How does the team nursing care model work in the ICU?

[thehutz]

i have worked in the icu for the last 7 years. most currently i have left a larger tertiary icu and moved to a rural hospital where the team nursing care model is in place. while having to float to m/s i find the team concept to work very well, however, i find it very difficult in the icu setting. the team concept includes a primary rn that performs the assessments and rounds with the md's, a technical nurse that passes meds and a cna that performs the cares. now i am not opposed to change but i really have enjoyed my primary nursing care in the icu -- where i would perform basic nursing care to advanced skills to my patients. i would have 1-2 pts based on the acuity level. now i may have 5 "icu" pts and maybe 5 m/s pts in a team with another rn and a cna. i am torn because the physicians are admitting pts to the icu expecting a greater level of care (in fact i am not giving any extra care due to the number of pts i have) and the pts are getting charged for a higher level of care (again i am not giving extra care to the pts), in addition to the pt care i am also expected to monitor the telemetry monitor. so my question is -- is anyone utilizing team nursing in the icu? if so, how is staffing done -- based on acuity? and if it is based on acuity then how do you determine acuity -- a point system? also, anyone know of any research/literature regarding icu and the team nursing concept? any advice/suggestions are greatly welcomed!

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

I have not seen the "team" model used in many years in the ICU. I am a one (wo)man band on the nursing end of patient care. There is no unit clerk/tele tech, no CNA, and no LVN(LPN's) in acute care.

At least I don't have to do housekeeping or take the x-rays myself!