Indivualized Care vs. Teamwork Care

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I am curious to see how others perceive this debate. Should patient care be done by an individual RN, LPN, CNA? Or should patient care be performed by whomever is available? I understand the legal ramifications of assigning patients to caregivers for documentation and continuity of care issues. But this leads to caregivers who feel they only need to help their assigned patients. This seems very self-centered and unfortunately, individualizes the patient's care. Whereas, in my opinion, every caregiver on a unit should work together to provide the best care for each patient. Documentation can still be accomplished by the assigned caregivers, but every patient receives care from a team/group of caregivers that communicate effectively with each other to ease the documentation process.

I am asking this because I am a student nurse working on a med/surg floor and I have heard (too many times) that's not my patient. Every patient deserves the same attention. I try my best to make myself available to all the RNs, LPNs, and CNAs I work with when they need help and many have reciprocated. After all, four hands are better than two! Let me know where you stand on this. Do you believe in individual care provided by RN, LPN, CNA or do you also believe that every caregiver is responsible to each patient on the floor and why?

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Each nurse is assigned to take care of a 10-20 or more patients.Each nurse is responsible for her own patients.It is impossible to find time to take care of every patient on the floor.When someone says "he's not my patient" it doesn't necessary mean they don't want to help. They probably don't know much about that patient and don't want to screw anything up. If a patient is having serious problems, falls, or a nurse needs help lifting a patient I can't imagine a nurse saying "he's not my patient." I love teamwork but only when it is necessary. Everybody has their own patients to take care of.

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It all depends on the flow of the unit, patient to nurse ratio, even time of day, (shift change). It depends on what help you need, like healthstar said, assisting a patient who fell to the floor, yes any medical personnel should help.

However, I do preach and practice teamwork. However I work in a less stressful, less hectic, low patient to nurse ratio unit, so I have the luxury of practicing what I preach!

You should know who the patient's primary nurse, lpn, or cna, is. If it not an urgent need take the time to find them. The staff on a busy unit may not be able to help you as they are busy caring for their own assigned patients.

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Specializes in Developmental Disabilites,.

On a busy unit it would be dangerous to have everyone responsible for the pt. Because when everyone is responsible no one really is. I say "it's not my pt" when other staff members are asking me questions related to care. If a pt needs help urgently all the staff on my floor assist regardless.

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Specializes in M/S, MICU, CVICU, SICU, ER, Trauma, NICU.

On a med-surg floor, that's a very difficult initiative. If you have 30 patients on the floor, do you think you will know every detail about him/her? Not so sure--especially with the co-morbidity of patients we have now. They are SO complicated.

I think teamwork and helping in general is very important, but being responsible in the "whole picture sense", may not be possible. It would take away the "responsible" aspect of it.

Besides, not everyone can multitask well. I noticed this about the people I work with. Some can only manage one issue at a time. I, on the other hand, can handle at least 4 or 5. Not everyone is like that--so expecting everyone to work at that level can bring many disappointments and resentments.

Just a thought.

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It is impossible to find time to take care of every patient on the floor.When someone says "he's not my patient" it doesn't necessary mean they don't want to help. They probably don't know much about that patient and don't want to screw anything up.

Exactly, I once had a nurse attempt to "help out" one of my patients. Pt was just brought up to floor, from a different facility. Had pain issues, that we were working on, but needed to clear up orders first. (MD ordered morphine which patient was allergic to) Verbal report was taken by me from other facility. Resident also had an order for another pain med PRN q6h, which had been given prior to pt coming up to our floor. Nurse attempting to "Help" gave the PRN pain med IV push, 5 hours too early!! Never consulted me (pt was assigned to me)

Pt had kidney issues which made things worse. Attempting to help out, a pt. that you know little about, can result in bad outcomes for pts!! I certainly do not mind assisting the CNA/nurse assigned for minor things like boost in bed, or 2 assist transfer, etc. Other things, I am more cautious of, since above described incident!!

