating something another co-worker just did...sounds like a recipe for disaster. And inefficient too, with all the time spent checking in with your team to keep each other up to date.

As an RN with only four years experience,you would not only not have to work with the student, but you would not be elgible to work with the student. Only certain experienced RNs in the unit worked with the program, all of which had 15+ years of experience and several of them were also clinical instructors part time at the university. It was called PIP which stood for "partner's in practice." The charge nurse would select an appropriate assignment. The communication between PIP team was key, and the program produced some exceptional graduate nurses who could start working with a much shorter orientation.

There were also days when a very sick patient on 1:1 care would get the PIPs where the RN had a skilled extra pair of hands the entire shift. If the PIP had three patients on 1:2 and one started to crash, the charge nurse who took no assignment would pitch in. There was never a challenge with the program, and again, only very experienced and skilled RNs were placed with the NAII. Inexperiened RNs were not allowed to work as a PIP team , RNs who didn't feel comfortable working in a PIP team did not have to, and not all experienced RNs who wished to work with PIP teams were chosen for the program.

I personally would have loved to work in a PIP team at the end of my career, but as an LPN and working part time, I wasn't elgible. In the twilight years of my 54 year career, I particularly enjoyed the informal mentoring of younger nurses and perhaps spreading some know how and wisdom on that may help that young person for the rest of their career.

Best to you,

Mrs H.

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Specializes in NICU.

Regardless of my amount of experience, I still will not at any time choose to take on supervising a non-licensensed personnel with an increased patient load. I LOVE to precept, but if I'm the one with the license, it is my legal responsibility to be directly supervising many of the tasks performed. The program sounds like a great deal for students looking for experience and hospitals looking for cheap labor but legally risky for the RN, regardless of experience. I think it would be fun, but if that student makes an error, it's my practice that is on the line. I'm careful to make sure that when I have student interns, our assignments are reasonable for one nurse so that I can appropriately teach and supervise. There is very little I will allow them do with an ICU patient without supervision no matter how many times they have done it well. For the good of all involved...patient, student, and myself.

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Specializes in Adult ICU/PICU/NICU.
Regardless of my amount of experience, I still will not at any time choose to take on supervising a non-licensensed personnel with an increased patient load. I LOVE to precept, but if I'm the one with the license, it is my legal responsibility to be directly supervising many of the tasks performed. The program sounds like a great deal for students looking for experience and hospitals looking for cheap labor but legally risky for the RN, regardless of experience. I think it would be fun, but if that student makes an error, it's my practice that is on the line. I'm careful to make sure that when I have student interns, our assignments are reasonable for one nurse so that I can appropriately teach and supervise. There is very little I will allow them do with an ICU patient without supervision no matter how many times they have done it well. For the good of all involved...patient, student, and myself.

There were only one or two NA IIs on staff at any given time and one PIP team scheduled to work. Occasionally in the summer time, we might have both NA IIs in the unit, but only one could PIP...the other served as an extra pair of hands and didn't have an assignment with an RN. So it wasn't about saving money, it was about mentoring and attracting talented young people into critical care. Like I said, if you didn't want to be involved with PIP you wouldn't have had to do it, even if you did have the experience required.

Best to you,

Mrs H.

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Specializes in ICU.

I dont think it could work in the ICU. ICU nursing is not task oriented. You have to be able to put the WHOLE picture together in order to care for the patient. You need ot understand your patient inside out and know every response to everything that is done I believe. That's just me.

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Specializes in Med/Surgical; Critical Care; Geriatric.

Hi All,

We use primary nursing in our 30 bed ICU and strictly staff with RN's. Usually we have no more than 2 patients. There are times when nurses do 1:1 - CVVH or a neuro, for example. We use the "buddy" system on our unit. Buddies cover for each other for lunches and potty breaks and also help each other with turning/repositioning (and poop patrol) :D Our charge nurse and rapid response nurse don't have assignments.

I don't see how team nursing can work in the ICU. There are too many unpredictable variables.

Rhonda

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Specializes in ICU/PACU.

sounds dreadful.

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Specializes in Critical Care.

We have a new Director of Nursing at our hospital and we got word she wants to try this in our ICU. After being run ragged by being so short staffed, it sounds pretty good to us. Heres is what has been explained to me so far. We will have a committee of nurses planning this, me being one of them. Instead of our huge nurses station, we will have "pods." There will be two nurses for four patients, and we will take care of them together. Everything will be within our area to take care of those four patients. When I go to lunch, she's there, and visa versa. What am I missing, its sounds pretty good to me.

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