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  1. Our med-surg unit (22 bed) is considering switching from team nursing (1 RN and 1 LPN for 10 - 12 patients - sometimes one CNA for all) to some form of primary care system where hopefully each nurse will have 5 - 6 patients. Our biggest issue is how to utilize the LPN's the best way possibe. Just wondering if anyone else had experience with this, or how your unit does it? Thanks for the help.
  2. BethC

    Team Nursing

    I am an RN currently working at a community hospital in Massachusetts. I am a student also working towards my BSN and have a project to do regarding innovative ideas about the nursing model used in my hospital and how to lead units in my hospital in different ways other than the primary care nursing model/or the nurse to nurse manager hierarchy. The group I am working with and myself wanted to explore team nursing models of care. I work on a 30-bed medical surgical floor and we are looking to explore if team nursing could be a model of nursing that could be implemented on this unit. Does anyone work in hospitals that uses team nursing? I am having a very difficult time finding hospitals in the United States that use team nursing in hospital settings. Thanks you to anyone if you have opinions or information on this topic.
  3. Geowhindsey

    Team Nursing vs Primary Nursing

    I am curious about what other Med Surg/telemetry departments are doing with staffing. Are you doing primary nursing or team nursing? What would you say are the pros and cons of each? I know team nursing is “old” but so was bedside report (has come back) and levophed (witness the rise of levophed in the treatment of the “new” devil sepsis). Even the AHA is bringing back the old drugs in the algorithms. Would love to hear other thoughts on the topic of team vs primary.
  4. lnle3618

    Team nursing?

    I'm a baby nurse of only 6 months, when I took the job we had our own patient load 6-8 pts. As of a month ago, they are trying to go to team nursing. Hiring more lpns, aids...does anyone have ecperience with team nursing? Having a pt load of 10. With an RN to assess, lpn to medicate, and both help the aid. I'm so afraid if we have a weak link in this, it will make it more difficult for the others in the team. I have spoken to more experienced nurses about this and they say if it's done correctly it is a great thing. I've only done it a couple of days here and there as it is not going in full force yet. The whole time I was worried if the lpn was getting everything done in a timely manner. I'm so punctual about med passes. I am my worst enemy when it comes to worrying. . So just seeing if you all have some advice. Thanks!
  5. Does or has anybody ever done this before, in the ER? Does it work well or not? If you haven't done it, have you thought about it? Any suggestions on teams/patient ratios? d/t the difficulty in finding available staff nurses to fill positions, adm is pushing to try this out. I think the agency costs are killing them......because we have been getting most everything covered through them for about 3 months now. I know my thoughts......lets hear yours.🙂
  6. Henry Mayo Newhall Memorial Hospital in California gets shot of team nursing in favour of primary care model, and in the process gives LVNs their walking papers.
  7. plumrn

    Team Nursing?