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Exactly, I once had a nurse attempt to "help out" one of my patients. Pt was just brought up to floor, from a different facility. Had pain issues, that we were working on, but needed to clear up orders first. (MD ordered morphine which patient was allergic to) Verbal report was taken by me from other facility. Resident also had an order for another pain med PRN q6h, which had been given prior to pt coming up to our floor. Nurse attempting to "Help" gave the PRN pain med IV push, 5 hours too early!! Never consulted me (pt was assigned to me)

Pt had kidney issues which made things worse. Attempting to help out, a pt. that you know little about, can result in bad outcomes for pts!! I certainly do not mind assisting the CNA/nurse assigned for minor things like boost in bed, or 2 assist transfer, etc. Other things, I am more cautious of, since above described incident!!

I wouldn't do anything to a patient that is not assigned to me without asking their nurse first. A small error at the beginning can lead to many problems at the end.If it is urgent and I can't find the nurse I would take an action.

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I am curious to see how others perceive this debate. Should patient care be done by an individual RN, LPN, CNA? Or should patient care be performed by whomever is available? I understand the legal ramifications of assigning patients to caregivers for documentation and continuity of care issues. But this leads to caregivers who feel they only need to help their assigned patients. This seems very self-centered and unfortunately, individualizes the patient's care. Whereas, in my opinion, every caregiver on a unit should work together to provide the best care for each patient. Documentation can still be accomplished by the assigned caregivers, but every patient receives care from a team/group of caregivers that communicate effectively with each other to ease the documentation process.

I am asking this because I am a student nurse working on a med/surg floor and I have heard (too many times) that's not my patient. Every patient deserves the same attention. I try my best to make myself available to all the RNs, LPNs, and CNAs I work with when they need help and many have reciprocated. After all, four hands are better than two! Let me know where you stand on this. Do you believe in individual care provided by RN, LPN, CNA or do you also believe that every caregiver is responsible to each patient on the floor and why?

A little perspective may help you see things in a different light.

Up until the 1980's or so "team nursing" was the norm on many floors, with what would be called "primary care" today being practiced on the units or areas of acute/sub-acute care.

While team nursing does have it's strengths in terms of staffing, it can and often did cause confusion in patient care. Having one nurse give meds, another doing treatments and so forth can lead to errors. It also means instead of one single nurse per shift "knowing" the patient, there could be several, and possibly frequent trips to the chart or Kardex to find information if the "other" nurse cannot be located etc.

Primary care is just that, you have one nurse charged with "X" patient and is responsible for his care during her tour of duty. Instead of many "hands", you have one nurse doing meds, treatments, well you get the picture.

This new model works today you consider that the average floor patient often would have been "acute" or "sub-acute" in years past, and probably would have been on a unit. In such instances having one nurse as the "go to" person is better for patient outcomes.

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I believe that every care giver is responsible for the patients when there is a need and rather or not that patient needs the bedpan or meds , and this can be done in a team effort ,of course I realize that patient are assigned to specific RN's LPN or CNA , but if Mr. Smith needs a bedpan then why can't Mr Reeds CNA give it to him and relay this to Mr. smiths CNa or if Mr Reeds needs Meds Why can't Mr Smiths nurse relay this to Mr . Reed's nurse . Good communication among the team is key and vilgilence to the needs of the patients from all on the team is important.

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Sometimes "that is not my patient" has to be said. One place I worked had a couple of long hallways.

For the nurse assigned to patients at the end of the hallways meant having to walk past many rooms to get to their assigned patients. A nurse with an assignment like that can get frequently ambushed by family members in doorways or patients calling out as he or she passed by.

If your assigned patients were to get any care at all, sometimes you would deal with non-emergent needs of others by telling the patient to use the call bell.

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Thank you all for your input. I definitely see the value in assigned pts when it comes to important nursing acts such as medications. However, the "small" stuff like moving a pt up in bed or providing a bed bath to a total care is always faster with another person! Thanks everyone for your input!

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