Has anyone tried team nursing? Opinions?

hwhetstone · Nov 9, 2012

The hospital that I work with is going to be changing it's model from primary nursing (I would get 7-8 patients per shift) to team nursing (1 RN, 1 LPN, and 1CNA) for up to 12 patients. The LPN would be doing all the medications and dressing changes while the RN would be responsible for the assessments, critical labs, doctors orders, etc.
Has anyone ever tried this type of nursing? What is your opinion? Is it manageable to take care of up to 12 patients when tasks are divided like this? Any feedback would be helpful....

Where do you live? I have never heard of that before.

RNGrammie · Nov 9, 2012

I work in LTC and we have 3 floors, one of them locked dementia unit....40 residents per floor...2 nurses per floor, 4-5 CNA's floor. I would love it if we did team nursing. Although our residents/patients are less critical, it's an incredible responsibility as a nurse to be responsible for 20 residents/patients. Team nursing sounds like a dream.

circularstaircase · Nov 10, 2012

Yes I haven't seen this done before either...although I know many years ago team nursing was pretty common.

turnforthenurse, MSN, NP · Nov 10, 2012

I don't know if I would like team nursing...seems like it would have their faults. More responsibility on the RN, more likely for stuff to get missed, less staff to keep an eye on patients who are fall risks/confused, etc. I prefer to have my own patients and be responsible for them alone.

Ernurse2012 · Nov 17, 2012

Yes when I use to work on a tele floor we had this and it worked okay depending on who was on your team.

anotherone, BSN, RN · Nov 20, 2012

A team is usually only as strong as its weakest member. i am not a big fan.

elkpark · Nov 20, 2012

Team nursing was the standard model used by most hospitals for many years until primary nursing was suddenly the Big New Thing in the late '80s. I've done both, and, IMO, one model works as wel as another, as long as everyone is willing to collaborate and cooperate to get the clients' needs met.

AR_RN · Nov 20, 2012

I've done team nursing some. I prefer not to though. As said above, it depends on who you're working with....I've had nurses use "team nursing" as an opportunity to sit on their backside and order the others around. That's not how it works. If you work with good committed coworkers, it can be good, but it's a crap shoot.

Nurse ABC · Dec 26, 2012

We do it on our floor and I'm not a fan at all! It's too many patients needing IV meds and assessments trying to keep on top of everything and notify the dr of pertinent info so you run all day long while the LPN's and aides are regularly taking breaks. I rarely have a team where the other members pitch in and help when "their work" is done. If I go in a room to do an assessment or give a med and someone needs help to go to the bathroom I stop and help them tying me up for several more min putting me behind on all the pts needing assessments or IV meds already waiting but yet if I go find an aide who isn't doing anything (or if they are on break) the pt gets mad having to wait or the aide spreads it around the RN is too good to do that which isn't true. The RN can do everything, the LPN most stuff except IV pushes, and the aide only basic care so somehow it always ends up falling to the RN to make sure everything gets done. We have a big problem on our floor with LPN's esp not pulling their weight. I'm not saying it's LPN's in general and we do have a couple that work hard but on our floor most of them will pass their meds and sit at the desk literally ignoring call lights and when the RN's say could you please check that because the aide is busy and I have to pass an IV med they get mad and roll their eyes. The RN's that delegate and ask the aids and LPN's to cover stuff regularly get talked about as being too good to do it themselves. I regularly help with taking pt's to the bathroom, bedbaths, changing linens, giving pain pills, doing dressings, etc so they'll see me as a team player but yet every night I'm working over to finish up my charting while they are going home on time so I'm starting to think I may just have to become one of those nurses who quits being nice, get talked about, and get out on time. It' s all the politics that create the problem. I just wish I had my own group of a few all to myself! Also, sometimes patients will ask another team member for IV pain med that will not get relayed to me in a timely manner so the pt is mad by the time they've had to ask again or someone remembers to tell me. Another thing is when the dr asks if the pt has trouble with something like swallowing pills, eating, etc and I have no idea because I haven't had time to be in their room enough to even spend time with them and since I'm not passing the pills, if no one tells me, I have no idea making me look stupid. The few times I've had 5-6 all by myself I feel like it's such an easy day and I'm able to keep on top of everyone. I don't recommend it. Our floor is the only one in the hospital that does it and all the RN's that get pulled down to our floor complain they never want to come back-it's just so over-whelming.

