RN & LPN Teams: How does it work?

[Florence NightinFAIL, BSN, RN]

Hello ALL nurses,

I hoping you could clarify something for me or tell me about how your system works wherever it may be.

My previous job - there were no teams - the LPNs would ask whichever RN was available to do the tasks that were out of their scope and everyone took their own report etc. etc. Typical.

My current job, an acute medical surgical floor, has RN-LPN teams. The team as 8 pts - 4 for the RN and 4 for the LPN. We take report together and help each other out as a team - which sounds great.

However, something came up recently that was very confusing. An LPN's pt had a new order which the LPN forgot to check/give. The manager not only called in the LPN but also the RN. The RN was reprimanded for not checking the LPNs chart.

Excuse me?

LPNs are not students that you have to look over their shoulder. They are licensed nurses. I thought the only responsibility the RN had was to do the few tasks that the LPNs couldn't - I.e. blood administration, IV insertion, hanging IV meds etc.

On top of my 4 patients - am I expected to keep up to date on the LPNS pts too? Who has time for that?

During my orientation I was never informed of this. I would have never known this if this incident did not occur. I plan on approaching the manager soon to clarify this some more but I was pretty shocked.

What do you guys think? And those in teams - what do you guys do?

Sorry if I'm all over the place and for any mistakes - I rushed this post because I'm leaving for work in 10 minutes!

[TheCommuter, BSN, RN]

Since the LPN has a license of his/her own, (s)he should bear the responsibility for orders not being taken off in a timely manner on his/her patients.

However, some opponents of team nursing dislike it for the fact that nurse managers often make the RN responsible for the LPN's patients. It doesn't have to be this way. I think team nursing is a wonderful way to provide care if all team members pull equal weight and take personal responsibility for their actions.

[kool-aide, RN]

In my hospital when the nurses are using team nursing on a med/surg floor the team takes up to 8 pts I believe and the RN and LPN have all 8 pts together. The RN does all assessments, and I think the LPN is mainly responsible for meds and they work together to do ADL's and answer their call lights. I work night shift and if there is an RN/LPN team they do not get a CNA on their assignment.

[Fawn222RN]

I was an LPN for 15 years before I became an RN. Each nurse had 6-7 patients, and we were all responsible for our own teams. It was a busy med-surg floor, and we all just had to pull together. RNs were responsible for the initial assessment on newly admitted patients (that changed), and they pressed the start button on the IV pump when blood transfusions were started. As far as IV stuff, I can tell you that LPNs having been starting IVs and doing venipunctures since the beginning of time. We were able to hang IV meds, but didn't initiate them on central lines. In those days we didn't do IV pushes, but things have changed & LPNs do give some IV push meds now (varies from one state to the next). LPNs can do a lot more than a lot of people realize :)

[APRN., DNP, RN, APRN, NP]

I was an LVN previously, and worked with the team nursing concept at many different facilities in California.

In the early 2000's, JCAHO reprimanded one acute care facility in California for the RN's not documenting that they were reviewing the LVN's charting by making some statement or another "Agree with LVN's assessment.....no changes to plan of care", or another similar statement that showed that the LVN was not the primary nurse for the patient. (Oh....and then there was a big ol' scuttle butt about *gasp* LVN's "assessing" acute care patients....then the wording was changed to "Agree with LVN's 'documentation'....)

I have not worked with any LVN's for many years, and I have no idea what is required of the RN as far as delegation/documentation now-adays. I can understand the confusion though.

[HouTx, BSN, MSN, EdD]

I think that the answer to this question really depends upon the Scope of Practice outlined by State BONs. Here in TX, LVNs must work under the direction of an RN or MD - they do not have an independent scope of practice. That is not to say that their clinical work is limited.... far from it. There are very few clinical tasks that our LVNs cannot perform, once competency is verified.

Every 'team' has to have a designated leader. In team nursing, it's an RN and this person is responsible for ensuring that everything gets done for that group of patients. The way that the work is divided should depend upon the skills and ability of the people involved. If a team member is a newbie (RN or LVN), the leader may limit her to specific tasks. But if the team member is fully competent, the team leader would just make assignments and expect everyone to do their work and holler for help when needed. Team leaders are expected to maintain awareness of what is happening - and make needed adjustments if anyone is floundering. Many hospitals do require the RN team leader to make a note on every chart to indicate that he/she has reviewed the care & agrees with what is going on. Some also require the team leader to round with the physicians and handle any physician communications. Just depends on the facility.