Team Nursing, Does it work??? - page 2

My hospital wants to go to outcome based nursing called Bold Steps. You see the abbreviation? It is based on a Racine, WI. hospital and it is essentially team nursing with an aide or an Lpn with 6... Read More

  1. by   purplemania
    we don't allow LVN's to do shift assessment. Therefore, an RN has to do all assessments. I worked a pedi floor where most pts. had IV's and LVN's are not allowed to do IV pushes. LVN's are not regular staff on our floor but "float" when census demands. So I did all the assessments for my 5 patients and the LVN's 5 (10 total). I also did all the IV pushes for 10 people. And the charting of each of these things. And all the IV starts (the LVN would say "I can't do kids"). Plus, I had to re-assess when changes occured with all 10 patients. That is why I said working with an LVN was more work for the RN. Other states and facilities have different rules of course.
  2. by   teeituptom
    I dont think pt loads were different back then

    However all the charting and computer work has added significantly to our workload.

    compare charting now to back then
    which is really better
    back then you did more pt care and less paperwork
    now its less pt care and more paper and or puter work
  3. by   fergus51
    When my aunt started nursing women stayed in the hospital 7 days after giving birth and anyone with an epidural insitu had to be in ICU at her hospital!! She had the same patient load as a nurse nowadays, but they weren't nearly as acute.
  4. by   missmercy
    One of the units in our facility is supposed to go to "team nursing" too. Upper management is pushing hard to get it going because they are saying it will save tons of money and drastically increase patient satisfaction numbers-- I am not so sure ... the gals in that unit HATE the idea -- said they have tried it before and it didn't work and they are reluctant to try it again. At this point, their staff mix is not condusive to the setup anyway, but administration seems oblivious to that little glitch. they are wanting the unit to "switch" within a 3 week period. Of course, if the unit crew is not on board -- it could be ugly.

    The RN's on the floor are nervous about delegating things -- aren't real sure what can be delegated and how they can KNOW that the things they DO delegate are going to be done well. I realize that LPNs are licensed personel and they can be held liable for things that fall under their scope of practice.... so as long as assignments are made within that scope -- have to be familiar with the nurse practice acts within the state and know the talents/abilities of the LPNs and STNAs on the team.
  5. by   mattsmom81
    Team nursing worked great when I was a new grad...but this was in a facility where it was part of the culture and everyone DID buy into it. We also had really good CNA's and nurses who were committed,longterm employees. We also appreciated each other's contributions, and the job descriptions were very specific.

    So yes team nursing CAN work...with all the right ingredients. The whole facility system and environment of care today makes it more difficult to implement IMO.
  6. by   veetach
    I work in a very busy ER, and we have always had "team nursing". It works well, the only problem is the lack of accountability for some nurses. Most of our RN's are hard workers and are very productive where patient care is concerned. BUT, there are some who like to look busy and have been found to be very non productive. That means someone is picking up their slack.

    After more than 20 years of team nursing we are investigating a primary nursing approach. go figure.....
  7. by   abbey5365
    I work in a small suburban hospital in the midwest. The MED/SURG unit averages 24 patients. We have been doing team nursing since '96. It works. But, only because all the RN's, LPN's and CNA's are dedicated to making it work. The teams are usually RN/LPN (6-8 pts) or RN/CNA (6-8 pts). Occassionally a RN will have TPC (no more than 4 pts). This unit gets everything that walks through the door or comes off the OR table unless they need tele or ICU. Peds, ortho, chemo, etc. There are some days that you will start out with your team and by the end of the 12 hours you have discharged most of them and admitted more to your team. It is a very busy unit with a lot of turn over because we don't have a separate unit for the 23 hour surgeries. We support each other without hesitation. When new staff is brought in they stay if they like our approach or if not they eventually leave. Some come back because the grass is not greener in some of the larger hospitals in the city. In order for team nursing to be successful, the staff has to make it work. We have a day shift nursing supervisor who is usually right in there helping. The dept. manager is usually in meetings and offers very little help to the staff. I think one of the main reasons this works is because our Chief Nursing Officer supports the team nursing approach. She is the one that set it up in '96. She also battles for the nurses on the admin. level. It is a great place to work. For those of you who may be changing to this approach...keep an open mind. It can work if you let it.
  8. by   missmercy
    Any suggestions as to how to encourage some of my staff to try it? They are REALLY resistant to change at this point (can't say that I blame them -- we're looking at a merger w/ the other hospital in town in July) -- the acting DON (she's interem -- are geting a new on w/in the next couple of months) is pushing for this change (like we NEED ANOTHER one) on one unit -- but we don't have the right staff mix or the staff buy in. GRRR!!!! I am thinking that this is not a real good time to force the change -- but I think she believes that it's a good time because everything is in flux anyway. WHat do you guys think?
  9. by   teeituptom
    It worked before and it can work again
  10. by   fergus51
    If you don't have the right staff mix I don't know why you are even discussing it.
  11. by   missmercy
    Quote from fergus51
    If you don't have the right staff mix I don't know why you are even discussing it.
    The upper mucky-muck are assuring us that the right people are "out there" to fill the gaps and provide the needed mix. My opinion, frankly, is that as long as they're "out there" we can't implement the change "in here"! I am not about to sell the idea if there aren't people in place to make it work! I had a meeting with the "big boss" this morning and told her that we could revisit the issue after I had names of the folks who were going to fill the holes on my orientation roster.... she laughed. We'll see -- jut another chapter in the continuing saga of non-nursing personel trying to make care decisions without getting input from the rest of us!!!
  12. by   fergus51
    EXACTLY!!! There are a lot of things "out there", but if you don't have access to them in the hospital there is no way it's going to work.
  13. by   missmercy
    I think one of my favorite (sarcasm dripping from the word) phrases our administration has handed out lately is "There are all sorts of resources available" while they are rubberstamping "DENIED" on our check request forms to purchase much needed equiptment. Unless they have some idea of what "life in the trenches" is like -- they live in a different world. I guess my job is to help them see what it's like "in here" where resources are scarce, staffing is short and hours are LONG!!

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