I Don't Understand Team Nursing

[Googlenurse, ASN, BSN, RN]

I do not understand team nursing.

On my new job, there are RNs, LPNs, and PCTs. Each functions as a team. 

The RN  as team leader does the assessments, care plans, orders, and other paperwork, the LPN passes out the medications, and the PCT take care of positioning, changing, etc. Every team is responsible for 16 patients total. ( it is a LTC sub acute position)

Is the RN responsible for any medication errors since she is the team leader?

[Rose_Queen, BSN, MSN, RN]

26 minutes ago, Googlenurse said:

Is the RN responsible for any medication errors since she is the team leader?

The LPN has his/her own license and is responsible for the actions they take with that license. Medication administration is within the scope of LPN practice.

However, you as the RN would be held accountable for anything requiring an RN license.

[Golden_RN, MSN]

As the RN you may be responsible for assessment/contacting MD, etc. following a med error, but the LVN is a licensed nurse that is legally responsible for his/her errors.

[Seththlivingston]

The California department of public health is classifying a state of emergency and allowing hospitals to practice out of ratio...if they could prove that they are trying to fill RN positions.  This has allowed hospitals to implement team nursing in which LVN's are working under an RN...a loophole to evade ratio laws in Cali.  When the hospital is fined for going out of nurse to patient ratio's, this money is then given to a quality assurance program which will then generate more questions as to why hospitals are always exceeding nurse to patient ratio's.  This is corrupt and should be addressed by all nurses. The nurses that quit because they find this practice unsafe, will be replaced by an LVN until the unit reaches the maximum number of LVNs to the RN. The Center for Medi-Cal and Medicare services that employs the subdivision JCAHO is another example of corruption in the healthcare system. The negative pressure rooms throughout my hospital do not function as a negative pressure room, according to the tissue test, and they're not suitable to house airborne precaution patients; however, these Safety issues are ignored by JCAHO and their focus will be on ipox and nursing diagnosis/evaluations. This organization is corrupt and nurses need to address it now.

[NRSKarenRN, BSN, RN]

LTC sub acute positions are not covered under California RN ratio laws, only applies to hospitals

[Googlenurse, ASN, BSN, RN]

Under the Nj BON, it says in a plain language an RN is responsible for anything delegated. 
Hmmm

[chare]

Googlenurse said:

Under the Nj BON, it says in a plain language an RN is responsible for anything delegated. 
Hmmm

Medication administration has been in the LPN's scope of practice in every state I have worked in.  Assuming this to be true in NJ this is not a delegated task.

[Googlenurse, ASN, BSN, RN]

chare said:

Medication administration has been in the LPN's scope of practice in every state I have worked in.  Assuming this to be true in NJ this is not a delegated task.

I have to reread it but that is what the NJ BON has in it.  An RN can delegate medication administration to an Lpn and even a UAP such as a med tech. 
 

Maybe I'm reading it wrong. 

[NRSKarenRN, BSN, RN]

 Refer to: NJ BON Decision-Making Model Algorithms

• Decision Making Model
• Determining Scope of Nursing Practice Model
• Delegations of Selected Nursing Tasks Model (N.J.A.C. 13:37-6.2)

13:37-6.2 DELEGATION OF SELECTED NURSING TASKS

In delegating selected nursing tasks to licensed practical nurses or ancillary nursing personnel, the registered professional nurse shall be responsible for exercising that degree of judgment and knowledge reasonably expected to assure that a proper delegation has been made. A registered professional nurse may not delegate the performance of a nursing ask to persons who have not been adequately prepared by verifiable training and education.

Quote

a) The registered professional nurse is responsible for the nature and quality of all nursing care including the assessment of the nursing needs, the plan of nursing care, the implementation, and the monitoring and evaluation of the plan. The registered professional nurse may delegate selected nursing tasks in the implementation of the nursing regimen to licensed practical nurses and ancillary nursing personnel. Ancillary nursing personnel shall include but not be limited to: aides, assistants, attendants and technicians.
b) In delegating selected nursing tasks to licensed practical nurses or ancillary nursing personnel, the registered professional nurse shall be responsible for exercising that degree of judgment and knowledge reasonably expected to assure that a proper delegation has been made. A registered professional nurse may not delegate the performance of a nursing task to persons who have not been adequately prepared by verifiable training and education.

c.) No task may be delegated which is within the scope of nursing practice and requires:

1) The substantial knowledge and skill derived from completion of a nursing education program and the specialized skill, judgment and knowledge of a registered nurse;
2) An understanding of nursing principles necessary to recognize and manage complications which may result in harm to the health and safety of the patient;

3) The nature of the tasks and the activities being delegated;
4) Supervision may require the direct continuing presence or the intermittent observation, direction and occasional physical presence of a registered professional nurse. In all cases, the registered professional nurse shall be available for on-site supervision

NJ regulations does not identify nursing tasks an LPN my perform.  PA BON has clear § 21.145. Functions of the LPN.  listed that may be a guide to consider under NJ delegation regs.

It is the responsibility of the employer to verify LPN license and instruction in job responsibilities which includes medication administration.  LPNS in NJ do not perform IV push meds, similar to PA and DE regs.  Therefore, if your patients have IV therapy, you should check medication list and discuss with the LPN to notify you of any patients needing IVP med for you to administer.

 3 staff for 16 patients in SNF/sub acute is good staffing.  Encourage a team mentality -- on slower days do one med pass so you can get fuller understand of patients condition re any med side effects, need stop med no longer needed or additional medication needed, etc.   Hope this position works out for you.