Team Nursing, Does it work??? - page 3

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   fergus51
    Ick. I don't envy you a bit. I think management is just stupid to try to implement a change the staff is not behind and not provide the resources needed to do it. I can understand management pulling rank and saying "this is what we're going to do", but I can't understand them doing that and not giving you what you need to do it.
  2. by   missmercy
    They are really pushing the issue too -- we are facing a merger and they are looking for ways to trim costs everywhere! I am just greatfull that I am not high enough on the food chain to be disposed of at this point. It seems like they are just trying things -- anything -- without really giving it serious thought, researching or planning. It will come back and bite them in the rear -- always does. Just would love to have them hear me out.
  3. by   busyrninva
    we have been doing "team nursing" for about 7 months now. Basically on our Med/Surg and Pediatric floor. There is a RN who does all the admissions, discharges, assessments, documenting, calling the doctors and making rounds, drawing blood, putting down NGT's, small bore feeding tubes, assisting the physcians with treatments, deep suctioning and so on. The LPN, does all the medications and dressing changes or treatments that they are allowed to do. The CNA does the baths, and vital signs, and things like that. We have 12 patients to a team. If we get rid of 4-6 patients and the other team still has their 12, we will get the next 4-6 admissions.
    I do not know of anyone who likes this type of team. It seems as if no one really knows the patients at all where as in primary care nursing, we knew basciallly just about everything going on with the patient. It is ALOT of charting and paperwork for the RN who always has to stay over to get it done, and heaven help if you have to actually work 12 hours, give report and take a different assignment at three when you haven't even charted on everyone yet.
    Basically, in my opinion, if it was just 8 or 10 patients, it would be alright but 12?? Good grief ! It is very dangerous and threatening to the nurse as well as the patient. Wish governmnet would hurry up and pass a safe nurse patient ratio in Virginia, I can't take many more days like this. I like to sleep at night, but it's hard when you go home knowing the patients didn't get the care that they deserved.
  4. by   teeituptom
    Now in the old days Team Nursing worked
    even with up to 20 and 24 pts on your team
    but then again things were diff
    charting was much less
    Never even heard of care plans back then
    none of the puter stuff to slow you down
  5. by   dlmickley
    I work in a hospital that does primary care. My experience with team nursing came about 7 years ago as a family member; it was not good. My mom was in the hospitial after surgery for a brain tumor, having medical power of attorney I tried to find out what was going on with her care and no one could tell me any thing !!!! The responses I would get would be I'm only the IV Nurse or I'm only the treatment nurse or I'm the assessment nurse ........... you get the picture. How can any one really know what is going on or recognize any changes when you don't take care of the whole person ?? I personally do not like team nursing. And as a nurse I want to know what is going on with my patient at all levels and all areas of thier care. Thanks for letting me spout off a little !!!!
  6. by   teeituptom
    Quote from dlmickley
    I work in a hospital that does primary care. My experience with team nursing came about 7 years ago as a family member; it was not good. My mom was in the hospitial after surgery for a brain tumor, having medical power of attorney I tried to find out what was going on with her care and no one could tell me any thing !!!! The responses I would get would be I'm only the IV Nurse or I'm only the treatment nurse or I'm the assessment nurse ........... you get the picture. How can any one really know what is going on or recognize any changes when you don't take care of the whole person ?? I personally do not like team nursing. And as a nurse I want to know what is going on with my patient at all levels and all areas of thier care. Thanks for letting me spout off a little !!!!

    Thats cool
  7. by   mattsmom81
    Quote from dlmickley
    I work in a hospital that does primary care. My experience with team nursing came about 7 years ago as a family member; it was not good. My mom was in the hospitial after surgery for a brain tumor, having medical power of attorney I tried to find out what was going on with her care and no one could tell me any thing !!!! The responses I would get would be I'm only the IV Nurse or I'm only the treatment nurse or I'm the assessment nurse ........... you get the picture. How can any one really know what is going on or recognize any changes when you don't take care of the whole person ?? I personally do not like team nursing. And as a nurse I want to know what is going on with my patient at all levels and all areas of thier care. Thanks for letting me spout off a little !!!!
    This is not true team nursing, it's actually functional nursing. In true team nursing, EVERYONE on the team is responsible for their group of patients, and works together to get the job done.

