I need some help

[RN2B07]

My facility has started team nursing & I dont care for it. I am on a busy sugical/ortho floor. We have had meetings about team nursing and 10pts at one time is to be our max. Lately we have been going up to 12. I told the CNM it is way too much for 1RN and 1LPN, she says well you have at least 2 d/c's. The point is I am ultimately responsible and must pass their meds and so an assessment. Not all the RN's are doing this seems only a few. And I dont know why. But I emailed the DON and her response was they will have 10 pts max and 11 pts if necessary. Which probably mean I will be in the same situation. What are my options? Can I refuse the pt. load of 12??

[Daytonite, BSN, RN]

How come your LPN can't pass oral medications? When we did team nursing 30 years ago our LPNs did all medications and most of the treatments except for IV meds. We had LPNs doing patient care as well. Just what is your LPN doing? When I worked on a stepdown unit each RN and LPN had 10 stepdown patients between us to take care of and at that time the LPNs in that particular state couldn't give meds, but they sure weren't sitting around. While I was giving meds and doing assessments, the LPN was answering lights, doing patient care and changing dressings. Sounds to me like you need to take a look at all the tasks you have to complete in your shift, prioritize them and see which ones you can delegate out to your LPN and which ones you absolutely have to do yourself. Outside of that, I guess your only other option would be to quit and find another job.

[CHATSDALE]

other post is right you must delegate respondsibility, lpn cannot do iv or assessments in many states but oral meds, scheduled and prn, making rounds to alert you of an potential emergency, assisting with charting if that is allowed,

but you do have some options

taking 12 pt instead of 10 d/t possible dc???it takes at least as much time to prepare for a dc as it does to give care to that pt

[AfloydRN, BSN, RN]

Let me guess, not a union hospital, right? Where I work the MAX nurse to patient ratio is 5: 1.

[gitterbug]

Seems like this model for care was instituted without a clear guideline on how to proceed. Team nursing, in it's true form, has clear roles for each member of the team. Get back to NM and let her know model in not working. Agree, with earlier post, if 10 patients are the limit for each team, then pending DC does not allow for more patients, teaching and pre-DC care needs are still needed. Charge nurse must take overflow.

It seems so odd to me that new nurses have such a difficult time getting team nursing to work, this was the model I worked under for 5 years, and we seemed to have a strong unit, good morale, patients got excellent care, and physicians were very satisfied. After the change, to primary care nurse, things were touchy and remain that way on a couple of units. I spoke to a retired physician/retired chief-of staff just yesterday, he was glad to be getting out while he can. Too bad, he is a good physician, ethics are above reproach, and has a genuiene caring for patients and staff. He hates to go but feels the new way of doing things has made his practice too difficult to continue. He will be missed. He mentioned team nursing, always felt he could get answers and input from all level of staff when that model was in use. Now, no one knows what the other hand is doing a lot of shifts.

Sorry to rant on, but I did used to enjoy this type of nursing. Now, I just seem to be marking time.

[sweetielin]

where i work, you are lucky if you only have 10 pts for 1 rn and 1 lpn. we can have up to 17. if there are between 18-23, 2 rns and 1 lpn. really it is too much. the rns do the ivs for the most part but lpns can do all but pac and ivp. lpns give po/im/sc meds, do dressing, accuchecks, tube feedings, paperwork.