Team Nursing, Does it work???

missmercy · Mar 26, 2004

AH! The voice of reason! I think that is a great idea!! Yep, you guessed it! When the idea of piloting a team or two to see how it would go was brought up, our DON said "No! We are not going to let them pretend to try it and allow them to make it nonfunctional so that they can get their own way." :angryfire SO... team nursing, here we come -- dragging some staff kicking and screaming all the way. I did win one small victory-- :rolleyes: -- told DON that I would not present the change and set a start date until they have hired 75% of the additional 10 people they need to hire to make it work. SHe didn't particularily like the idea, but agreed after I said that I didn't want to get everyone all psyced over a change until we KNEW we could get enough people to make it happen. I think appealing to the "we'll look stupid if we force this without the resources to make it work" plan was good.

yaddadoit · Mar 26, 2004

Team nursing is only what the team makes it! One person who is not a team player can make it very difficult for the rest of the team to be a success. I've been involved in team nursing off and on through the years. Most of the time I loved it, however, I just recently had one of the worst experiences of my career. I hired on with a local hospital who is trying to implement team nursing. I was the first LPN hired on my unit (I've had a lot of firsts in my career and was eagerly looking forward to this position). The second day on the job I sat down in report with all of the RN's (CNA's are not allowed to attend report there--first time I've encountered that in a team situation)-- the charge nurse for the day informed me that although she had nothing against me personally that the RN's didn't want me there, resented me and that "people like you are hired to put people like me out of a job". :angryfire When I went to the unit supervisor to inform her of what I had been told, she told me that my coworkers "would just have to get used to the idea of LPN's whether they liked it or not". I stuck it out for 6 months and finally reached the end of my endurance and resigned. After the fact, I was told that the unit supervisor did not want LPN's on the unit and had been forced to hire me by hospital management.

One of the biggest obstacles to success of this team is that there were no clear cut guidelines for LPN's to follow. The expectations changed daily. Many of the RN's on the floor were supportive and positive. However, it's really tough to count on a team member when you don't know what the role is. For example, initially we were told that LPN's were not allowed to do physical assessments, then we were, then we were not again, the same happened with admissions, discharges, patient teaching. Also, for whatever reason, when changes were made about what could/couldn't be done, the entire staff was never informed, just a person here, or a person there. That left room for a lot of "well I thought you could do this, or you did it yesterday, why couldn't you do it today". I could write a book about the things that happened to me on this unit, but the bottom line is, team nursing was set up for failure in this situation.

Yes, team nursing does work. Each member needs to be clear about what the expectations are for all of the other team members as well as themselves. Communications need to be clear. A team is only as good as the members choose to make it!

fiestynurse · Mar 26, 2004

Team Nursing does not work in the current health care environment, where patients are more acutely ill and their care is complex. In the "old days" of team nursing you might have 10 patients on your team, but only 2-3 were critically ill or fresh post-ops. The others were pre-ops or in for tests or 4-5 days post-op (in the days were patient stays were longer)

recent studies show that higher licensed nurse staffing levels prevent complications and unnecessary deaths:

Low nurse staffing levels leave nurses too overburdened to monitor patients or prevent medical errors adequately, which cause up to 98,000 preventable deaths each year.

For each additional patient over four in a registered nurse's care, the risk of death increases by 7 percent for surgical patients. In hospitals with eight patients per nurse, patients have a 31 percent greater risk of dying than those in hospitals with four patients per nurse.

Understaffing was a contributing factor in 24 percent of all sentinel events (unanticipated incidents in hospitals that led to patient deaths or injuries) reported to the Joint Commission on Accreditation of Healthcare Organizations (JCAHO).

In hospitals with fewer registered nurses, patients are 2 to 9 percent more likely to suffer complications like urinary infections and pneumonia, 3 to 5 percent more likely to have a longer stay in the hospital and 2.5 percent more likely to die from "failure to rescue" (conditions that might have been reversed if treated in time).

An extra hour of nursing attention per surgical patient each day cuts the risk of urinary tract infection by nearly 10 percent and the risk of contracting pneumonia by 8 percent.

A higher proportion of care by registered nurses results in a lower rate of medication errors and patient falls.

This is why the nurse/patient ratio bill passed in California.

missmercy · Mar 26, 2004

Yaddadoit,

Thanks for your candid input! I am really steamed about how you were treated. :angryfire That is just WRONG!!!!! That is what I am afraid of in our situation -- if administration tries to "force the issue" won't that set the table for some resentment and feuds?! I think so. However, since the management is so determined to do this, I am going to be sure that I try to establish clear guidelines for our LPNs and Aides. (and the RNs for that matter) I am studying the OH nurse practice act for guidelines. Hope that will help to eliminate some of that nitpicky, nastiness!!!

yaddadoit · Mar 27, 2004

It sounds like your team is already off to a great start!

The unit that I had my bad experience on was one of the last to incorporate the team philosophy... obviously kicking and screaming the whole way. Wish I would have known beforehand and I never would have accepted that position!! However, within the same hospital, there are several units which are utilizing team nursing and the teams are thriving. I had the opportunity to float and loved it! All of the team members seem to be enjoying it. One of the nice things this hospital has done on the units where team nursing is working is adjust the team/patient ratio accordingly. Originally, when primary nursing was being done, the RN might be responsible for 5 to 6 patients, however, when the team with 3 members are given assignments, the team might be assigned 7 to 9 patients. With 3 teammembers 9 patients is not so overwhelming, however, with one primary nurse, 6 patients certainly can be. I also observed that depending on the teams, sometimes the RN's chose to continue with primary care for specific patients while assigning their LPNs to provide primary care for other patients with the CNA's helping where needed. Other teams did tend to become task oriented, ie, LPNs doing med passes and treatments, CNA's doing bed baths, etc. One of the RN's I worked with told me that she varies the team assignment based on the skills and knowledge level of her team members as well as the individual needs of the patients. I did find that the expectations were clear and that there was mutual respect between the team members-- I think those are two of the biggest factors to being successful with team nursing.

I wish you luck and success with your teams. :)

JWaldron · Apr 22, 2004

3rdShiftGuy said:

We tried it. The main problem we had was the team didn't buy into it. There was massive uncooperative and closedmindedness by the staff.
The other problem was the RNs were so green compared to the LPNs. Taking a new grad from nursing school and putting him/her in charge of a team was very intimidating to the new grad, and frustrating for the LPN who had to carry a bigger load (with some resenstment).

We are not doing it anymore, as we seem to like the single nurse-single assignment, with CNAs on the floor way of doing things.

Good luck. Keep an open mind. It only works with a spirit of team work.

When I finished nursing school, I got a job as a float (tough way to develop your clinical skills, but what experience!) mostly to units were staffed, 1 RN, 1 LPN and maybe 1 NA, for 16 pts. One floor, the RN and the LPN each 'took' 8 pts, but of course the RN has to assess the LPN's pt's, do the pushes, central lines, certain IVs (at our facility at least). NAs do not do FS, caths, or anything like that. No IV teams, no transporters. On another unit *same hospital) the LPN was the med nurse, did dressings, etc, RN did all the paperwork, assessments, and of course the pushes, centrals, hung blood, and so on. Unit I'm on now, I have 8-9 pts, and usually a CNA. I feel like this is a vacation compared to before. I can do more pt. teaching, listen more, be present for pts in general more. Much better. But this is not really primary nursing either, because I may be on a different hall of the unit after every day off, or because the Charge needs to take the assignemtn I had the day before because it is nearer the main desk, or is lighter, so she can also carry out other responsibilites.

Savvy