DogWmn · Dec 26, 2012

OK so I''m old enough to have worked in a team nursing environment and I loved it, we only had LPN's and RN's no aids,techs etc. The new grad LPN's did the patient care until they could take their advanced pharm courses and sometimes some of the new grad RN's did the same, then there were rotations for med passing or we did total patient care including our own meds. But it was a very different world back then, everyone pulled their weight, we all left on time because if someone got buried with a late admission we all pitched in to get it done...including shift supervisors on occasion. Blew me away when I was working Ortho and we had several late admissions to our floor due to some traumas, the shift super came up and helped me set up a striker and get the patient transfered into to bed and set up. It was really TEAM work, we also were staffed well, we had floats that would be sent in for lunch breaks if necessary or help out if our census went up. These floats were very very experienced, sent to the "hot spots" throughout the shift we had both LPN and RN floats they were the cream of the crop, they also worked a regular schedule.

Today health care is all about the money, not the patient and it shows.

iluvivt, BSN, RN · Dec 26, 2012

Team nursing is not a new model it has been around for years and practiced in California until the ratio law was passed. There are pros and cons to the system and I have done it all team..primary...charge nurse on both systems.

It allows the RN to focus on the tasks and skill that only they can do such as the nursing process and plan of care and evaluation of that care. Administering IV therapies per licensure (varies by state) LVNs can do some of this, Calls to MD. role of team leader and setting a plan for the day and modifying the plan as needed. The RN needs to take charge of the team and needs to delegate well and know exactly what the LVN can legally do. Communication is imperative and team members must sometimes work to improve this. If you like to work somewhat independently this model can be challenging. It also can be difficult for some RNs not to see every wound and other things but it is important to get a report from the LVN in a timely manner so if there is something you need to see they come and get you. You need to communicate with your LVN what you want to be made aware of. For example ,if you a fresh post-op with a Thyroidectomy you want to be notified of any s/sx of hypocalcemia or if you may want to be notified if a patient is febrile.

You need to be good at keeping track of a lot of things so you need a really good worksheets. I think you need to see every patient especially if you are working with an LVN you are not familiar with! The IV therapy can be overwheming on some days. I usually had a team from 12-14 and I hung a lot of IV antibiotics and antifungals and other IV medications ..up to 20-40 per shift. So have a good system with a stock of all the little things you need such as IPA scrubs and flushes. Try to group your tasks b/c you will be doing a lot of hand hygiene and your hands can get really dry not to mention it is very efficient. Before you call the MD...make sure there is nothing else you need for that pt..check with the LVN...this will eliminate mutiple calls to the MDs or LPs.

If you are working several days in a row it really helps to try and keep the same general teams and try when possible to not split the the rooms too much although it is necessary to do it.

Many RNs like this model b/c the LVNs and aides end up doing most of the baths,bed changing,toileting and tasks of that nature. Sometimes because of this and the fact the model places the RN in a supervisor role the LVN and aides will develop some animosity towards the RNs. If this is not controlled it can create chaos and anger on the unit. To stop this each member must know and feel they are a valuable member of the team. Always address them with respect..remind them they are valued..thank them for a job well done (when it is so)...offer to help and pick up the slack...(very important)..comminicate your expectations clearly..provide support as needed..make sure your team members get breaks. All of these work wonders and your team will work their butts off if they feel appreciated!!!! The RN has to be the leader and the backbone of the system.