changing to team nursing

lisa122 · Oct 14, 2004

Lisa122 Is There Always A Rn, Lpn, Aide On The Teams? What Kind Of Unit Do You Work On? Before Team Nursing How Were You Providing Patient Care? Why Did Your Facility Change To Team Nursing

We have one RN, one LPN for about 10-12 patients, usually only have one CNA so they are helping with 20-24 or sometimes 30 patients. I work on a busy med-surg/oncology floor, we used to do primary nursing with a 1:5 ratio, and it seemed to work just fine, we were always helping others if they needed it, we always worked as a "team", but didnt have to chart on everyone, only our five patients. From what i understand our facility is going to team nursing because they believe there will be a nurse in the patients room more frequently. My experience, there may be someone in there, but they are not as familiar with the patient's status, past medical hx, or new orders or changes in condition, as they have 10 other patients to worry about, and the charting is not always in front of them. Also, the RN is responsibe for checking, and signing off on orders so they LPN or medication nurse is not always aware of what is going on until later. Maybe this will work out when we have more of a system in place, as I said before i think computer charting would greatly benefit us!

skay · Oct 15, 2004

thank you for the input. i plan on sharing it with my peers. today was a better day till late afternoon when the admissions came.generally that is when we get hit with admits. we had 2 teams today. one team with rn/rn/na they had 9 pts. to start. team 2 had 2rn/1lpn/na who had 12 pts. team 1 had 1 discharge took in 2 transfers from cicu and 2 admits. team 2 had no discharges took in 2 admits. team 2 had 1 rn do all assess 1rn pass med on 6 lpn pass on 6. team 1 rn all assess 1 rn meds. any thoughts on this? tommorow same rn/rn/na will have 10 pt. team 2 will be rn/lpn/na and then x rn is going to take 6 pts passing her own meds and doing own assess. the two aides will split her patients along with their team assign. is this workable ? guess we will see.

P_RN, ADN, RN · Oct 15, 2004

Exactly the same. 30 beds/3 teams of 10 and a charge nurse.Love it. We started it in 1990, and it is HEAVENLY! You always have a relief. The charge nurse cheecks off orders and passes new orders and stat ones to the team leader. Your tech does all the baths and charts basic vitals. Usually the LPN did the 9am meds while the RN did the assessments. The 1pm meds and post op vitals are shared by the 2 nurses. Beautifully done.

purplemania, BSN, RN · Oct 15, 2004

One thing we have tried that seems to help (since we are not doing computer charting YET), is to have a small binder representing one bed. The nurse's notes and the MAR go in the binder. Whenever the RN, LVN or student nurse needs to chart, they grab the binder. Whenever anyone gives a med, they grab the binder and take it into the room (it really has decreased med errors related to ID of patient, etc.). At least our charting is able to be done on a timely basis. But it is a pain to do team nursing. The RN's resent it because they are ultimately responsible for everyone they have assessed, even though an LVN is caring for the patient.

P_RN, ADN, RN · Oct 15, 2004

What time frame are you talking about to get it going? It's not going to work instantly. Best thing we did is the teams stayed exactly the same....Room 1-10, team I etc etc.

The RNs have always been responsibe ultimately for assessments and management of their patients.That came with the job. Team nursing didn't change that. In a Team you have 3 people who have the information plus the charge nurse........In primary you have one person......now if a patient gets in trouble which team has the advantage of knowing all the particulars?

I'd say it took us about 5-6 months to get it set up,:balloons: and by the end of a year no one would ever go back to the old way.

skay · Oct 16, 2004

change is difficult. our rooms to not go in a section like 1 to 6 etc etc. mainly because our difficult total care patients are often put in these rooms therefore one team gets the heavy load. actually the geography of the assigned rooms is not a problem the staff prefers this to having all complete care pts. we do not have a charge nurse but our unit manager. our teams could have 13 patients to 1rn 1pn 1 aide but most of the time that team would have 2RN 1LPN 1 NA. the work load has been split diff. ways 1. 1 RN does all assess. 1RN and LPN split meds to orders help aide. 2. both RN split asess. and LPN passes meds. any other ideas? another day there was 2 teams with 3 counting the aide and the x RN took her own pts.

ShirleyS · Jun 14, 2005

Anyone have any helpful hints for team nursing. Our hospital is now changing to team nursing and we are having a difficult time adjusting. How many patients has anyone had on one team as well as how many nurses. We have tried two nurses for 10-11 patients and it is hard for both nurses to chart on the same chart without having to make late enties, etc. Any help is appreciated!!

Hi, Lisa....I've found it works better to have a teams of RNs, LPNs and NAs. How many beds does your floor have? Once I get that info, I'll be able to give a better answer. Team nursing is WONDERFUL!! Shirley

ShirleyS · Jun 14, 2005

Team nursing sucks if the people on your team are lazy and you have to pick up the slack.
I did it once 10 years ago. The RN was unit coordinator and stayed at the desk, made us aware of new orders, made rounds with the docs. Usually had 10 or 11 patients. Even though I'm an LPN, I was usually team leader, other LPN passed meds, and a CNA. I assessed the patients and the RN would come behind and sign after me.
I worked my tail end off. The LPN would pass meds and nothing else. I would be starting foleys, IV's, address changes in patient's status, assist patient's on the bedpan when the CNA was busy elsewhere, etc. Responsible for all the charting and signing off new orders, making sure they were all carried out. Busy med/surg floor.
It was a horrible experience and I wouldn't wish it on anybody. As far as co-workers go, it's like a box of chocolates. You never know who you're gonna get.

I love team nursing! It appears you had a poor RN leader. That's too bad...the experience could have been so much better. The patients seem to like team nursing, too.

snowfreeze, BSN, RN · Jun 14, 2005

Maybe 'teaming' should be more awareness of who had what and needs what...Just everyone helping out when needed. We need to make sure everyone gets their breaks or they will not work well and we need to make sure our patients get their needs met as well as we can.

ShirleyS · Jun 14, 2005

The hospital I work in utilizes team nursing. We are supposed to run our floor with 3 RN's, 3 LPN's, and 3 aides. Each team has 10 patients (Many x's we have 2, 2, and 2 with 15 patients on each team). The RN's are responsible for assessing patients, charting, and certain IV medications. The LPN's are responsible for medications, and charting meds given. The aides are responsible for vitals, baths, etc. Ultimately the RN is responsible for EVERYTHING that is done, and is why you hope that you have a good LPN and aide on your team.
On the floors, we chart on computers and do not have problems with more than one nurse trying to chart at the same time. When we look at our charts to verify orders, I usually start at one end, and the LPN starts at another. The LPN is looking for medications, and the RN checks it all. That's how we do things, and it seems to work out fairly well.

Team nursing works well with RN/LPN/NA members of the team and if all members understand their job duties and help each other. It's sad to read so many articles about bad team members when the team concept is great for patient care. In my experience, primary nursing creates tunnel vision, chaos and patient's always asking, "where's my nurse?" Actually, I think both models work well if you have caring, compassionate, responsible staff. It also sounds like you experienced poor nursing leaders who didn't deal properly with behavior and/or care issues.