Team Nursing

MendedHeart · Jun 12, 2013

We did team nursing for a while on my floor. It was 2 RN and 1 aide for 8 patients. Each nurse had 4 primary but every one helped out. It did not last because we have always hekped each other so it wasnt a big change just harder on the aides because their assignment was all over the place instead of a section

jmdRN · Jun 12, 2013

We've been doing team nursing at my hospital for a little over a year now, and I hate it!

Our med/tele unit has 28 beds, divided into 2 teams. Each team has an RN team lead, 2 RPNs who each have 7 pts on days and 1 PCT. As RN, I'm supposed to evaluate the 14 pts in my team, communicate with the Dr's, meet w/ the multi team (physio, SW, dietary, pharmacy etc) and elaborate the care plans for these pts and work on discharge planning.

there's never enough hours in my 8hr day to get it all done, and I feel like I'm often missing things.

HyperSaurus, RN, BSN · Jun 13, 2013

I've worked for a year on nights on a medical with tele floor alternating between team and primary nursing. As a team, I work with an LPN (and if I'm lucky, an aide) with anywhere between 8 to 12 pts. The aide does call lights, toileting, turns, I/Os, and chems. If there is no aide, the LPN does those tasks as well as vitals, med passes (excluding IV pushes), and assists with wound care. The RN helps with all of the previous tasks, as well as assessments, communication with the MDs and other support staff, monitoring labs, charting, and generally putting out fires. It has its strengths and weaknesses. Team works really well when the team-work is there. The pts tend to be heavy and having an extra body (and set of eyes) is really helpful (more than one person who knows the pts and can recognize issues). I can get a lot done. However, the sheer number of pts you're responsible for means you know less about each of your pts...considering that I work nights, sometimes the only time I see a pt is their initial assessment. The LPN has a more hands on idea of what's going on. You have to trust each other, and make sure that trust is earned.

Bringonthenight · Jun 13, 2013

If your team members are team players it can be good. When you work with lazy/slow team members it can be brutal.

Hoozdo, ADN · Jun 15, 2013

When you work with lazy/slow team members it can be brutal.

I used to get floated to a tele floor that did team nursing. I disliked it very much since I was usually the only person on a "team". No LPN, no CNA, just me and at least 10 tele patients. Those were the good old days when there actually was a nursing shortage.

Team nursing is actually a good concept if you have conscientious and congenial team members.

Bringonthenight · Jun 15, 2013

I used to get floated to a tele floor that did team nursing. I disliked it very much since I was usually the only person on a "team". No LPN, no CNA, just me and at least 10 tele patients. Those were the good old days when there actually was a nursing shortage.
Team nursing is actually a good concept if you have conscientious and congenial team members.

Exactly it's all about who is in the team. I've worked in team nursing environments where one day it would be great- CNA answered call lights. ADLs etc. the PN performed vitals and did what meds they were allowed. And the RN would do IVs, admissions etc etc everyone communicated well and helped each other out.

The next day the CNA is sitting checking her emails with call lights going off everywhere. The PN is sitting at the desk telling everyone that she could "run circles" around any RN and the RN is saying that she is above showering/cleaning/feeding patients.

It really depends on your unit. If all your colleagues are "team players" it will work well.

Nurse ABC · Jun 15, 2013

Our floor just did away with this since they booted the LPN's out. (Totally unfair to them but that's another topic.) We had one RN, one LPN, and an aide for up to 10 patients. The RN assessed all ten patients, did all IV meds, rounded with dr's, charted, administered blood, etc and put out the fires all day long. The LPN's would do med passes of anything not IV, dressing changes, bs checks and insulin admin, and were supposed to help with call lights and the aide work (although some felt that was beneath them). The aides did all vitals, am care, feeds, turns, diaper changes/bathroom breaks, etc. I hated it because I was so busy I rarely got a break and worked over a lot to get stuff done. Trying to keep track of 10 people and their problems was very difficult. Also, many times I'd find an LPN or aide hiding or taking a 45 min break (they'd tell me they were-I'm not assuming) because their work was caught up except for the fact call lights were going off all over the place and in the middle of giving IV meds, calling the dr, doing an admission, etc I was told by other members of different teams that so and so needed whatever so I'd find my hiding people and delegate then they get all upset and roll their eyes. Because I could do it all they wanted me to but I was so busy getting my stuff done I didn't have time to do theirs too. This caused lots of issues. If I had some hard workers on my team the day would go great. The politics were the worst part. If I just tried to do it all myself I'd work myself to death with no breaks and working over but if I delegated (even if it was their job) they would act like I was better than them. All the RN's had this issue. I'm going to miss some of the LPN's I worked with because I made some good friends but I'm not going to miss the politics of the situation. When some of the LPN's worked their last day a couple of them said to the RN's in general-you're really going to miss us without us doing half your work-in a really sarcastic way so it creates a really bad situation where they feel taken advantage of by us being allowed to ask them to do stuff and the RN's feeling like we shouldn't have to tell them. They rarely worked over and usually went home before we were ever done giving report, let alone catching up on charting. I am going to miss some of them because there were some that made my day go much better than it would have otherwise and those were the ones I never had to ask to do anything-they just saw what needed done and went for it. It really does depend on your team members how your day goes and our teams changed every day due to people getting pulled, being off, etc. I'd much rather be in charge of less patients and do it all myself that way I know what needs done and I don't have to worry whether someone else got it done or not. The downside is we are only supposed to have 5 patients per RN now but some days we have 7 and that's just way too many esp when you have high need patients. The aides now have 10-11 each. They really miss the team nursing.

Stacey1234 · Feb 16, 2016

I just started orientation on a surgical floor that does team nursing. It's ok on day shift (1 RN and 1 LPN share 8 patients) but on night shift its totally different. On nights there is only 1 LPN on the unit. The RNs start out with 9 patients, do assessments and meds until 2400h THEN it changes to team nursing where 2 RNs share ten patients. ( you end up losing half of the patients you had before 2400h and gaining new ones). The meds and bells are shared between the two nurses and I find myself answering bells, giving meds to patients and charting on patients I barely know anything about. I feel that there is no accountability and I am not providing patient centred care. My unit has very high turn over and I'm starting to figure out why. I would much rather have my own patient load and get everything that needs to be done for them. I am still new to the floor so I am hoping I can get used to it eventually.