RN1963

Sorry about previous missent reply.(Learning how this BB works.) We use the same banding system at our hospital...I thought it was a national system that everyone used.Just found out few days ago..another hospital transfer..they don't use the blood band system. I am wondering what safety net they have in place. A few years ago, our hospital stopped using phlebotomists for inpatient lab draws and trained the nursing staff and CNAs to do the draws. I was apprehensive, but it has seemed to work well from my experience. Though I have to tell you, from the mistakes I see some CNAs make with addressographing the charts with the wrong names..entering the orders on wrong patients...how scarey is it that they are doing the type and cross lab draws? Cold sweat attack!

Team nursing might work well in a LTC setting where the pts. are more stable, I don't know.But on med/surg where you have 2-3 discharges out of 10- 12 pts, readmits from ER or PACU,3 new postops and 2 total care pts.....you might as well be in Olympic training to run that far up and down the halls to get to the rooms spread out. It is an out of control feeling to have to try to get to see those pts. often enough to be able to pick up on any new developments. It is great for the CNAs. They have fewer pts. on a team and they cluster at the desk chit chatting while we run our buns. In the meantime, we haven't exactly figured how to divide the labor between the Manager (charting, assessments, MD orders) and the Provider (meds. and treatments), so we end up duplicating..who did what? In Primary care, I know what I have done and I trust it. I have a problem with the methods of some nurses.It is one thing to be working side by side on separate patients and quite another when you work together to see how dysfunctional some of them can be and how they are either missing or wrongly performing some aspects of care or not following all the hospitals policies and procedures and blow it off with.."I don't do THAT".With another top notch nurse the team works well...but still not as well as primary nursing.With an inexperienced or dysfunctional nurse where you have to both do your job AND assist the other...nightmare!

Many years ago team nursing was routine. It is raising its ugly head again.A team is one RN manager, a provider(RN or LVN) and a CNA. They have 12 pts. The manager does the assessments, charting and care plans; the provider does the meds., IVs and treatments.The aide does v/s, blood draws, accuchecks, I/Os, etc.The problem lies in having a person on the team who does a shoddy or unreliable job. My license is on the line. Admin. says we are only responsible for the work that WE do. Each person is responsible for their own care. I have a problem with that. I often find that an aide may not take the required 15 minute v/s on a postop because "I was busy cleaning up another patient."I can usually catch this oversight if I have only 6 patients, and take the v/s myself. I can't know what is being done or overlooked on 12 pts. We have a few experienced RN's that I feel uncomfortable having on my team.When I give them report, they just stand and listen..no notes. I notice that their meds are often overlooked or given late and the med times changed.I have challenged them on needing to have a list of med times per patient so they can at least be timely with medications if nothing else. What are your thoughts on this? Is there a way to ensure your colleages are doing proper nursing care?Isn't that what administration is supposed to do? They say...write a complaint. If it isn't written, we can't do anything about it.This is what sets nurses against each other. I know I have two separate issues here: team nursing and ineffective coworkers. The scarey part is that with team nursing, they aren't just coworkers..they are part of the care of YOUR patients.

I used to do charge all the time.A few months ago, Admin. decided to try one cn for both units, North AND South (64 beds). Now, these poor CN's have a cell phone to their ear constantly. ER calls for beds,PACU calls for beds, she has to call employees at home for staffing for the next shift, make out the next shifts assignments (how can you make a fair assignment not having time to know the needs of 64 patients). In addition she often has to either take patients, or be desk clerk, answering phones and entering doctors orders in the computer.Then there are the requests from the staff who are having crisis problems with their patients, can't start an IV, or need input on a patient condition. They have to do it all! All this for .25 extra per hour! Who needs it?