Team Nursing

AroundtheBlockRN · Jul 2, 2010

Team nursing was around in the 70's and 80's in most hospitals. Your basic team consisted of an RN, LPN, and a nursing assistant or two. You had a team report at the beginning and end of shift and sometimes in the middle. The whole team was present and this was also a good educational experience for the assistants as well. They were some of the strongest, most important members of our team. Eyes and ears that matter.

The number of patients the team cared for could be anywhere from 10-30, depending on the type of unit and/or the shift. The RN was the med nurse, LPN performed treatments, i.e. dressing changes, wound/ostomy care, tube feedings, etc. The Nursing assistants teamed between them to do bathing, bed change, toileting, vitals, etc. All would team together to pick up the slack, where needed. We also had lab techs that drew all the labs, ekg techs for ekgs, respiratory therapists, PT, etc. Then came primary care nursing which early on, was very good, depending on the hospital and how they staffed. Some totally got rid of nursing assistants, others staffed one to two on a large unit. All they had time to do was vitals and occasionally, something extra.

As hospitals changed and added more layers of management and downsized assistants, ancillary departments (ekg, lab techs, respiratory therapists) their duties were picked up by nurses. Most staffed with mainly RN's, fewer LPN's.

All in all, the RN was responsible for everything and everyone under her. To save money, cutting other departments and training nurses to do more, this is the model today

All well and good, knowing everything about your patient: how did the med work, what does the wound really look like, did the lab get drawn, ekg done, etc.

This pretty much is today's model. Problem is, with more things being computerized, mechanized, more charting, less patient care, you're back to the place where you don't always know as much about your patient any more because you now spend 75% or more of your time on the phone, computer, charting, etc.

Going back to the team approach might be better for the patient in that they may see more nurses in their stay than what they see now.

Good Luck. Anything you try where the patient gets seen more often and by more than one nurse could be a benefit.

drmorton2b · Jul 2, 2010

Some Psychiatric Hospitals still use team nursing.

One Nurse is the Charge/Admissions Nurse for the unit and does care plans

The other Nurse (either RN or LPN) is the Med Nurse and also does documentation unrelated to meds.

Sometimes another LPN or RN will be on the floor helping out, this varies on the size of the unit.

At the beginning of each shift everyone gets report (All Nurses, all Mental Health Techs= to CNAs).

I didn't realized that CNAs and PCAs in most places don't get report until I was in nursing school in most places the CNA or PCA is strictly task oriented. Of course this varies from facility. Having the CNAs or PCAs in on report would be a very useful experience. It is a need to know that Pt A in Room 1 has a G-Tube dressing that is having issues. Instead of walking in on it.

Older nurses recall the days of true Primary Nursing. Which if I read correctly in Suzzane Gordan's books that RN followed that patient from Admission to Discharge. I think modern case management nurses/social workers have taken over some of that role.

The "Primary Nursing" I have seen as of late is what aroundtheblock RN describes. I agree with this system. It all depends on the facility.

One Rehabilitation Facility had "Primary Nurses" in name only. I was unclear as to how this worked, I think it really met care plan follow ups with general rehab progress notes utilizing nursing care plans. Maybe only the CRRNs were Primary nurses.

I think a combination of Primary Nursing and "Special" Team nursing still exists in most hospitals.

Example Staff RN is having trouble with an IV, the IV "Team Nurse" is called he or she is part of the Specially trained IV Nurses.

I agree with the Primary nursing system of today, except the exclusion of LPNs who would be great eyes and ears in the hospital and CNAs or PCAs not "allowed" to go to report.

This is a moot point with Magnet Hospitals. Different discussion.

2ndcareerchange · Jul 3, 2010

In my hospital, in the emergency room, we went to team nursing. There was lots of education due to everyone was use to primary nursing. They are constantly having in service on the "role of the LPN" and the "Role of the Team leader (RN)". The way its set up is a RN, LPN and a CNA to every team. The team leader gets report and passes it on to her/his team. They have assigned rooms (its the ED) and everyone pitches in when needed or just do their assignments. To my knowledge its hard to tell the RN from the LPN since they both do treatments and meds, its just the IVs, hanging blood you can see the difference. Since everyone is wearing the same colors, its hard to tell who is who. This can or can not be a problem if one is sensitive about their position/title. From the outside it seems to work seamlessly.... but I am not in that dept so I cant say first hand. Hope to be on the team come this January.

Regi

lkwashington · Jul 3, 2010

I know some facilities wear certain colors. Bon Secours wears only navy blue and white scrubs. I dont know what color their CNA/PCT wears. I would think if every department have their own colors would be a good idea so we can tell who is who. Even the EVS wears scrubs.

Team Nursing

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