I was curious to what your patient load is? I'm not in the hospital setting at this time, I work in a prison, and from my nick I guess you can see it's a prison with death row inmates.
When I did work in the hospital setting I work Med/Surg with patient load of 10-12 pts at the most. We had 1 RN, 2 LPNs and 1 CNA on days and evenings, 1 RN, 1 LPN and 1 CNA on nights. The state I worked in allowed LPNs to do IV meds as well as injectables and PO meds. On days there was also an Med Nurse (LPN) she was responsible for giving the scheduled meds (all routes) and the LPNs assigned to the floor gave only PRNs. RNs were mostly responsible for the paper work, like care plans
, admissions, taking orders off the charts, etc. Of course we were avialable when needed by the LPNs or CNAs, for advice or help with the patients. RNs made rounds with the doctors, and handled the pt's families. The CNA's helped pts with baths and other dailey living skills needing assistance by the pts and take VS. CNAs were also able to help the nurses as they needed assistance in any procedure such as catherization, NG tubes, etc. The LPNs were able to do any skilled procedure as the RNs with the exception of hanging blood. Thus the reason for 2 LPNs on days & evening shift when most admissions and procedures were done.
The RNs weren't required to co-sign any documentation by LPNs. I don't understand the rationale for this. You also mentioned assessments were made by RNs only, why? In my state LPNs learn how to make assessments in nursing school and can do this very well. LPNs can start IVs and push meds such as antibiotics, after going through training provided by the hospital.
The team worked well for us and we worked well as a team. Even were i work now we have team nursing and it works well for us. Of course there's days when everyone is overwhelmed, I think that's just part of the job. When duties are allocated properly, and utilizing each nurse properly I feel it's the only way to work.