how do I present my concerns without seeming negative?

Nurses General Nursing

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Specializes in M/S, SNU, Office, and Private Duty.

On my skilled unit (which I have been on for barely 6 months), there are many many changes going on. The biggest change is that we are going to team nursing. The change was piloted when I first started and things started to go down hill from there. From what I understand the NM did this just to see how it would work, well the higher ups heard about it and implemented it on the 1st of July.

Well EVERYONE is extreemly upset and negativity begats negativity. However even if everyone was in a good mood this simply does not work with the acuity of our patients. At max we have 12 pts and I am the medication nurse. Many of these patients require many many medications and I simply cannot give all the meds on time. (one of the NM's main issues with me)

Also there is a large breakdown in communication between the RN and I and between the techs and the nurses. We have tried many different strategies however things are just falling apart we have tried to talk to the NM about it and the higher ups and my nm's response is basically go in with a better attitude and try harder. We simply cannot meet the patients needs while staying within rules and regulations. It has also gotten to the point of almost mutiny where many of the nurses simply refuse to do team nursing.

I want to present the facts in a way that does not make the higher ups think that I am not a team player and just being whiny about change. Im extreemly frustrated, this is a great hospital to work for and I do not want to loose my benifits. However there is nowhere else in the hospital to go that fits my schedual since I am a LPN. :banghead:

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Specializes in Oncology, Palliative care.

Hi there

Sorry to hear you are going through a bad time :icon_hug:

Sorry if i am being a bit thick here :confused: but can I just check that I have this right, you say you are the Medication Nurse? so does that mean you are just doing this? Are you not allocated your own patients each day?

Perhaps what you could do is ask to see your Ward Manager with the rest of your colleagues and present a constructive argument for why this is not a beneficial way of working, it does not sound like you are able to deliver holisitc care if you are only able to address part of their needs leading to fragmented care, which is bad for you and the patient. I think if you can all get together as a team and put your argument forward and perhaps come up with some suggestions of how you feel it can work better for both the staff and the patients then everyone is happy. We nurse in teams but we are allocated our own patients and must attend to all of their needs from making their bed to complex discharging.

Hope that helps, let us know how you get on ;)

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Specializes in ICU.

we did team nursing once......it lasted only a few weeks.....it worked about as well as it sounds like it's doing there....we kept our sense of humor, marched from room to room as a group, army style, stamping our feet all the way.....we let the 4th floor wonder what was going on......it went away......even this too will pass.....:lol2:

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we did team nursing once......it lasted only a few weeks.....it worked about as well as it sounds like it's doing there....we kept our sense of humor, marched from room to room as a group, army style, stamping our feet all the way.....we let the 4th floor wonder what was going on......it went away......even this too will pass.....:lol2:

That sounds hilarious. Wish I could have seen it.

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Specializes in M/S, SNU, Office, and Private Duty.

Sorry if i am being a bit thick here :confused: but can I just check that I have this right, you say you are the Medication Nurse? so does that mean you are just doing this? Are you not allocated your own patients each day?

The nursing responsibilities are divided between nurses. The RN of the unit does the assessments, charting, admits, and discharges, while I the LPN do the medications and treatments (wound dressings and such) while the CNA's take care of the ADL's ect. the theory seems great on paper but in real life its hectic crazyness:no:

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I have never seen team nursing work. It's one of those great fantasies that every facility has.

Write out the specific problems. See if you can come up with a solution - any solution. That will help show that you aren't just griping. Look online, in journals, etc for any references you might use to help your cause.

Good luck!

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Specializes in med/surg, telemetry, IV therapy, mgmt.

man! when i came out of nursing school in 1975, everyone was doing team nursing. what i wouldn't give to just be the medication nurse for the whole shift.

simply change some of the medication times in order to distribute them out over your shift. this is what we did in the nursing homes where i worked to keep in compliance with med pass times. there shouldn't be any facility policy that says you have to give medications at any specified times. so what if some am meds are scheduled for 8am, some for 9am and some for 10am? as long as they are being given in the am and within the 1-hour window, who cares? for people who only had one daily medication, if possible, we scheduled for noon instead of the am. some medications, of course, (diuretics, dig, insulin, oral diabetics) have to be given in the early morning.

