Team Nursing?

RN1963 · May 19, 2001

Many years ago team nursing was routine. It is raising its ugly head again.A team is one RN manager, a provider(RN or LVN) and a CNA. They have 12 pts. The manager does the assessments, charting and care plans; the provider does the meds., IVs and treatments.The aide does v/s, blood draws, accuchecks, I/Os, etc.The problem lies in having a person on the team who does a shoddy or unreliable job. My license is on the line. Admin. says we are only responsible for the work that WE do. Each person is responsible for their own care. I have a problem with that. I often find that an aide may not take the required 15 minute v/s on a postop because "I was busy cleaning up another patient."I can usually catch this oversight if I have only 6 patients, and take the v/s myself. I can't know what is being done or overlooked on 12 pts.

We have a few experienced RN's that I feel uncomfortable having on my team.When I give them report, they just stand and listen..no notes. I notice that their meds are often overlooked or given late and the med times changed.I have challenged them on needing to have a list of med times per patient so they can at least be timely with medications if nothing else. What are your thoughts on this? Is there a way to ensure your colleages are doing proper nursing care?Isn't that what administration is supposed to do? They say...write a complaint. If it isn't written, we can't do anything about it.This is what sets nurses against each other. I know I have two separate issues here: team nursing and ineffective coworkers. The scarey part is that with team nursing, they aren't just coworkers..they are part of the care of YOUR patients.

capgirl · May 20, 2001

I worked in the Peds unit of a large metro hospital. Very high acuity, lots of hem/onc patients, chemo etc. We had the team set up. For each side of the unit -13 patients, we were to have 2 RNs, 1 LPN and 1 PCA. Looks good on paper, and in theory. However, in the 9 months that I worked there, we NEVER had all the partners of the team, NOT ONCE ! Needless to say, I left due to burn out and fear for my license.

jamistlc · May 20, 2001

I like the "Team nursing" concept! When I work in a nursing home or LTC (staffing) I have between 30-50 pt's under my care, 1-2 aids. I am responsible for Meds, Tx and charting for all those clients! It would be a breeze to work as a team member compared to what I have to do now! :eek:

Peace,

Have a Blessed day,

Jami :)

Brownms46 · May 20, 2001

I'm with you JT! When I came into nursing, team nursing worked well. Then they started primary nursing, and this was where I started seeing the increase in nurse/pt. ratios. It was supposed to be 4-5pts on days, but it soon became 6 or 7! I also started seeing the "it's not my pt." syndrome playing out.

Where I work now, we have team nursing, and the LPNs also Team lead! There is an RN Charge nurse, just like in the "OLD DAYS, and we all work together, to get the work done. Like yesterday, one of the CNAs thought he had my pt. who was a feeder. When I came into the room he had already fed this pt., only to realize he still had another feeder to do. So I in turn fed his pt. Whomever is team leading, also gives the meds. When I team lead, and I'm finished with the med pass, I go and find others who may need help. Same with my other team members. Sometimes we have MORE hands then we need, in assisting a pt., to get out of bed or to turn a pt..

Yesterday a CNA had to go home with an emergency, and everyone pitched in to help.

That is what team nursing really is. Pulling together to give the best care we can, no matter what the staffing.

Brownie

Brownms46 · May 20, 2001

Originally posted by Brownms46:
I'm with you JT! When I came into nursing, team nursing worked well. Then they started primary nursing, and this was where I started seeing the increase in nurse/pt. ratios. It was supposed to be 4-5pts on days, but it soon became 6 or 7! I also started seeing the "it's not my pt." syndrome playing out.
Where I work now we have team nursing, and the LPNs also Team lead! There is an RN Charge nurse just like in the "OLD DAYS, and we all work together, to get the work done. Like yesterday one of the CNAs thought he had my pt. who was a feeder. When I came into the room he had already fed this pt., only to realize he still had another feeder to do. So I in turn fed his pt. Whomever is team leading also gives the meds. When I team lead, and I'm finished with the med pass I go, and find others who may need help. Same with my other team members. Sometimes we have MORE hands then we need, in assisting a pt., to get out of bed or to turn a pt..
Yesterday a CNA had to go home with an emergency, and everyone pitched in to help.
That is what team nursing really is. Pulling together to give the best care we can, no matter what the staffing.
Brownie

