Primary nurse VS Team Nurse

RNPATL, DNP, RN · Jul 21, 2004

I just had an informal interview at a hospital. They do team nursing there. Has anyone had experience with this? I am used to primary nursing. I would love to hear your opinions. Thanks

There are a number of unique and different models of nursing that hospitals use today. Most, work under a primary care model, where the nurse is responsible for the total care of the patient (personal care, medication, treatments, orders, etc). However, under a team nursing model, the RN leads a team of people, generally an LPN and a CNA. The RN is responsible to ensure that the orders are taken off, assessment is complete and the overall care needs of the patient are being attended to. The LPN generally passes medications on the team model and the CNA provides the personal care. In most cases, the team cares for 10-12 patients. While on the outside it may look wonderful, it can be as challenging as primary care.

Of course, there are variations of the team nursing model, some that do not use CNA's and the RN and LPN are responsible for a larger group of patients. Others use the team model with a charge nurse that deals with orders and the RN/LPN team deal with the assessments and meds, while the charge nurse deals with orders and physician contact.

I have worked with many different models and do like team nursing, but prefer primary care. Hope this helps. :coollook:

Dixiedi · Jul 22, 2004

I'll ditto what RNPATL had to say. I've worked team and primary as an LPN. When I last did team nursing, the team leader, usually an RN, did the orders and all care for a smaller group of pts than the LPNs did all care for. We had one CNA and she helped out with toileting, and other personal care, she was there for all of us and she was fantastic. There were a lot of evenings I just don't know how I would have ever gotten out of there without her.

DHnurse · Jul 22, 2004

Thank you for your replies. I felt better after reading them that it can work. I got an offer and decided to accept. I am very excited to start.

barefootlady, ADN, RN · Jul 23, 2004

Like most experienced nurses I did team nursing for years and loved it. I worked with a great LPN and CNA. We had a charge nurse who did trouble shooting and let us know of any big changes, otherwise I checked the back order sheets hourly, labs q 2 hours, and etc. It was a wonderful working model and we had a great team. If we had a heavy load we always pulled together and got the job done, I covered for the LPN while she was at lunch and another RN, then they covered for me and the LPN on the other team while we had lunch. Yes, we did get lunch and breaks, we had less injuries because everybody jumped in to assist with heavy patients when transfers and turnings were needed. I only had 10 patients a very few times, usually 8 was the load. I know the patients got really good care, more nurses were on the floor every shift, and support staff too. When primary nursing was instituted at one facility, an older nurse said, this is a way to get more work from each nurse and not give her support as she needs it. I think she was proven right in many ways. Like many experienced nurses have stated here time and time again, the old days and old ways were not always wrong. I for one miss team nursing.

RNPATL, DNP, RN · Jul 23, 2004

Thank you for your replies. I felt better after reading them that it can work. I got an offer and decided to accept. I am very excited to start.

Congratulations on your offer. Hopefully all will work out well for you. Please come back to the forum and let us know how the new job is going. :balloons:

RNPATL, DNP, RN · Jul 23, 2004

Like most experienced nurses I did team nursing for years and loved it. I worked with a great LPN and CNA. We had a charge nurse who did trouble shooting and let us know of any big changes, otherwise I checked the back order sheets hourly, labs q 2 hours, and etc. It was a wonderful working model and we had a great team. If we had a heavy load we always pulled together and got the job done, I covered for the LPN while she was at lunch and another RN, then they covered for me and the LPN on the other team while we had lunch. Yes, we did get lunch and breaks, we had less injuries because everybody jumped in to assist with heavy patients when transfers and turnings were needed. I only had 10 patients a very few times, usually 8 was the load. I know the patients got really good care, more nurses were on the floor every shift, and support staff too. When primary nursing was instituted at one facility, an older nurse said, this is a way to get more work from each nurse and not give her support as she needs it. I think she was proven right in many ways. Like many experienced nurses have stated here time and time again, the old days and old ways were not always wrong. I for one miss team nursing.

Very few words for me to add other than ..... I agree with you about team nursing. However, if primary care nursing is done right, it can be an excellent way to provide care. But, that is if it is done right. :)

barefootlady, ADN, RN · Jul 24, 2004

RNPATL,

You are right, primary nursing is great when it is done right. But Right is the issue. I think I can keep up with some of the best of nurses, but I cannot do justice to a 8 patient primary care load. Especially if any of these patients have a complication or need something other than push the pills, hang the IV's, and do a small, uncomplicated dressing. I really pity the poor CNA who has 12 or 13 pts. to a side and has to help more than one nurse. While I will pass ice and water, give a bath, make a bed, assist with turns/transfers, I have worked with many an RN who will not do these things. HN/CN in a lot of facilities today do not know the role they are supposed to play or just won't do it if they do know. I am afraid I am starting to get a little toasty around the edges from being burned by coworkers. Please excuse the rant, I really just wanted to say thanks for allowing me to support a model of nursing practice that provided many a good day at work for me.

RNPATL, DNP, RN · Jul 25, 2004

Where I work, we have several different models of nursing that we use. Somedays, we don't know what we are doing ..... it depends on the charge nurse and we are generally at her whim. Anyway, the days we do team nursing, it seems like things go a lot better. For one, the unit is NOT set up for primary care. We have 2 med carts, multiple students and nurses. Trying to get access to the med cart is terrible and usually ends up with meds being given late, when we do primary.

For me, when the tools and equipment are available, I prefer primary care, but for the unit I work, right now, the best way to do things is with a team nursing model. Unfortuantely, we do not have CNA's on my unit, so if the LPN is passing meds, the RN is usually doing patient care, treatments, orders and dealing with the physicians. Our CN generally has to take a full assignment also, so at times it can be very tough.

barefootlady, ADN, RN · Jul 25, 2004

A CN who takes patients, what a change. I have not worked with one of those in over 5 years. Oh, sure, there was always the pep talk at the beginning of the shift, "I'll help if you need me", but when she was asked she was always "too busy". Complaints do no good, HN had no clue to floor procedure, she had pushed papers for 15 years. I got out and I am having trouble convincing myself to ever check another hospital. Yes, there can be some rewarding moments in primary care nusing, but, as I stated earlier, the facilities just don't staff for primary care, at least not here. It sounds like you have a unit that works for the best outcome for the patient and staff, that is a rare animal here these days. Well, I hope your next shift is a good one.