    RN1963: We tried team nursing at our hosp.and it didn't work.1 RN to 12 pts just didn't work.For one thing,our PCA's aren't allowed to do any invasive procedures; pretty much limited to beds/baths and vs's.1 team (1RN,1LVN,1PCA) could have from 10 to 15 pts.and you're right.If you delegate something,such as vs's on someone getting blood,it often didn't get done because they were busy with so many other things,(just as we were).Of course the team leader is responsible legally if something goes wrong. The work is constant,and charting on 15 pts just did not get done until the end of the shift,and I call that forced overtime!
  8. Welcome to the world of team nursing, where two nurses and a nursing assistant share the burden of a larger assignment but have the advantage of teamwork. As a nursing student and new nurse, I heard about team nursing from some of the more experienced, seasoned nurses. They spoke about team nursing with nostalgia, not because of the larger assignment, but because everyone worked together as a team, because they had too. I was thinking about team nursing today and its advantages. For one, it is great to have an extra nurse around when you are dealing with a psych patient, even on a non-psychiatric unit. Psychiatric patients and even those without diagnosed psychiatric disorders may practice splitting, which means attempting to turn staff against each other in order to manipulate a particular staff member. One common example of this is when a patient tells a particular nurse that they are much "nicer" or a "better nurse" than their nurse last shift or that the CNA "isn't very friendly." What they are saying may be true, but it could be an attempt to win your favor. Psych patients may also attempt to manipulate staff by making requests and then undoing them. If you call them out on their behavior, they will deny it at times. For example, I had a patient in the ER who had documented psych issues last week. She was very selective about when she spoke or answered my questions. She kept pushing the call bell and when I asked her what she needed, she didn't answer. Finally, after the 3rd time, she said "I need a blanket." I got her a blanket and spread it out on her, and they she took it off and said "I don't want this." This is an example of classic manipulation. Having another nurse there would help curb these behaviors. It can also be helpful for patient compliance because a united front is a stronger front. If you patient is insisting on leaving the unit to smoke for example or doesn't want to ambulate in the hall, having two nurses educating the patient about the healthier choice may encourage them to choose the option that is best for them. When the nurse is sharing your assignment and is therefore in close proximity it is easier to get this kind of help and support when you need it. I think it can also make the shift go much more smoothly. For example, one nurse can focus on doing assessments on the eight, nine, or ten patients assigned to them, while the other nurse can focus solely on passing medications. Nurse #1 who did the assessments will pass off relevant information I.e. abnormal finding in her assessments to Nurse #2 before Nurse #2 starts his med pass. If he gets a phone call, he can safely ignore it and it will go to the other nurse's phone. This can decrease medication errors because the nurse feels less rushed and can focus on the task at hand without interruptions. The CNA can hover between the rooms the nurses have not yet reached to document vital signs and or help patients to the bathroom (to avoid such requests when the nurse comes to pass meds or do an assessment as so commonly happens). An alternative would be the nurses going in together to do assessment, one doing the assessment and the other nurse documenting for her. The nurse doing the assessment would take a quick look at what was documented prior to signing the assessment. This would also help both nurses be informed about each patient's assessment findings. Having another nurse available can also help nurses deal with the emotional and physical parts of the job. By sharing patients, both nurses feel vested in their assignment. When the CNA is busy in another room, one nurse can call the other to help turn or toilet a patient or even to do wound care. When you need a break or a hug, there is always someone there to back you up and support you. Team nursing can also be a good way to help new nurses acclimate to nursing once they are off orientation. Being teamed with a more experienced nurse can be a great learning experience. If there is a problem, the more seasoned nurse can step in and offer a solution. If the novice nurse has questions, there is a more experienced colleague close by to answer questions. However, if tasks are divided and the newer nurse is assigned to do the assessments and the more experienced nurse questions her assessments it can create resentment even if her concerns are legitimate. There has to be a great deal of trust in this arrangement. Team nursing requires trust in another nurse's abilities as well as the ability to get along. A toxic nursing environment that uses team nursing can be detrimental. An industrious CNA make it or break it in primary or team nursing. There would have to be a lot of thought put into the assignment regarding which nurses and CNAs work best together and to make sure skill level is compatible. For example, it would be better to avoid having two nurses fresh off orientation working together. Team nursing can make shifts go more smoothly by minimizing interruptions and helping patients behave better. It can help with the emotional and physical burdens of the job. To me, the challenges seem easy to overcome and a good tradeoff to reap from the many benefits. Post your thoughts below.
  9. michelle999

    Team Nursing vs Primary Nursing

    I am currently investigating the possibility of reintroducing team nursing to our ward. Does anyone have any research or information on team nursing V primary nursing??
  10. madwife2002

