Team Nursing, Does it work???

[nurse lucky]

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?

[theblondeone]

The hospital I work at did this for the first year I worked there and it was wonderful for me. As an new LPN I was trained by more experienced RNs, it also comes in handy for me as I'm in school right now for my RN. I've learned to do their assessments hands on and am way ahead of most of my classmates as far as skills go. We had an RN and an LPN for each six patients and an aide for every 12 patients. The one thing that I love about where I work is that there is no "role confict" in that everyone RN, LPN and aids alike answer lights, record I&O, toilet patients and basically do whatever needs to be done. But with me doing all the meds and vitals, it does free the RN up to do more thorough assessments and documentation. In the last couple of months, we've been extremely short staffed and I've ended up with my own patient assignment with an RN covering me. Without the team model I learned from, I would never feel confident enough to do this.

[nurse lucky]

theblondeone said:

The hospital I work at did this for the first year I worked there and it was wonderful for me. As an new LPN I was trained by more experienced RNs, it also comes in handy for me as I'm in school right now for my RN. I've learned to do their assessments hands on and am way ahead of most of my classmates as far as skills go. We had an RN and an LPN for each six patients and an aide for every 12 patients. The one thing that I love about where I work is that there is no "role confict" in that everyone RN, LPN and aids alike answer lights, record I&O, toilet patients and basically do whatever needs to be done. But with me doing all the meds and vitals, it does free the RN up to do more thorough assessments and documentation. In the last couple of months, we've been extremely short staffed and I've ended up with my own patient assignment with an RN covering me. Without the team model I learned from, I would never feel confident enough to do this.

Why only for the 1st year? They are now looking at about 10-12 patients on a team. That seems unmanageable, especially as we don't have transport teams or iv teams. Anything out of the ordinary happens and you are all in the room with 1 patient, it seems that there would be no one to watch the other 11. Less people on the floor in general seems unsafe. Our population is quite elderly and we specialize in neuro. Could you tell me the name of the hospital? I am on the team that is helping the union decide if we will approve this? Good luck with your remaining schooling and your boards. You sound like you love your job. I still do after 16 years!

[purplemania, BSN, RN]

I don't understand what "theblondeone" means by now you are not doing team nursing, but the RN covers you. Does that mean the RN does your IV pushes, assessments and whatever else is required of an RN? Sounds horrible for the RN as now he/she has even more patients for whom to be responsible. Would not trust my license to that set-up. Team nursing means the RN is responsible for more patients and more staff. Sorta like mini-charge nurse.

[BuffaloLPN]

We team- RN alone has up to 6 pts, RN/LPN has up to 10 pts. No aide on nights(well not after 11pm). Lpn's can do Iv meds (no push) and blood draws. Basically RN assesses, charts and helps with meds if needed, and LPN does vitals, meds etc. We truely work as a team, not uncommon to go room by room together. Lpn can do charting as long as RN does first assessment of 12 hr shift. Unfortunately on some floors, they call it 'delegating responsibility' where RN charts that first assessment and they split the 10 in half and each do everything for 'their 5'. I hate working that way but some like it.

This is peds med/surg floor

[Tweety, BSN, RN]

We tried it. The main problem we had was the team didn't buy into it. There was massive uncooperative and closedmindedness by the staff.

The other problem was the RNs were so green compared to the LPNs. Taking a new grad from nursing school and putting him/her in charge of a team was very intimidating to the new grad, and frustrating for the LPN who had to carry a bigger load (with some resenstment).

We are not doing it anymore, as we seem to like the single nurse-single assignment, with CNAs on the floor way of doing things.

Good luck. Keep an open mind. It only works with a spirit of team work.

[fergus51]

I hated team nursing. I would rather be responsible for my own patients and my own work. It's just easier and less communication problems....

[canoehead, BSN, RN]

Beware of administration changing the structure of care delivery every few years in the name of patient satisfaction. They cut hours every time the change is made, but eventually you get right back to the original method, but somehow it takes less people to do the same amount of work.

I've seen it many times.

[theblondeone]

What I should have said was that we "teamed" in the purist sense for the first year that I worked there, 6 patients, one RN, one LPN and one aide because we had the staff to do so. The day shift still uses this approach. Unfortunately on nights, we just don't have the staff right now. We're running short constantly with 2 RNs gone, 1 RN out on Maternity leave and 2 LPNS gone. I'm on a med/surg unit with no tele. Our floor is split into "mods". 2 Mods have 6 patients and 2 have 7. Typically on nights I work we have 3 RNs, me and two aides. Two RN's will split covering me, 3 patients each. They do my IV med pushes, but we have very few on our floor. LPNs can hang IV bags. I do a complete assessment on each of my patients and all documentation. They come in a do a quick assessment of each patient and rely on me to tell them if any problems arise. I always go to them for help if it's something I'm unfamiliar with or unqualified to handle. I understand that I'm risking their license as well as mine because they're covering me and I'm very very careful. I can understand how this can be a tough spot for an RN to be in if they don't fully trust the LPN they are working with. I can see myself feeling the same way soon. All I know is it works for us on our night shift and none of the RNs have complained so far. We would love to have more staff, ofcourse, but we all do work very well together during crunch time. Maybe it's because the other LPN that works nights has 15+ years experience and they "trained me the way they want me" according to them. I consider myself extremely fortunate to work with such great, experienced RNs willing to "teach" me what they know.

I should add that of the two RNs we lost, one retired, one husband was transferred, and the LPN's; one moved across the country to be with his kids and the other is out on long term disability. We don't have many that leave because they aren't happy with conditions.

[nekhismom]

I've wished for team nursing at times just to get by!!! HA HA, really, some days it's practical and others, it isn't. And like TWeety said, you gotta have a good team spirit or it's all down the drain.

[LolaRN]

I didn't mind it as a LPN. We had a team of an aide, LPN, and Rn for about 10-12 patients. I took a group and the RN took a group. I did all oral meds for my group and did assessments, dr calls, etc. The RN did the same plus all IV meds. We covered each other for breaks and fielded questions from family for all patients. Sometimes I would take 6 pts and she would take 4 or something like that. I really learned a lot and it has given me tons of confidence as a new RN because I am used to doing a lot myself. However, I left that hospital when I became an RN because I didn't want to be responsible for that many people. I now have 7 patients of my own but I don't have to worry about the LPN being competent and worry about whatevr goes wrong that the LPN can't handle. As an LPN, it was great, I could take on a lot but when the going got tough, I could turn it over to the RN. Not so great for the RN.

[teeituptom, BSN, RN]

Worked fine in the olden days, before primary care