Stacey Tortorice · May 20, 2001

That is what nursing is pitching in helping out where and when needed weather it is you regular patient or not.I am a C.N.A and i try to help out when i see that another co-worker needs help.think what really gets me at times is that when the second shift gets on 3/11 and they see something minor instead of doing it they run to the person in charge i cannot count the number of times that I have done something and not said a word about it.when I get their at 6.45am and make my rounds set up for am meal and find that my patients have not been clean and dry or in bad shape i will clean them up and not say a word right then but i do say something when it is really bad.also another thing that gets me is that you are trying to help out in a team and then a day or two later others try to take an advantage of it you can tell pretty much when someone is busy and not when it is time to do ccertin duties that they do not want to do. :) web page

RN1963 · May 20, 2001

Team nursing might work well in a LTC setting where the pts. are more stable, I don't know.But on med/surg where you have 2-3 discharges out of 10- 12 pts, readmits from ER or PACU,3 new postops and 2 total care pts.....you might as well be in Olympic training to run that far up and down the halls to get to the rooms spread out. It is an out of control feeling to have to try to get to see those pts. often enough to be able to pick up on any new developments. It is great for the CNAs. They have fewer pts. on a team and they cluster at the desk chit chatting while we run our buns. In the meantime, we haven't exactly figured how to divide the labor between the Manager (charting, assessments, MD orders) and the Provider (meds. and treatments), so we end up duplicating..who did what? In Primary care, I know what I have done and I trust it.

I have a problem with the methods of some nurses.It is one thing to be working side by side on separate patients and quite another when you work together to see how dysfunctional some of them can be and how they are either missing or wrongly performing some aspects of care or not following all the hospitals policies and procedures and blow it off with.."I don't do THAT".With another top notch nurse the team works well...but still not as well as primary nursing.With an inexperienced or dysfunctional nurse where you have to both do your job AND assist the other...nightmare!

fiestynurse · May 20, 2001

This is not the OLD DAYS!! The team nursing that existed 20-25 years ago, when I entered nursing, was different from the so called team nursing that nurses are being asked to do now. Patients are in and out of the hospital much quicker and many procedures and tests are now performed on an outpatient basis. In the present hospital setting the acuity is much higher. All your patients require quite a bit of nursing care. In the old days the patients were in various stages of recovery or just in the hospital to have some tests run,etc. Todays team nursing is just a way to cut costs and deal with the nursing shortage.

LoisJean · May 20, 2001

Jeez, either some of us haven't been around long enough to know what 'the good old days' were, or some of us are so 'long in the tooth' we don't want to remember! I do know that the impact of working experiences depends greatly on geographic areas and institutional restrictions. My experience with team nursing was always most positive whether in hospital, LTC or Home Health Care. The areas and institutions in which I worked understood the scope of practice of the RN, LPN and aide and utilized those positions accordingly. The LPN used to be viewed and utilized as an Assistant to the RN. Every one knew what everyone else was responsible for...the RN supervised her aides and LPNs. She knew that her LPN could provide all the basic cares that an aide could plus all the skilled cares for which the LPN had been specifically trained. So I (and thousands upon thousands like me), received training in nursing school to do a great many things that, at that time, an aide could not do but an RN could. As my clinical experience grew so did my responsibilities; I was given more on the job training, took courses of all kinds, gained entry into the speciality areas where I could ultilze these skills...in different States and large teaching hospitals. All of my skilled training was provided by most excellent RNs who understood the absolute value of well trained LPNs. We worked along side of the RN and the aide. We filled in when the RN could not; we filled in when the aide could not; while the LPN passed meds, the RN might be giving a bed bath to help out an aide who was a bit behind; when the RN was imprisioned behind the desk and up to her kiester in paper, the LPN would make out care plans for new admits or update old ones; as LPNs we admitted and discharged; we took phone orders, we contacted the doctors when needed-these things were not done without the RNs knowledge, but the RN knew she could continue her job, initial our work and sleep well at night. The LPN could take her training into a LTC setting and demonstrate excellent skilled supervisory abilities often, as in my ten year experience, without an RN overseer. Speaking for myself and the LPNs I worked with at the time, we didn't blink an eye when the IVs needed inserting and the NG tubes had to be placed. At the beginning of my post I used the word, "was"...I don't work in institutional settings anymore. Looking over my resume I see that I accomplished wonderful things as a nurse. I see that it has been faithfully updated with many CEU credits; it shows my Professional and community services to date; it does not, however, show any type of 'in-house' or agency experience since 1995. That is because my skills are no longer wanted or needed. I continue to practice nursing, but not with you guys. I am an advocate of Team Nursing, but I liked it better when it was a Partnership. I cannot tell you how much I miss the 'good old days'...God, we worked so well together and had such great times, all of us. Remember how we'd all pull together for our patient's best? Remember how we'd work so hard together-we aides, LPNs and RNs, and then find a bit of relaxation and release together when our shifts were over? I'm not in a position to pack up and find the place where nursing personnel work with each other, where my scope of practice hasn't been blurred by insurance regulations, institutional requirements and an American Nurses Association who tells me I am 'limited'. I can put up with a lot because I'm older now and have gotten used to it. However, I am reminded of the words of a wise old man..he said, "Our world is being destroyed by the very same 'do'gooders' who are trying to save it".

