team nursing in acute care

Sour Lemon · Jul 9, 2018

Yes, I've done it and it is as horrible as it sounds. When something goes wrong, they will seek the "supervising RN" to blame. The nurses being "supervised" don't actually follow direction ...especially when they're used to working alone.

Good luck! You're going to need it.

smf0903 · Jul 10, 2018

I'm with Sour Lemon. We tried it as well (on Tele med surg unit) and it sucked big time. We had 2 Rns with 10 patients. THE powers that be wanted it as one RN did assessments and the other RN passed meds. It was impossible to look up labs and pertinent info on 10 patients and get the med pass done ina timely manner. The docs even complained because they'd be talking to one of the RNs and we were fumbling to give him/her the full picture because we simply didn't have time to get a full picture on all 10 patients.

Another issue is the "quality" of the RNs. A less experienced RN may not bring up something that's important to the second RN. I'm very type A, and I like to know everything I can about the patients under my care. Period.

In my experience it's a sucky way to treat patients in a high turnover area. I hope your experience is better!

JKL33 · Jul 10, 2018

Huh. Well, having never encountered this particular idea gives me one more thing to be happy about today!

medsurg4ever · Jul 10, 2018

I'm type A too. I've been doing med Surg for 9 years now and I have my system down. I'm really not going to be comfortable with the extra responsibility of sharing an assignment. We have had a high turnover and a lot of new nurses so i can't say I would necessarily trust all of my coworkers' judgement. What I enjoy about being a floor nurse is having the independence and autonomy to come to work and really focus on the care of my patients. This might be the final straw for me if it really happens. Why would management even want this? I feel like it's a ploy to give us a larger assignment. We already are routinely up to 6 patients as it is.

Horseshoe, BSN, RN · Jul 10, 2018

Why would management even want this? I feel like it's a ploy to give us a larger assignment. We already are routinely up to 6 patients as it is.

Ding Ding Ding! We have a winner.

Jedrnurse, BSN, RN · Jul 10, 2018

Why would management even want this? I feel like it's a ploy to give us a larger assignment. We already are routinely up to 6 patients as it is.

That is so cynical. Management would never do that...

Daisy4RN · Jul 10, 2018

I worked at a hospital that did this team approach but with 1 RN and 1 LVN. It was horrible! There is no way to keep tract of what is going on with these patients because you need to rely on your partners competence, giving you all the info etc. I imagine they are doing this either because of too many new nurses or too many incompetent nurses, thus they now have the "lead" RN to blame; Or, they are slowly easing into teams with 1 RN and 1 LVN to save money, or both. Either way it is horrible and I would never work at any facility again that does this. Like you, I enjoyed having my system down and did not like having the responsibility of another nurse. Brace yourself...

Ddestiny, BSN, RN · Jul 10, 2018

This sounds awful. I've never experienced it (thankfully) but I can't wrap my head around how it would be at all helpful. Even if they want to increase your patient ratios, I don't think it's helpful to give you more work already with your *current* ratios and then add more patients to the mix....sounds insane. I can definitely see how this would trickle down to having annoyed docs, nurses that don't know what's going on with their (10+) patients and patients confused about who is really "in charge" of their care.

I am ALL ABOUT helping my colleagues, answering call lights, grabbing meds, whatever....but if I don't know 100% for sure how to do something for their patient (do they use bedpan/commode/bathroom, is it okay to give them the PRN pain med they're requesting, can they have ice/water/a snack, do they need a BG check before their tray is delivered?) then I always give a quick phone call to their nurse to find out so I can help in the best way. Luckily my unit culture is the same so I get those same calls and am always happy to answer questions for someone that's helping me out. I'm assuming that if you have two nurses responsible for the same patients then, yes, they might know more about the patients than I do walking into a random room with the call light going off, but the two different nurses might not be privy to the same information (Nurse 1 gets a verbal order for a procedure and schedules it for this AM while 5 minutes later Nurse 2 brings him a big jug of water and a snack). Your communication would have to be on point 100% of the time, and sometimes that's not possible and just adds more steps to your day...which would already be busy with your 10+ patients.

So, who thought this was a good idea, again? :wtf:

kbrn2002, ADN, RN · Jul 10, 2018

Yeah, this sounds like a wonderful idea. No matter how the "team" is assigned there is always, without a doubt going to be one of the team nurses that carries the heavier load and of course feels overwhelmed and resentful. Not to mention never really knowing what's going on with the so-called secondary patients but still being held accountable for their care. Way to foster good working relationships management!

NurseBlaq · Jul 10, 2018

So, who thought this was a good idea, again?

Some administrator who has no idea what it's like to be a nurse on the unit yet trying to save money so they can get a big bonus. Of course, the nurses who slaved cause of this treacherous plan will never see any of that bonus.

peripateticRN, BSN, RN · Jul 11, 2018

I graduated in the last few years and team nursing is all I've ever known. Seems to work pretty well to me - Honestly, I can't picture how it would have worked any other way (In medicine, at least).

Our system works like this:

Each unit typically has 3 teams of 1 RN, 1 LPN and 1 Healthcare Aid (for day shifts, that decreases for eves and nights).

The RN is the lead, but you generally each have your own 5-6 patients, and knowledge about the other 5-6 from report. As the RN you may be expected to do certain tasks on your teammates patients if they are outside their scope (ie for us, LPNs cannot hang blood, TPN and others), typically your buddy will help you pick up the slack on your patients if you are helping them with something.

AM assessments are typically done together on all 10-12 patients, one person assesses, the other records, in some cases the HCA may go on ahead to start vitals. The RNs are generally expected to do the MD calls and check the labs, but it's something that can be discussed between buddies. Routine meds are done by the patient's primary nurse (so you do 'your' 5-6 patients, and your buddy does theirs).

What I like with this model is that you always have a partner in close proximity with at least vague knowledge of the team's patients and you have someone to bounce ideas/thoughts off of. For breaks you alternate off with your buddy and I have, the vast majority of the time, found that my buddy has settled all their patients before leaving, so you may be called on for a PRN or help to mobilize to the washroom or something but you aren't doing full med passes or anything. Its really not as bad as it sounds.

Remember, your buddy is a nurse too and despite being you being the team lead their actions still fall on their license.

The downside with this model (again.. at least for us) is that we no longer have a designated charge nurse. One of the RNs is 'resource' and covers the administrative unit stuff while having a full patient load. There isn't usually much as the team leads are responsible for most 'chargey' type stuff.. but some days it can be hell being resource.