Team nursing is causing many good nurses to leave any suggestions

General E. Speaking, RN, RN · Oct 29, 2004

team nursing is only as good as your team. depends on who u work with.

Jolie, BSN · Oct 29, 2004

I am not in favor of team nursing either. Generally speaking, it seems that there is no one with a clear picture of what is going on with a patient, but rather a whole lot of people with tiny bits and pieces of knowledge.

I once worked on a post-partum unit where each patient had an RN who did the assessment, an LPN who passed meds, a CNA who did vitals, a nursery nurse who provided baby care and teaching, a dietary aide who passed trays and snacks, a breastfeeding specialist for nursing moms, and a bath tech for post-op C-sections who were not out of bed yet. For some patients that meant 7 team members! No wonder hours would pass before the nursery would be notified of a mom with a fever, or the floor RN would find out that a baby had been sent to NICU, etc. It was a disaster in terms of continuity and quality of care. Not to mention the endless intrusions these patients endured.

I couldn't stand it and quit. I hated to be responsible (as the RN team leader) for the actions of so many others, many of whom were floated to our unit. No cohesive team ever existed. They did eventually change to a primary nursing model with mother-baby care. It's not an easy transition, but so much better for the patients and staff!

fergus51 · Oct 29, 2004

Ratios are the facility's problem. Primary nursing requires each RN to be responsible for fewer patients. Only a goof (read hospital administration) would suggest you should be looking after the same number of patients with less staff.

Mattsmom, it isn't elitism that has led me to prefer primary care, it's fear. My job is hard enough without worrying about miscommunications.

mattsmom81 · Oct 30, 2004

I understand your point Fergus, but I doubt the reasons for initially pushing primary care were fear based...suspect it originated with 'all RN based' stuff...closely related to 'all BSN stuff' that started with the NLN position paper waaay back. JMHO.

I agree with primary care BUT with appropriate ratios...something I don't see today. And yes I prefer to only be responsible for myself too...who wouldn't? But when I see medsurg RN's taking care of 9-10 patients without ancillary help I can't help but wonder why...I'd sure prefer adding some CNA's and LPN's to THAT scenario vs managing that load alone. But that's just me.

Of course I've worked in successful team environments and I understand many here have not.

fergus51 · Oct 30, 2004

Again, that's about a bad facility. No med-surg nurses here in California are looking after 9 patients on their own. No nurse should be expected to do that. Primary nursing can't be judged by looking at hospitals that don't implement it properly.

I know a lot of nurses who agree that it is elitism that drives the move to primary nursing. I know just as many nurses who argue that the move towards team nursing is just about the bottom line, since LPNs are cheaper labor.

lisa122 · Nov 1, 2004

We started team nursing 3 weeks ago. We are a 44 bed unit that manages, medicals, telemetry, oncology, and occasional step downs from CCU. We average 25-30 patients a day. We use to staff 7-8 nurses every day and four aides and 2 ward clerks. We would have 4-5 patietns of our own, the charge nurse would have 1-3 patients and would help out. We now staff five nurses for 24 patietns. Each team has 10 patients and the charge nurse has one. When our census is up the charge nurses takes her own team of 8 along with another nurse. The aides split rooms evenly so each has about the same number of patients. One ward clerk does all the orders.
This is not working and many of the staff are looking else where. Administration tells us that Most Indiana hospitals and other big hospitals are doing this and that we must adjust becasue TEAM nursing is here to stay. If this is true please let me know this will get better. How are your units set up? Our unit alone has made several med errors, lab errors, and entering order errors. Our patients are suffering some have even commented that this care delviery system is not working!!:angryfire

Sounds just like the situation our facility is in! Nurses are frustrated and looking elsewhere for jobs. I have a problem with team nursing as many times you are not aware of all aspects of teh patients care, especially when you are the med nurse, someone else is doing the assessment, talking to the docs, and taking off new orders so when the MD approaches you and asks how the patient is doing you must first find your team member before giving the MD the full picture of what is going on, makes me feel incompetant at times. Also, charting is a problem only one nurse has the charting available to him/her, so many late entries are made and it looks unprofessional, and is not logical. When I started this job, primary nursing was in place and i felt as if we functioned as a team then, but with our own patients. If someone needed help, you gave it! If you had questions, you asked other nurses, our patients were well cared for and there were less errors!! I think those who have implemented team nursing should come work the floor for a few days!!!

nurse01 · Nov 4, 2004

We also use team nursing. Our unit is very similar, 48 beds---step-down, trauma, neurosurgery, orthopedics, telemetry, and occasionally ENT and urology. We (usually) have one charge nurse, who does not often get the opportunity to help down the hall. We have 6 nurses(3 on each wing),2 nurses with 8 patients, and 1 nurse with 7 patients. If at all possible, there is an aide with each nurse, or 2 aides will split the hall. Whenever we use a team leader for each wing, we must be very selective who will be the team leader, because some nurses are much more involved than others; some just disappear. It works in our hospital because 99% of trhe staff is very involved and team-oriented. All it takes is one who does not do their share and it screws everything up. It is rough until everyone knows the expectations, and the bugs get worked out.But, it can work.

