Functional / Team Nursing

P_RN, ADN, RN · Feb 13, 2003

Do a search here on team nursing. This has been discussed many times. Do a search on GOOGLE.com (over 1 million related sites) or another search engine. Look in the library in the various journal indexes for team/functional nursing. Good luck.

EMTPTORN · Feb 13, 2003

did everything you said already.

RNinICU · Feb 13, 2003

We did a form of team nursing at our hospital years ago. An RN was in charge of each team, about 12-18 patients. RNs were responsible for assessments, signing off orders, patient teaching, physician rounds, calling docs, giving IV meds and generally managing patient care. There would be two or three LPNs on the team, each assigned 5 or 6 patients. LPNs did all direct patint care, including giving meds, dressing changes, bathing, and most of the documentation. There would usually be one aide split between two teams to help with care. We have not done this kind of team nursing for years though. You may have a difficult time finding resources. Hope this helped.

EMTPTORN · Feb 13, 2003

RNinICU,

Yes that did help some, can you remember what was good and bad about it? Also, are you familiar with the functional nursing concept? Thank you for your time.

EMTPTORN

Darlene K. · Feb 13, 2003

I did team nurses about 4 years ago. 1 RN, 1 LPN, 1 CNA. We normally had about 11 patients. I thought it worked well. The RN did the assessments and the IV push drugs. The CNA and I would work together and I would give the medications and help her/him with turning the patients. With the right team all three of us could have a great night no one left feeling overloaded. Sometimes with primary nursing you are the only one responsible and if you have a heavy patient- there is no one to help you.

Dr. Kate, BSN, RN · Feb 13, 2003

Go to the library. Ask the friendly librarian for help. To get this information you're going to need to get into some older material, 60s and 70s stuff, maybe older than that.

See if you can get a hold of a copy of Thora Kron's The Management of Patient Care, from the 1970s. She does a nice job of describing the various systems of patient care delivery.

And not to be too contradictory. While your instructor is right that these are antiquated systems of care delivery, they are very, very efficient means of delivering care when there is shortage of RNs. No one should be too surprised if we start to see these older systems of care delivery "reinvented" and/or reintroduced as the shortage of RNs becomes more acute.

Oh, functional nursing involves having a specific nurse who does medications, one for treatments, one for orders/unit management, and some for direct physical care.

IMHO, the greatest benefit of team nursing, and probably functional, is that they provide a way for nurses to leanr the skills of supervision while dealing with patient care. I am convinced that the wealth of bad managers we are seeing today are a direct result of no one having leaned supervisory skills at the patient care level. (No one has learned team nursing since somewhere around 1980.) I really think that to manage people you haev to learn the skills, and functional and team nursing helped nurses learn them. But that's just my opinion.

EMTPTORN · Feb 13, 2003

Thanks Dr. Kate for your definitions and insight. To me the team nursing style sounds pretty good.

EMTPTORN

jemb · Feb 13, 2003

I just went into GOOGLE and found tons of info on "team nursing" -- just not on the first page of results.

Having worked agency for a number of years, I've had both good and bad experiences with team nursing, depending on how the particular facility tilized the system.

Several places I've worked, as recently as three years ago, did team nursing.

Charge RN would make any necessary calls to docs, etc., check off orders (and implement orders if no secretary), coordination type stuff,

RNs would be responsible for assessments, IV meds, blood products, carrying out new orders , and delegation to LVNs and CNAs.

LVNs would do most treatments, pass po meds, IMs, prns(including insulin coverage).and possible blood products if the hospital's policy allowed it.

CNAs would assist with ADLs, do VS, weights, accuchecks if hosp policy allowed, and many incidental chores.

I found that the team system worked well when there was a charge nurse , but not all places have a charge. Then the RN on each team makes all the calls, takes off the orders, and still does patient care. Plus, for a team system to work, the team must have a reasonable patient load. I've had everything from five to fifteen patients under one team's care.

Advantages: More than one personality on the care team gives a better chance that the patient will have a caregiver they can relate to; more people are popping in and out of the patients' rooms so a problem might be noticed earlier (assuming good staff).

Disadvantages: Communication may get lost in transit from patient through the various caregivers; docs sometimes don't care who they talk to and don't understand why the verbal order given to a CNA wasn't carried out before the RN finally tracked down the doc for clarification; and, if the team is caring for a large # of patients, the RN is responsible for picking up anything that the LVN and CNA don't have time to finish.

Does this help?

EMTPTORN · Feb 14, 2003

jemb,

yes that did help, thanks.

I learned the "advanced search function" on google today ( I guess i am slow) this time i found tons of pertinent stuff on the topic, so with the help of ya'lls posts, and with this new found research, i will be fine!!

later

jax · Feb 14, 2003

I work team nursing at the moment. There are approx. 14 RN's in one group of nurses and we work the same bed allocations for one month. Two RN's are allocated to our area on am/pm shifts, one on night duty ( 10 - 11 pt's). We work together and do total pt. care. It's generally one experienced RN and one not so experienced. It 's good for pt. continuity, I work ortho, lots of trauma so quite a few long termers. It's a good opportunity to teach junior RN's, you cover each other for breaks, and as long as people pull their weight I find it a very enjoyable way to work..

RNinICU · Feb 14, 2003

Quote

Originally posted by EMTPTORN
RNinICU,

Yes that did help some, can you remember what was good and bad about it? Also, are you familiar with the functional nursing concept? Thank you for your time.

I would actually like to see our hospital go back to team nursing. I think that patient satisfaction was higher, and staff was happier with this method of care delivery. LPNs at our facility are now basically med nurses, and aides do most of the direct care. I think the LPNs felt more valued when they had more patient contact. And I am not putting down CNAs, but I believe that LPNs are more likely to see a developing problem and either intervene, or bring it to the RN's attention than an aide is.

There were disadvantages, too. Some times a 12-15 patient workload could be overwhelming, especially if acuity was high. You could also get tied up with a patient that was having problems, and your other patients would be slighted. All in all, I liked doing team nursing. Hope this helped a little more.

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