Charting at bedside and team nursing question

[tokmom, BSN, RN]

My hospital is gearing up to move to a newly built hospital. I'm excited about this but am wondering about a few new approaches management wants to try.

The first is computer charting in the rooms. We have to have computers in the room for medicine scanning, so we are used to being in rooms for long periods of time. Now management wants us to chart in the rooms and not be at the station for charting. The computers will be on either side of the head of the bed. The nurses are having fits and I can't blame them. For starters, no patient wants to listen to clicking of a keyboard at 2 am. Secondly, nurses are worried the pt will sit and chat while they are trying to concentrate on charting. How can you politely ignore a pt while you are trying to concentrate when you are literally next to their head? Mangement thinks this will help with customer service as the patient will feel more looked after since the nurse will be in there a lot. Too much in my opinion.

Second: management wants to attempt team nursing. It would be 2 RN's and a CNA. Once again how well does this work? I can see it being a disaster. We have many weaker nurses and the stronger ones would be carrying a huge load while the weaker ones were clueless. I told my manager these concerns and he said that was the reason for doing it. It made me upset. If I work with another RN it should be as an equal. I didn't sign up to babysit another nurse. Many nurses have said they'd quit if we go this route.

Another option is primary. Not sure how'd that work if we have CNA's and another approach called Care Partners. Ever heard of that?

[Annaiya, NP]

We have computers in all of our rooms, but I still do most of my charting at the nurse's station for the exact reasons you mentioned. I work nights and there is no way I'm going to stand in the dark and try to quietly chart all night. That is crazy. I used to try to do a lot of my inital charting in the rooms, but I found that I would miss things because I couldn't concentrate well enough with patients and families talking to me. Also, it is really uncomfortable for the families to have you just standing in the room when they don't know what you're doing on the computer. It just makes for an uncomfortable situation, which is why I think they always end up trying to start a conversation. I do not see standing in the room staring at a computer screen making any patient feel less "ignored." I strongly believe that it isn't quantity it is quality when it comes to time spent with patients.

As for team nursing I've never heard of it. It sounds like a staff disaster waiting to happen, imo!

[tokmom, BSN, RN]

Just as I thought. As a pt, I wouldn't want the nurse in the room typing away.

[APRN., DNP, RN, APRN, NP]

I would abhor standing at the bedside with my "infection control outfit" on with a patient in isolation. Pure torture.

[SummitRN, BSN, RN]

So management is basically saying: "we don't think that standing up most of your shift is enough... so could you please stand while you chart too?"

[lkwashington]

Several years ago, the facility I worked had team nursing. One nurse passed meds, the other did all the assessments/treatments, and the CNA helped with treatments if needed and they did their assigned duties. I was told it worked. So I guess it depends how management go about I guess. Everyone have strengths and weaknesses. It may work atleast give a chance. If it dont work inform you NM. Good luck.

[Up2nogood RN, RN]

We have computers in each room also and are expected to chart in real time. I do find it easier to chart initial assessments in the rooms because I tend to forget where things may be located. But during the night I will go outside their rooms to chart when they're sleeping. It takes some getting used to but having families in the room doesn't bother me in the least bit. I will tell them what I'm doing and ask them questions also to involve them in the plan of care. A lot of times you can glean excellent info from family members when the pt is too sick to remember or care.

I'm not familiar with team nursing but it sounds like too much to start all at once for your unit.

[CoolKell10]

I think charting at the bedside would be a disaster. I know that I wouldn't like it. There's many nights where I'm so busy that I can't chart until 1-3am. By then, hopefully, most of my patients are asleep. I wouldn't want to come in their room and wake them up because of having to chart. I could understand that it would make it easier to remember things about your assessment when you're in the room, IV location, etc etc but you should already know some of those details from report, etc.

As for team nursing...I've never been involved in it but heard of it working great and being horrible as well. I guess it depends on the type of floor that you work on and what your co-workers are like. I could see it not working out if you get paired up with a lazy nurse or something like that. G'luck!

[Up2nogood RN, RN]

CoolKell10 said:

I think charting at the bedside would be a disaster. I know that I wouldn't like it. There's many nights where I'm so busy that I can't chart until 1-3am. By then, hopefully, most of my patients are asleep. I wouldn't want to come in their room and wake them up because of having to chart. I could understand that it would make it easier to remember things about your assessment when you're in the room, IV location, etc etc but you should already know some of those details from report, etc.

As for team nursing...I've never been involved in it but heard of it working great and being horrible as well. I guess it depends on the type of floor that you work on and what your co-workers are like. I could see it not working out if you get paired up with a lazy nurse or something like that. G'luck!

Really it is such a breeze with our computer charting! I can be in and out of a room, do a thorough assessment on a surgical pt and chart it in 10 minutes. We chart by exception so it's a copy, paste, scroll thru each body system, make changes if needed, and put in a note in each individual category if desired. I'm all done with everything except for care plans, pain with prn's, and I & O's in less than 10 minutes, sometimes longer if I'm talking with the pt and/or family. With our system I've found more time with the pt and less with charting. Everyone's system is different though and that can make or break charting at the bedside IMHO.

We do bedside rounds with the oncoming shift so we aren't expected to give each other every minute detail in shift report. Just pertinent details and safety checks.

[tokmom, BSN, RN]

I can see the good and bad. I can chart quickly but once again the weak nurses will constantly be in those rooms for a long time. One nurse takes a half hour for one patient. It won't matter if she drags her feet. If we are doing team the strong nurse will end up picking up the slack.

[KneKno]

I think team nursing requires a lot and almost constant collaboration between the team leader and the other staff members. I'd think that would be difficult if all the team members are charting in their pt rooms.

What's the hospitals goals? What are they trying to accomplish with the change in care delivery mode? Are there not enough staff? Too many nurses staying too late? Pt complaints about care? What's the hospital trying to fix?

[OttawaRPN]

Team nursing is the approach many hospitals are trying to get away from. At least with primary nurse model of care there's a good opportunity to establish a strong nurse-patient relationship, ensure continuity of care and no excuse for missing something on your patient you thought someone else was supposed to know. I say nuke the team nursing plan.