Charting at bedside and team nursing question

[tokmom]

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?

[Up2nogood RN, RN]

tokmom said:

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.

Why do they want to go to team nursing, to cut staff and corners?

With primary nursing, bedside charting works ideally.

[jbee]

I just started a new job in which there's team nursing and bedside charting. I've been working in this hospital for three weeks, and so far there's been quite the learning curve!

Re: team nursing... The "team" is two RNs paired with one CNA for twelve patients. So far I find it VERY disorganized... there are just too many cooks in the kitchen! I never know when anything was done last (ie. dressing changes, routine vital signs) and things get done twice in a row. For example, today I took a BP on a patient, left the room for a quick moment, and came back to my partner taking the patient's BP as well. It never hurts to double check a BP, of course, but what would happen had one of the nurses forgotten to sign off a med that was passed? A lot of the nurses that I work with prefer that we split the patients and check in with one another throughout the day... I must say, I prefer this method of team nursing, as well. Sometimes we divide the tasks up as a team... for example, one RN will grab the vitals for all of the patients while the other grabs the meds. So far, I've learned that team nursing requires a great amount of communication, patience, and organization. It seems to work well when the team gets along well with one another, but when you have one person with a bad attitude/work ethic the day seems to drag. As a previous poster mentioned, some days it does seem as though one nurse picks up a lot of slack.

As for bedside charting, I hate it! It's IMPOSSIBLE to chart in 4 bed wards- your attention is pulled in too many directions. It can also be difficult to dip into a room to chart and listen for call bells at the same time. Unfortunately, we have paper bedside charting, which must be a huge infection control issue. I also wonder if it could be seen as a privacy issue: there's nothing preventing patient in bed #1 from reading bed #2's notes.

[HouTx, BSN, MSN, EdD]

I certainly agree with th PP's astute observation -- trying to institute 2 major care delivery changes at once, especially while trying to adjust to a brand new environment, is a recipe for disaster, since both changes will require bedside nurses to change the way they organize their days. Trying to do both at once will absolutely produce chaos. I only hope that the management staff realize that each of these changes will also have a huge impact on productivity & adjust staffing accordingly.

I disagree with the PP who stated that most facilities are trying to get away from team nursing. Just the opposite is happening as hospitals are trying to figure out how to cope with ever-decreasing revenues without compromising patient care. RNs are the most highly paid caregivers and it doesn't make good business sense for them to perform tasks that lesser-paid staff can handle.

Of course, since I am as old as dirt, I have worked in team nursing environments that were very successful. The key to success is for each team to have a leader even if all members are RNs. The transition from 'every nurse for herself' to team nursing is not easy. Effective team leading requires a very specific skill set. If an organization is serious about implementing this care model, they need to provide training.