Absence of Teamwork

[Ruby Vee]

nursing has changed a lot in the past thirty years, but when i reflect upon it, it isn't so much the technology, although that is definitely a factor. it's more about the nontangible things -- ethics, the courtesy and gratitude of patients and their families, and the teamwork of the staff. if i had to put one of those above the rest, it would be the lack of courtesy and gratitude. but a close second would be the absence of teamwork.

team nursing was still the unit structure when i started nursing. primary nursing had just come into vogue, but it hadn't yet filtered down to the small midwestern community hospital where i was working. we worked in teams. thirty beds, fifteen to a hall. two teams led by an rn and staffed by a combination of one or two of the following: a less senior, less experienced rn, a lpn and /or an aide -- because that's what we called them then. the assignment was a shared one: the two of us or the three of us were responsible for our 15 patients. the team leader passed scheduled meds, called the doctors, took off the orders, etc. the lpn or junior rn did prn meds and treatements. and the team member or members were responsible for adls and toileting. we all worked together.

i remember working with an na and cranking out 15 baths and linen changes together in a morning. we'd go into a room together and work together until that room was finished and move on to the next one. if someone's patient was incontinent anyone who was free changed him and everyone who was free helped. the closest person answered a call light. there was camaraderie. we worked together. there was none of this sitting at the nurse's station while everyone else was busy running around. either we were all working or we were all sitting.

these days, or maybe it's just this unit, we don't work together. we can all work in one big room, six patients. one nurse is running her posterior off while a second sits on hers and looks at facebook and the third does chart audits and bugs the first nurse about missing admission documentation rather than offering to help with the hourly glucose checks, taking a line out or pushing a wheelchair down to the step-down unit. the 20-somethings are all friends, which is great. they'll help their friends out if needed, but they won't help anyone else unless asked directly and even then sometimes they won't. i remember trying to make a patient comfortable a few weeks ago -- you may remember that vent -- and the 20-something guy i asked to help me came into the room, helped me boost my patient and then went back to his facebook page while i was still asking the patient if he was comfortable yet or if he wanted to be turned some more. the charge nurses will sit at the desk and read your computer charting in between bids on ebay and call you to come out to the desk and explain why you haven't gotten the hourly glucose for 80 minutes rather than getting up and coming to help you out or at least to investigate. did you fall asleep in your room? are you wrestling with a sundowner? did you have a syncopal episode? did your computer crash the minute you finished your charting but before you signed it? or are you too freaking busy to get to the glucose and thus possibly too busy to come out to the desk and explain why you didn't?

years ago, i was involved in a sentinel event. among many other factors was the fact that instead of helping me with an overwhelming assignment that included one patient crashing while an inept resident attempted to do a procedure on her while the other (stable) patient screamed continually for ice and her family kept pushing the curtains back to threaten me with legal action or bodily harm because i was "ignoring sister because she's black," the charge nurse was sitting at the desk reading my computer charting and commenting to all of the other nurses on shift who were sitting at the nurse's station about what i was doing wrong. how would she know? she never even popped her head into the room to look? nor did anyone else who was listening avidly to lab values that charge was reading out: glucose of 22, hemoglobin of 5.9.

i'm not saying all nurses are like that, or even all of the nurses where i work. but it's an alarming majority.

i miss the gratitude and courtesy of patients and their families. but i sure miss the teamwork, too.

[jkaee]

Ruby....your post made me nostalgic and sad. It was that kind of atmosphere that made me excited about nursing, when you could acutally be a nurse and not (as another poster so eloquently put it) "nurse the chart more than the patient." I loved hands on nursing, including bed baths and changes, as much as any other aspect. I would jump back to floor nursing in a heartbeat if it could be that way again.

[OgopogoLPN, LPN, RN]

I completely agree! And I don't even have any years of experience to compare to, just different floors/wards that I work on.

There is one place I completely REFUSE to work due to lack of teamwork and poor, poor communication. I've turned down two 12 hour OVERTIME (double pay) shifts to this place because of how horrible some of the staff are.

[pagandeva2000, LPN]

It breaks my heart to see how nursing has broken down. Sometimes, I suspect it is managed care, new insurance rules, remodeling the physical structure of the hospital, etc...

I watched my grandmother, who was a supervising RN of the OR work. The CNAs and nurses were a team. I remember when I used to work in psych and would bring my patients to the current hospital I now work in as a chaparone. My mother worked as a CNA in some of the same clinics I currently work at as an LPN. I remember meeting these nurses, and I noted that they ALL pitched in to help each other and the CNAs. I remember sitting and chaparoning psych patients on the med-surg unit and I saw the nurses who had MORE patients than now gather together with the CNAs for bedmaking and bathing. CNAs knew how to do simple dressings, would let the nurses know if the IV was running out. Some even knew how to change normal saline bags for the nurses. LPNs were not considered to be 'less than' as much. The team nursing model had more successful outcomes to me than this primary nurse model. And, I also noted that NO ONE went home physically or mentally tired, unless the day just went BANANAS!

Nursing staff had productive lives, then. Even the ones that work evenings and nights. No exhaustion to the point of neglect of their homes, families, etc... Now, with all of this charting ridiculous crap, computers timing how long it takes a poor nurse to care for patients, more cut throating,etc, the stress has hit it's all time high.

I remembered wanting to work in my hospital. I already knew everyone, because they watched me grow up. Now, only a few people that remember us are there, and sometimes, I feel that the minute I walked through the door was when I noted a decline in the morale of the nurses and patient care.

Nostalgic? Yes, I am. So, I do understand.

[PureLifeRN]

You wanna know why the "team" mentality stopped? Because when sh**t hit the fan, and the public started going crazy suing for medical malpractice, they couldn't sue "the team." The sue the RN. Logistically, I wouldn't want to be on the hook for 10-12 patients and depend on someone else to do their job (how many posts do we see about lazy co-workers??). I would rather take my 4-5 patients, have a tech that will sometimes do vitals and a bath, and go about my day. It's all about covering your butt.