Team Nursing?

[plumrn]

RN1963:

We tried team nursing at our hosp.and it didn't work.1 RN to 12 pts just didn't work.For one thing,our PCA's aren't allowed to do any invasive procedures; pretty much limited to beds/baths and vs's.1 team (1RN,1LVN,1PCA) could have from 10 to 15 pts.and you're right.If you delegate something,such as vs's on someone getting blood,it often didn't get done because they were busy with so many other things,(just as we were).Of course the team leader is responsible legally if something goes wrong.

The work is constant,and charting on 15 pts just did not get done until the end of the shift,and I call that forced overtime!

[Brownms46]

Originally posted by Brownms46:

You're absolutely correct about pt. requiring more care than they previously did. I did not imply that this was the "OLD DAYS, but that "WE" HAVE a charge nurse NOW "like in the old days". And yes many times, pts. did just come in for tests, and stayed much longer. And yes, the pts. in the hospitals now are much more acute. When I talk about team nursing, I'm not speaking about ltc. I have worked in nicu/icu/ccu/sicu/micu/trauma er, and on med-surg floors. I have very rarely worked any LTC. When I have worked ltc, it was as per diem on rare occassions. "I" still believe team nursing works well.

Besides where I work now on assignment, there is another hospital right now, that does team nursing For the most part it works pretty well depending on who you work with. Most of the time it was a good working relationship, but not always. There will always be someone, who tries to get away with not pulling their weight. As in a recent assignment I had, where team nursing was awful to say the least!

So even in the hectic world of nursing today, team nursing can, and in some instances does work well.

Brownie

[moonrose2u]

has anyone found a pt acuity grid online? i have searched, and haven't found anything..

any ideas?

[Lulu]

I worked Inpatient Rehab for 8 years with team nursing at first and Primary nursing toward the end. Loved team nursing there. Am in med/surg now and can't imagine it working for me now. Too much to do, we'd lose track too easily.

[rndiva1908]

These posts are really scaring me. I just accepted a position on a tele floor that uses the team nursing approach. I start next week. The pt ratio will be 6-7:1. The LPNs or new grad RNs will pass meds, do dressing changes, tube feedings, etc. We're responsible for the assessments and ensuring everything gets done. There are also CNAs to do the basic care. At least that what I was told in the interview. I wonder how the adjustment will be for me going from primary nursing to team nursing. I know a couple of RN at this hospital and I've heard mixed reviews. I've heard a couple say that they absolutely hate it, and a few say it's okay, and others say it's wonderful. I guess I'll have to arrive at my on conclusion when I start.....

[live4today, RN]

Team nursing was great at some facilities, lousy at others. Primary nursing is what I really prefer as long as I have a CNA to help with the routine vital signs, I/Os, feeds, changing beds, baths, weights, etc. The BEST team approach is pitching in when needed, helping one another out, and ensuring EVERY patient receives the ultimate of care. That's teamwork! Whenever I wasn't busy with my own patients, I was busy helping other staff with their patients. If I had a chance to have lunch, I made it possible for some other staff members to go take their lunchbreaks. Nurse/patient ratios should NEVER exceed 5:1 - regardless of the shift worked - IMHO. :)

[jilpil3]

I work on a ICU/STEP-DOWN Unit, we are going to start using some kind of bar code system for giving meds. The concept is some kind of team nursing with one nurse giving all the meds. Has anyone else heard of this new system?

Jil McDaniel, RN

[globalRN]

As a general duty nurse many years ago, in the early 80's I did primary nursing in acute medicine. We had no support, auxiliary staff, you were it!!! The patient load was 1: 5 or 6 patients on 12 hr days and 1: 8-9 on 12 hr nights.

When I was an instructor in a BSN program in HK, I got to see team nursing and to be a 'team leader' with my 8 students.

On days, I'd take 16 patients and on nights 24-32 patients.

I wised up to not taking too many patients....especially on nights

but also had to balance giving the students opportunities to learn.

You had to be super organized and know exactly what was going on. Since we walked into the wards and they were usually acute care: I learned to read(pick out important pieces of info)from a chart and assess patients in very short time. I would briefly read the chart, look at the meds, vital signs sheets, in/out sheets, care sheets and recent labs AND check the patient. I have to say that was one skill I didn't learn in nursing school and that I did try to hone with my students as a clinical instructor. Had to have a very good knowledge base in order to

provide anticipatory care and identify trends...talk about multi-tasking.

I am not against team nursing but I have seen medication nurses(who just give the meds) give inappropriately because they don't really know the patient that well.

I think team nursing leader takes someone who is quite experienced and as I said on the ball. It must be scary to work with team members whose work you can't trust.

Personally, I preferred primary care nursing....at least you knew it was done and to your standards.

[TheLionessRN, RN]

I think team nursing is a whole lot better than primary nursing, but, when I worked a floor with primary nursing, the ratio was 1:7 and there was no cna to do vitals and baths, etc. My greatest complaint was that, because that group was mine alone, I didn't have anyone else there to help me pull a patient up in bed, or refill a water pitcher while I was busy cleaning up a mess in another room. At least with team nursing, there is someone else that can be called for a patient need.

As has been said, the team is only as good as it's members. My biggest gripes with the system all came from the other member not doing their job.

[canoehead, BSN, RN]

I think team nursing would be easier to use in an area where it is less life threatening if prioritizing is not done exactly right. For example UAP's or CNA's may be asked to do post op vitals, but they prioritize the huge code brown as being more important and do it first, then come back and do the vitals an hour later. They are working with what they know, but the RN assigned with them has just been flushed down the crapper. ( :) ) So many situations like that can come up in acute care that I think it would be frustrating for everyone involved, including the UAP, and could lead to patient injury.

I noticed that most good experiences with team nursing come from LTC, perhaps because the patients are supposed to be stable, more or less. Also the pt population does not turn over as quickly so priorities can be set for your patient group and remain consistent over time, making it easier to rely on each other.

[longtermcarern]

Originally posted by RN1963

Team nursing might work well in a LTC setting where the pts. are more stable

Where I work at in LTC, we are attached to the hospital. On any one day we may get 3 to 4 admits from the hospital. Some of these admits come right from recovery room, they don't even go out to the med surg floor. I have 40 patients and 2 cna's to help me. I may be running blood down one wing and IV antibiotics down the other. As the nurse I pass all the medication's, do all the vital signs, and all the bowel care. In the morning I have 6am meds to give, currently 30 patients recieve them at that time. The cna's turn them and keep them toileted. never do I have less then 4 fresh hips. Patients come from the hospital a lot sicker then they ever used to and staffing in long term care has not changed since the 1960's.