Staffing Model - Team lead, 2 care partners - 10 patients

[SLB78]

Our facility is starting a new staffing model. For 10 patients there will be a Team lead (RN) and 2 care partners (RN's or LPNs or SNA's). Previously RN's took 3 patients (primary care) or RN's took 6 patients with a LPN or Student.

We are on a med surg floor and majority of patients are higher acuity. This change has left the nurses feeling they do not know the patients and they feel unsafe and that it is just too much.

I am wondering if anyone else uses this staffing model and if so, what are some tips to help this model work?

Thank you.

[Parrhesia, BSN, RN]

We also use the same care model for 9-10 patients that we have and I'm the team lead as a RN. I noticed that we would be required to constantly communicate to keep other team members updated on every patient's health status - meaning, as a team lead RN, I need to know all the health status and care plans for the 10 patients, but between the LPN and I, we would split up the patients in terms of administration of medications or nursing interventions (wound dressing, ..etc.). It also means that even though NA/HCA would do basic hygiene care, we would also participate to help out if needed. Of course, if we have very acute patients, the RN may take fewer patients compared to the LPN who would take on more, but stable patients.

Tips: After morning report, gather your team members and talk about what they will be doing for the first couple hours. Who does the blood glucose checks, wound care, inform HCA/NA about who needs daily weights, and AM care. We also check in every 1-2 hrs with one another if anything else needs to be done and addressed.

What we do for morning assessments and medications is the RN and LPN would go from end to end (beds/pt rooms) and work towards the middle. Whoever may be faster in AM assessments, might take on more patients. Of course, we also take into account of if there are more acute patients, then the RN would attend to those acute patients first in terms of AM assessments. Feel free to DM me if you have more questions. Thanks

[SLB78]

Staff is having a hard time with team nursing. Before this model, they did primary care (RN to 3/4 patients). Directors will be addressing the required role for the lead RN. Although, I feel that the main difference with team nursing vs primary nursing is "team".

My opinion is the team should get report on all 10 pts. and then the lead will break down the assignment accordingly (which is usually all RN'S). Since the goal is to still work to scope of practice - RN's can all take 3 pts and share 1 high acuity pt.

The complaints:

• Report takes to long. Why cant each RN get report and then meet with team for a "briefing"
• I do not really know what is going on with my patients."their story"
• If team is all RN's, what is the responsibility of the lead
• How do other areas do hand off report? Is it expected the lead will always give report, if team is made up of RN's?

Thoughts?

Thank you !

[RN/WI, ADN, BSN, MSN, RN, APRN]

This sounds like the old nursing home , LTC model, not inpatient setting. What is wrong with nursing leadership? No wonder the new nurses don’t stick around!