Sorry for the long post--but it's my one day off.

fiestynurse · May 20, 2001

I also remember making $4.50/hr!! as a team leader!!

Brownms46 · May 21, 2001

Originally posted by LoisJean:
Jeez, either some of us haven't been around long enough to know what 'the good old days' were, or some of us are so 'long in the tooth' we don't want to remember! I do know that the impact of working experiences depends greatly on geographic areas and institutional restrictions. My experience with team nursing was always most positive whether in hospital, LTC or Home Health Care. The areas and institutions in which I worked understood the scope of practice of the RN, LPN and aide and utilized those positions accordingly. The LPN used to be viewed and utilized as an Assistant to the RN. Every one knew what everyone else was responsible for...the RN supervised her aides and LPNs. She knew that her LPN could provide all the basic cares that an aide could plus all the skilled cares for which the LPN had been specifically trained. So I (and thousands upon thousands like me), received training in nursing school to do a great many things that, at that time, an aide could not do but an RN could. As my clinical experience grew so did my responsibilities; I was given more on the job training, took courses of all kinds, gained entry into the speciality areas where I could ultilze these skills...in different States and large teaching hospitals. All of my skilled training was provided by most excellent RNs who understood the absolute value of well trained LPNs. We worked along side of the RN and the aide. We filled in when the RN could not; we filled in when the aide could not; while the LPN passed meds, the RN might be giving a bed bath to help out an aide who was a bit behind; when the RN was imprisioned behind the desk and up to her kiester in paper, the LPN would make out care plans for new admits or update old ones; as LPNs we admitted and discharged; we took phone orders, we contacted the doctors when needed-these things were not done without the RNs knowledge, but the RN knew she could continue her job, initial our work and sleep well at night. The LPN could take her training into a LTC setting and demonstrate excellent skilled supervisory abilities often, as in my ten year experience, without an RN overseer. Speaking for myself and the LPNs I worked with at the time, we didn't blink an eye when the IVs needed inserting and the NG tubes had to be placed. At the beginning of my post I used the word, "was"...I don't work in institutional settings anymore. Looking over my resume I see that I accomplished wonderful things as a nurse. I see that it has been faithfully updated with many CEU credits; it shows my Professional and community services to date; it does not, however, show any type of 'in-house' or agency experience since 1995. That is because my skills are no longer wanted or needed. I continue to practice nursing, but not with you guys. I am an advocate of Team Nursing, but I liked it better when it was a Partnership. I cannot tell you how much I miss the 'good old days'...God, we worked so well together and had such great times, all of us. Remember how we'd all pull together for our patient's best? Remember how we'd work so hard together-we aides, LPNs and RNs, and then find a bit of relaxation and release together when our shifts were over? I'm not in a position to pack up and find the place where nursing personnel work with each other, where my scope of practice hasn't been blurred by insurance regulations, institutional requirements and an American Nurses Association who tells me I am 'limited'. I can put up with a lot because I'm older now and have gotten used to it. However, I am reminded of the words of a wise old man..he said, "Our world is being destroyed by the very same 'do'gooders' who are trying to save it".
Sorry for the long post--but it's my one day off.

You have said it all very well LOIS! You and I must have worked at the same hospital . I enjoyed those days, and I'm again enjoying the same kind of supportive surrounding now. Thank God that in some places they still work well! Enjoy your day !

Brownie

Team Nursing?

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