    Primary Nursing Care

    Where I used to work, 8 nurses have left in the recent months and not 1 nurse has been employed to fill in the gap. The work load has increased, expectations remain the same and the clients are getting sicker. We all know despite the current nursing job freeze and the effects this is having on our new nursing graduates, we do face in our near and distant future a increased nursing shortage with the 'baby boomers' getting older, generations are living longer and RN's who are in their 60's and 70's working because they cannot afford to retire. Is Primary Nursing Care being seen by some as the new way forward? If you said yes then you would be correct, there is current a new wave of thinking that we must revert to the old in order to move forward to the future. We must always think first and foremost about pt satisfaction, because financially this means pts will return to our facility time and time again, and will recommend the hospital to others, which in turn increases our revenue. In recent surveys at my hospital patients said what helped to improve their stay in hospital was lots of interaction with their RN. The least satisfied Pt's were the ones who said they hadn't seen enough of their nurse and some could not even remember the name of any RN's who had cared for them. What happened recently in my hospital, they closed 6 beds because there were not enough nurses but then they open up 3 beds because ER was full as there were no more beds in the hospital. Did the floor get another nurse no they had to flex up. This added pressure and stress on the already overworked RN now they have 1 more pt which means 3 more daily assessments and all the work which comes with a new admission that I don't need to explain at this time. So somebody came up with a brilliant idea to do Primary Nursing Care where all pts will be more actively involved with their RN. The aim of this is that RN's will spend 70% of their working day at the Pt's bedside, the goal increased pt satisfaction. Is this ambitious? Who can say it is early in the experiment, and RN's are going through the typical problems change brings. It is important to stress at this time that management did not get any floor RN's on board before commencing this trial and the only documentation the RN saw was a piece of paper which stated their new role. There was however a meeting once a week for a month, and staff were encourage to attend one session this allowed the staff to hear what was happening and an opportunity to ask questions. They are still waiting to see the patients satisfaction levels to see if this way forward was the right way to go. Sometimes I think health care management are just fumbling in the dark and are so far removed from the shop floor they are unable to think critically. Management just don't seem to comprehend what is happening, the tools they use to measure are old and antiquated and need to be revamped by asking the regular nursing staff to be more on board. Maybe primary nursing care is the way forward all I know is it didn't work in the 80's and 90's so why should it work now? The disadvantage of involving the floor nurses is again cost. Cost of what cost of time, self, responsibility, education, the list is endless. Baby boomers - Wikipedia Primary nursing
  11. jfpruitt

    Team Nursing Approach?

    I'm finally in my LAST semester and graduating in May. After numerous clinicals and rotations, I learned something new this week that I wanted to get input on. I attend a small, rural RN program and our clinicals are limited to 2 hospitals. This semester we started learning about management styles and nursing. They have told us that many hospitals use a "team" approach. Where the RN may be responsible for a whole wing of patients and they delegate out to maybe 4-5LPNs and 4-5CNAs. The RNs work as the "managers" and handle the complicated procedures and IVs while the LPNs and CNAs do the bedside care/meds. In the 2 hospitals I have been, both of them did NOT use this approach. Each RN had 5-8 patients and you did all the bedside care. There were no LPNs and the RNs shared the CNAs. Is this team approach the standard now? I really like the idea of delegating to LPNs and CNAs but wonder if this is something that happens in other hospitals or just a few? Never heard of this before and I'm intrigued. Just thought I'd ask. Thanks...
  12. RN1263

    Do you like team nursing?

    I'm still a student (one semester to go), but there are hospitals in my area w/ & w/out team nursing. Should I stay away from the ones w/ team nursing?...Opinions?....The good & the bad?
  13. Julie Reyes

    We Are a Team!

