Has anyone tried team nursing? Opinions?

[circularstaircase]

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....

[eatmysoxRN, ASN, RN]

I think it depends on several factors. Unit size is important. We get an LPN that passes meds for the entire floor (with RNs doing all IV meds and usually a couple patients regular stuff to help out). I wouldn't like to take 12 and have an LPN and a CNA. I know some places where LPNs take patients and have RNs do pushes and blood and central line management if needed on their patients. I love having an LPN when I have my 8 patients. She mainly does accuchecks and passes PO meds while the aid does the aid work and I do my assessments and communication with the docs or whatever is needed. It usually works well.

[unreal RN, ASN, RN]

The unit I worked on for years tried it for awhile. I hated it. No one could really get the gist of it. The docs hated having to deal with more than one nurse ( usually). I'm sort of a control freak when comes to caring for my patients...I like to be on top of everything and that's harder to do with team nursing, IMO.

[HyperSaurus, RN, BSN]

I work a medical with tele floor on nightshift with the team format. On nights, we can have up to 12 patients with 1 RN, 1 LPN, and 1 aide. On days and afternoons they can have up to 8 but usually only 6 or 7 patients with a team. There are some good points and bad points. If it is a busy night or you have some more intensive patients, it is hard to get a good feel for what's going on with your patients--there are just too many for that. Usually we start out the night with the LPN looking up the medications for the night whil I check charts for new orders or important labs. At midnight, the LPN starts getting vitals and doing med passes. I will usually go with her to do my own assessments (saves on waking the patient ore than necessary, and we can take care of turns at the same time). Usually by 0200 I have seen everyone. I spend the next six hours charting my assessments, calling for any issues (love having hospitalists), and putting out any fires. Some nights I am incredibly busy with demanding patients, pain medications (LPNs can't do IV pushes at our facility), someone taking a turn for the worse, ect. Other nights, I am on top of everything, ect. Something I do enjoy about the team format is having other hands available for help and another set of eyes on our patients (especially as most of the LPNs have 3+ years experience and I have about 7 months). My night can be made or broke by what my team is like--if I have to follow the LPN or aide to make sure they do their actual job duties or don't cut corners or if the LPN doesn't tell me about critical changes with vitals, that makes my job harder than it should be. On the flip side, if the RN has no clue what she's doing, refuses to listen to the LPN when there's a change (ie, refuses to call the doctor), then the LPN has a rough night.

I used to hate the team format (I do work primary as well on our oncology unit), but the teams on our unit are great--everyone pulls their weight and more.

[namiller1213]

I did it at the VA. I hated it. We had one RN who was the charge nurse, they did the admits, discharges, assessments, and dressing changes for 20 patients. If it was the day or evening shift there was a LPN to pass medications. Also if it was the day or evening shift there would be 1 CNA and the rest of the RN's would work as CNA's on the floor.

On NOC shift there was one RN and one CNA for 20 patients. For me it was unsafe, and a waste of talent and money for the RN's who were working the floor. They were not allowed to help with the "charge nurse" role.

[Kay28]

I worked in a free standing psych hospital where we did team nursing of sorts. There were six units with 13-26 pts in each unit. We would get one RN who was "charge nurse" and an LPN who was "med nurse". Charge would do admission, discharges, and dealing with the treatment team. Med nurse passed all scheduled and prn meds along with helping with note. Then 3 MHWs who did checks and vitals. This worked well enough.

[lemur00, BSN, RN]

We follow team nursing on the unit on which I work. It is often confused with "functional nursing" where each member of the team has a very defined and narrow role (ie vitals or meds). That is not what team nursing is.

The main feature is the "team conference" where all members of the care team have input into the plan of care. The emphasis is on communication and working together to provide comprehensive care--thus everyone has a responsibility to get the work done for their team as their scope allows.

The role of the charge nurse is usually bigger in team nursing, and on our unit it is the charge nurse who primarily deals with paper work and doctors, relaying that info to the team nurses as needed (who are able to focus more on direct care). It is a particularly good model for inexperienced nurses because there is more supervision of their practice, and the charge is more aware of what is going on with the patients.

The main advantage over primary nursing is that one nurse isn't expected to shoulder the responsibility for everything, with increasing duties and responsibilities falling on the primary nurse. The workload is ideally distributed a little more evenly.

Additionally it is democratic. For anyone who prefers an egalitarian environment where decisions can be discussed and decided on as a team, team nursing might be a welcome change (conversely, people who like to be in control usually hate it). Since decisions are made as a group, there's a higher chance of someone catching mistakes or coming up with a new and workable approach. People can also play to their strengths and contribute different types of expertise, and it's easier to learn from other team members and disciplines in ways that the primary model doesn't allow.

Most problems with team nursing have to do with a team that doesn't "gel" and work together. As we all know, being forced to work with the same patients doesn't make people a "team"--just as in athletics, the team that doesn't work together doesn't succeed. For example if you work with lazy people, you still have to get all the work done yourself. If there is a high turnover rate on a particular unit, the team members don't get to know each other and usually don't communicate well enough. The care can be really fractured without good communication and co-operation, with team members disagreeing on an appropriate approach or missing things when they don't communicate.

In my experience, you really need a strong base staff for team nursing to work. If you don't have that it can go pear-shaped pretty fast.

[lemur00, BSN, RN]

I should also add that our teams consist of 1 RN, 1 LPN and 8 patients (or ten if there are overcapacity patients). LPNs in SK have a much greater scope of practice than basically anywhere and thus often function simply as a second nurse, with only a few tasks left solely to the RN.

[musicnursing]

We currently do this, 12 patients with an LPN and aide. I don't like it just because I prefer to do my own vitals and dressing changes and med passes, although I have to say it all depends on what your team is like. It will be a good night with a good team, bad night with a bad team.

[HyperSaurus, RN, BSN]

Our teams don't take 12 patients anymore, but we also don't have aides anymore. We usually have a max of 9 now (RN/LPN team), with 10 being a particularly bad night.

[weirdscience]

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![/quote']

This happens all the time on primary care nursing floors, too. Makes me NUTS. Yep, it's because I haaaate getting my hands dirty that I asked you to toilet someone. Couldn't possibly be because you're sitting on your phone texting while I am running in and out of 5 rooms pushing PRN's and helping with the tasks you're licensed to do as well. End rant--I know the subject here is team nursing. Just pointing out that all's not rosy in the primary nursing world either.