shawng007 · Nov 4, 2004

As an LPN at a hospital, primarily Med/Surg, when I started nursing over a year ago(I worked as an aide prior to that) I found that rn's had fewer patients and did less, LPN s got stuck with six patients, and there was very little teamwork because you had rns who had been there since the ice age and thought they were God(still do as a matter of fact), now we do primary and i get five patients (on a rare occasion when staffing is really poor i may get six), an rn covers me, and i get my work done, if i have problems the rn's know i will come to them and that i am capable. people today dont understand teamwork, and so unless you have a good team, it won't work.

salinajd · Nov 6, 2004

We started team nursing 3 weeks ago. We are a 44 bed unit that manages, medicals, telemetry, oncology, and occasional step downs from CCU. We average 25-30 patients a day. We use to staff 7-8 nurses every day and four aides and 2 ward clerks. We would have 4-5 patietns of our own, the charge nurse would have 1-3 patients and would help out. We now staff five nurses for 24 patietns. Each team has 10 patients and the charge nurse has one. When our census is up the charge nurses takes her own team of 8 along with another nurse. The aides split rooms evenly so each has about the same number of patients. One ward clerk does all the orders.
This is not working and many of the staff are looking else where. Administration tells us that Most Indiana hospitals and other big hospitals are doing this and that we must adjust becasue TEAM nursing is here to stay. If this is true please let me know this will get better. How are your units set up? Our unit alone has made several med errors, lab errors, and entering order errors. Our patients are suffering some have even commented that this care delviery system is not working!!:angryfire

I am an lpn, I left primary nursing about 3 months ago. Liked my job well enough but wanted to work someplace where they would pay for me to continue my education. Found that place but I am not sure I will ever like it. At S. hospital I was assigned a max of 7 patients, working nights. I did assessments, meds, treatments, etc. The Rn's had to do the pushes and admission assessments. They also had up to 7 pts. We had cna's also. At S. I was able to peek into my patients rooms at least every two hours, chart resp. etc. Knew the pts were alive. I knew what was going on with my pts. Now at V. hospital I am a "med nurse" I pass out meds. Period! The rn's do assessments, sometimes on some pts that is all they do, one assessment, they don't see the pt the rest of the night. With up to a max of 28 pts for me, I sure don't make rounds. If the pt. doesn't have meds during my shift, I never see the pt. I work midnight to 8am, so some pts don't have meds. The rn's have up to 14pts. each, have to do all the computer charting which takes some time. Not to mention they are cardiac pts. several on monitors. The aides also have up to 14 pts each, the only time they may see some of the pts is the one time that they do vitals in the am when they are doing their i&o's. So some pts never see anyone during the night, not that we don't care but when do you find time? I am just very thankful that I am not the RN who is responsible for these people, and to think I changed jobs so I could become an RN! Wait a minute, something just ain't Right. :uhoh3:

dmbnurse · Nov 9, 2004

At My Hospital We Have Been Doing Team Nursing For About 4 Weeks. Is It Working?????? Some Days Are Better Than Others! It Depends On Who Is Working With Who. The Nurses Are Still Confused About Their Role And Most Have A Lot Of Problems Delegating Esp. To Another Rn. The Teams Can Be As Big As 13 Patients To 2 Liscenced People That Could Be 2 Rn Or 1 Rn 1 Lpn. Everyone Thinks The Rn Should Not B3e Responsible For That Many Pts But In Primary Care 1 Rn Could Have 6 To 7 Pts And Resource A Lpn With 6 To 7 Pts. So What Is The Difference Really?

What makes you think that is Primary nsg, and if it is, you are right, what is the difference?

Forcemaster · Nov 20, 2004

I work in a busy inner London (UK) hospital on the Orthopaedic/Trauma ward, and this is a ward that operates team nursing.

Team nursing is working for us as...

Even though ive only been working the ward for 2 months now i've gotten to know my colleagues very well by working along-side of them closely.

Jobs that require more than 1 member of staff (like helping pts with spinal injuries with their personal care) can be organised at the start of the shift between all the staff working in that team.

It promotes good communication by forcing staff to talk to each other throughout the day.

It also means that inexperiened staff have that bit of extra support because they are not isolated with their own pt workload and more senior staff can more easily supervise them.

As for the duplication of effort by staff, this can be gotten around by talking to each other about what you are doing. Sometimes what helps is, when taking handover, the senior nurse on that team documents all the jobs that need doing for that day in a book that has basic details of all the pts under the care of that team. When a job is done, the nurse that did it can then cross it off the book. This means all it would take is a glance at the book to see what still remains to be done.

Finally, there is nothing stopping you dividing the pt workload within your team so you basically are responsible for the 5 or 6 pts you would have been under primary nursing...

Now i'm not saying that team nursing is the best way to work, and each ward/department needs to look at the best format of nursing for them and their staff... i'm just saying that give it a few months if your new to it... it CAN work.

NannaNurse · Nov 20, 2004

We have always done 'team nursing'........yes, we are overworked and stessed, but if we were to go back to the old standard of 'caring for our own patients', we would probably loose all the of nurses on the spot.

We have between 5 and 9 patients, a tech (na) and we pass our own meds, change dressings, remove sutures, etc.... We have 2 unit clerks, but one works M-W-F and the other works T-Th-Sa. We have none on Sunday.

I must be lucky. We all work as a team and if one of the other nurses or techs need help, we are all there to assist. The only problem we have is the 'shirts'.......we have a grid to go by, for staffing and they never seem to stick to it. We are also now 'closed staffing' and manage our own schedules.

We all, as nurses, work our tails off and I think that we are all just getting tired of not being appreciated.........I know I am!!