    I have heard it said that nurses who work with children have big hearts - but I think EVERY nurse working anywhere is truly gifted with a "big heart". Every nurse is unique in their personality, and a field where one nurse loves to work, another nurse would never be able to handle that particular job. Thus, the beauty of the nursing field. Oncology, emergency, L&D, ICU, OR, med-surg, community, schools, companies, occupational health, primary care, educators, etc., nurses can touch the lives of anyone in almost any area you can think of. As nurses we must all be able to work with our teammates in the field we are in to help improve the outcomes of our patients. Here is a story of how this may happen: It occurred to me as he held my finger in his tiny hand and I looked into his big brown eyes - he trusts me with all of his heart. As a nurse, I have done everything in my power to ease his pain. I have given pain medications and antibiotics, followed the orders of specialists and intensivists, worked along with therapists, all in a great effort to bring him comfort. Still, he only has enough strength to moan weakly and stare at me, imploring me for help with such intensity that it causes my heart to flip and my eyes to swell with tears, and all I can do is put my finger in his tiny hand so he can grip it as hard as he can - which isn't much, but enough for him. I touch his head gently, and he peacefully falls asleep. Sometimes healing comes from a gentle and compassionate touch. Often, you need to bring in the cavalry. In the hospital where I work, school teachers, doctors, nurses, pharmacists, techs, chaplains, therapists, and even our housekeeping team - all of us - we give everything we have to each and every child, no matter who they are. Each child has our whole attention; we give all we have and more to the healing, health, and happiness of this child. Each child is more precious to us than gold, and we value them as a sacred treasure. We understand that we may be the most important people in their life- besides their parents- when they come to us, because their life is in our hands. It is our great honor to serve children with steadfast dedication and undying loyalty. I have seen a busy housekeeper in our ED stop what she was doing because a young girl was crying when she lost her sticker the nurse gave her after an injection. The housekeeper went up to the crying child and said, "I will find you another sticker, and I will give it to you, OK?" The little girl gratefully accepted the sticker from our housekeeper and with timid but thankful eyes, looked up at her and smiled, no longer crying. I have seen our Chaplains and Social Workers hold parents in their arms as the parents collapse when doctors give devastating news or their child dies. I have seen the grace and comfort offered by a simple hug or a touch on the arm by a staff member. I have witnessed LPNs and techs running for equipment that was needed in order to save a child's life and never grumble when asked to run for more items. Techs who take vital signs for their nurses are keyed in on abnormal ranges and report them to nurses, and help save lives. Therapists are amazing in their field. I love to see our RTs work with the patients - they are always so calm in any situation. I have seen them take time to educate student nurses on everything from suctioning intubated patients to inhaler administration techniques. PT, OT, ST - an amazing group of healthcare workers who develop a trusting relationship with patients and parents and help patients improve by leaps and bounds. We work hand in hand with each other to find solutions and treatment for hurt or sick children. We work with children who scream, kick, bite, and cry when we approach them - and are grateful because they are well enough to do these things; and we work with children who cannot respond at all. We fight for each child's life, we scramble for each battle call, and we never stop trying to save the life of a child. All of us - all healthcare workers - are healers to some degree, and when we work as a team, we increase the odds "forever in their favor" for each patient. All of us touch the life of our patient in some very important and special way. We work together in an intricate fashion, directly or indirectly, for health and healing. We are nurses, doctors, therapists, technicians, clergy, social workers, case managers, security, environmental workers, and administration. We work as a team, we fight as a team, we win or lose as a team. Whatever happens, in any situation, we can handle it together. Because we are here - side by side - for the patient.
  14. EMTPTORN

    Functional / Team Nursing

    Hello All, Anybody know much about functional nursing or team nursing? I have to do a presentation on these two different delivery systems, and to find good articles and research has been very challenging. i have tried proquest, subscribed to another database, and tried to find a book to buy, but still feel like I am lacking info. My Clinical instructor told me these were antiquated delivery systems, so maybe this is why I am having difficult time... would greatly appreciate anyones insight and knowledge. Any help with advantages/disadvantages and definitions of these delivery systems wouild be great! Thanks in advance! EMTPTORN
  15. NurseGr39

    Team Nursing Vs. Primary Nsg

    I work in a small community hospital on a med- surg floor where our total capacity for pts is 26. Our nurse manager wants us to change our nursing model from primary nursing to team nursing. She is looking for a model and I have been selected to research what works. I am originally from ma where a small community hospital consisted of 240 beds (this hospital consists of 40 beds). Anyways, from my understanding ma is struggling and I want to submit info on a team model that works. I am looking for teams of 13 patients a piece -- need numbers that work as well as how tasks are delegated among the team. We have a rate opportunity in that it will be the staff nurses that make the determination (within reason) so I want to submit information for success. Thanks for all who can help. 🙂 Nurse on a Mission
  16. I am curious to know what others' experiences are in their practice. Where I am employed is currently changing from a Primary Nursing Care approach (RN's doing most of the care/assessment/etc) to a Team Nursing Care approach (One RN to 13 pts, with LPN and PCT assistance). My understanding is that the RN is 100% accountable for the work done by the LPN and PCT. Has anyone had experience with this? What are the pros/cons that you have seen/encountered?
  17. nurse lucky

    Team Nursing, Does it work???

    My hospital wants to go to outcome based nursing called Bold Steps. You see the abbreviation? It is based on a Racine, WI. hospital and it is essentially team nursing with an aide or an Lpn with 6 patients or whatever they decide. That will allow the Rn to have more time to teach and chart and assess. I am very concerned as it seems the old team nursing with a new name. Anyone currently practicing this way and how is it going?