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Specializes in RN- Med/surg.

We have team nursing here and it works great...BUT- our "teams" take 6 patients together.

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Specializes in Med surg, Critical Care, LTC.

I too have no tolerance for team nursing. Our hospital tried it once on one of the med surge floors. I made the biggest med error in my career that day. I was the RN with 20 patients to pass meds on, do assessments, etc... I had two LPN's working with me and 2 aids. Long story short, the charge nurse was hounding me to hurry up with my meds because "You have blood to hang in room bla, bla, bla,..." It was her hounding me that distracted me and I made a doozie of a med error.

Suffice it to say, I ran into the doctor of the patient that I made the med error on about 2 weeks later. I went to him (because I was still beating myself up) and said "I'm the nurse who made the error on your patient a couple of weeks ago, I'm very sorry) the doctor said "I read the incident report, while you actually gave the med, I feel is was a systems error, and you won't have to worry about team nursing again!" then he said "No worries, I'm discharging him today, he's doing fine. Stop beating yourself up."

I thought team nursing was a bad idea when I first heard about it, and I think it is a bad idea now. As the RN, I am very teritorial about my patients, and I want full responsibility for them.

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I wonder why facilities are going back to team nursing. Is it the teamwork that is missing. I know where I use to work primary nursing was used but they used to do team nursing and I can see how just doing meds and a nurses just doing pt care can benefit everyone. The nurse doing pt care just does pt care so you actually would have time to ambulate your pts and help them eat ect. Who says daily meds have to be given at 8 am or 9am. I started my meds at 730 and did my assessments at the same time so by 1000 I had all my charts opened and could help with everything else. I know primary nursing really has its ups and downs as everyone says you need great teamwork, if everyone is really busy with there own pts when do you have time to help everyone else. I would like to try team nursing. I know when another floor i was on tried to cut our staff(we really didn't have any) we would have 3 nurses and 1 tech for 17 pts so as a new rn I wasn't charging yet but i was a strong lvn prior, me and the other rn just split the floor as to what side we were doing the rn stuff for and it worked really well. I really just depends on the nurses you have working on the floor i think

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Splitting up the work to do team nursing is too dangerous IMO. Team nursing is usually used to take care of greater numbers of patients. If you were only caring for a small handful, it would be easier to have time to communicate. The way team nursing usually works - the staff are two ships speeding by in the night and can go forever without seeing each other & the don't know what/when to communicate.

If I am the med nurse, I want to know what the vs are, what the lung sounds are, if they have pedal edema, etc.

On the other hand, if I am the assessment nurse, I want to know what meds that the patient is on and has scheduled. Otherwise the patient could receive a med that dangerously drops their bp, raises their bp, they don't get the prn KCL and lasix because the med nurse wasn't aware that they needed it per the protocol, etc.

There is just not any good way to relay all the info needed between two or more nurses to ensure that the patient receives, or does not receive, meds and treatments that are appropriate to their condition and at the appropriate time.

Perhaps in the dark ages when nurses, both RN and LPN, did not take as much responsibility for the patients, and there was only one stethoscope per UNIT (not nurse), team nursing worked. But these days of high liability issues, dangerous drugs, and care standards that are set very high - no way does team nursing have the best interest of the patient at heart. And it sure puts the nursing team in the line of fire with too many potential for errors.

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Specializes in Psych, Med/Surg, LTC.

Team nursing works well when you can communicate well with each other and already know most of the patients. Everyone has to listen to and take report, even if you are the med nurse. If you get a member of the team who does not pull their weight or not share pertinent info, it is a disaster waiting to happen.

I actually like being the med nurse. I am super busy, but I like it. I can just pass off any issues, phone called needed to the doc or family, etc to the nurse assigned to assessments, treatments, and charting. :imbar I don't have to be the one to make the call about Mr. Jones vomiting blood, etc. The stuff that sucks about it is that I have to search for and find the assigned nurse every time there is an issue, to let them know if I held a bp med for a low bp, etc as soon as possible for if they want to call the doctor. You can't just wait until the end of shift/report to tell them that Mr. Smith had a dextro stick of 35 and you held the insulin.

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