    What you're describing is not team nursing as I knew it..just some crazy invention of someone who wants to CALL it team nursing.
  8. by   stbernardclub
    COULD BE POSITIVE OR NEGATIVE...DEPENDS WHO IS ON THE OTHER END AND THEIR EXPERIENCES....BEST THING TO DO IS ASK MANY QUESTIONS. ADMIT TO WHAT YOU KNOW HOW TO DO WELL, AND WHAT YOU MAY NEED EXPLAINED.IF ANYTHING, A NURSE CAN ALWAYS USE A HAND AT REPOSITIONING, AND PLEASE,HOLD UP YOUR END WELL, IT COULD MAKE OR BRAKE A PATIENTS BACK...GOOD DAY NURSES
  9. by   abbey5365
    If your admin. is pushing for team nursing, suggest a pilot program. Choose or ask for volunteers to pilot 2 teams for each shift consisting of RN, LPN, CNA. Define the roles of each team member, and the expectations. Communication among the team members is essential for this type of approach to nursing care.
  10. by   missmercy
    AH! The voice of reason! I think that is a great idea!! Yep, you guessed it! When the idea of piloting a team or two to see how it would go was brought up, our DON said "No! We are not going to let them pretend to try it and allow them to make it nonfunctional so that they can get their own way." :angryfire SO... team nursing, here we come -- dragging some staff kicking and screaming all the way. I did win one small victory-- -- told DON that I would not present the change and set a start date until they have hired 75% of the additional 10 people they need to hire to make it work. SHe didn't particularily like the idea, but agreed after I said that I didn't want to get everyone all psyced over a change until we KNEW we could get enough people to make it happen. I think appealing to the "we'll look stupid if we force this without the resources to make it work" plan was good.
  11. by   yaddadoit
    Team nursing is only what the team makes it! One person who is not a team player can make it very difficult for the rest of the team to be a success. I've been involved in team nursing off and on through the years. Most of the time I loved it, however, I just recently had one of the worst experiences of my career. I hired on with a local hospital who is trying to implement team nursing. I was the first LPN hired on my unit (I've had a lot of firsts in my career and was eagerly looking forward to this position). The second day on the job I sat down in report with all of the RN's (CNA's are not allowed to attend report there--first time I've encountered that in a team situation)-- the charge nurse for the day informed me that although she had nothing against me personally that the RN's didn't want me there, resented me and that "people like you are hired to put people like me out of a job". :angryfire When I went to the unit supervisor to inform her of what I had been told, she told me that my coworkers "would just have to get used to the idea of LPN's whether they liked it or not". I stuck it out for 6 months and finally reached the end of my endurance and resigned. After the fact, I was told that the unit supervisor did not want LPN's on the unit and had been forced to hire me by hospital management.
    One of the biggest obstacles to success of this team is that there were no clear cut guidelines for LPN's to follow. The expectations changed daily. Many of the RN's on the floor were supportive and positive. However, it's really tough to count on a team member when you don't know what the role is. For example, initially we were told that LPN's were not allowed to do physical assessments, then we were, then we were not again, the same happened with admissions, discharges, patient teaching. Also, for whatever reason, when changes were made about what could/couldn't be done, the entire staff was never informed, just a person here, or a person there. That left room for a lot of "well I thought you could do this, or you did it yesterday, why couldn't you do it today". I could write a book about the things that happened to me on this unit, but the bottom line is, team nursing was set up for failure in this situation.
    Yes, team nursing does work. Each member needs to be clear about what the expectations are for all of the other team members as well as themselves. Communications need to be clear. A team is only as good as the members choose to make it!
  12. by   fiestynurse
    Team Nursing does not work in the current health care environment, where patients are more acutely ill and their care is complex. In the "old days" of team nursing you might have 10 patients on your team, but only 2-3 were critically ill or fresh post-ops. The others were pre-ops or in for tests or 4-5 days post-op (in the days were patient stays were longer)

    recent studies show that higher licensed nurse staffing levels prevent complications and unnecessary deaths:

    Low nurse staffing levels leave nurses too overburdened to monitor patients or prevent medical errors adequately, which cause up to 98,000 preventable deaths each year.

    For each additional patient over four in a registered nurse's care, the risk of death increases by 7 percent for surgical patients. In hospitals with eight patients per nurse, patients have a 31 percent greater risk of dying than those in hospitals with four patients per nurse.

    Understaffing was a contributing factor in 24 percent of all sentinel events (unanticipated incidents in hospitals that led to patient deaths or injuries) reported to the Joint Commission on Accreditation of Healthcare Organizations (JCAHO).

    In hospitals with fewer registered nurses, patients are 2 to 9 percent more likely to suffer complications like urinary infections and pneumonia, 3 to 5 percent more likely to have a longer stay in the hospital and 2.5 percent more likely to die from "failure to rescue" (conditions that might have been reversed if treated in time).

    An extra hour of nursing attention per surgical patient each day cuts the risk of urinary tract infection by nearly 10 percent and the risk of contracting pneumonia by 8 percent.

    A higher proportion of care by registered nurses results in a lower rate of medication errors and patient falls.

    This is why the nurse/patient ratio bill passed in California.
  13. by   fiestynurse
    **********
    Last edit by fiestynurse on Mar 31, '04

close