Team nursing in ICU?

sunnycalifRN · May 6, 2011

No. Is this a homework question?

thehutz · May 7, 2011

No, this is not a homework question. I work in a facility that just transitioned from primary nursing to team nursing and I struggle with this concept in the ICU. Just looking for any advice on how it works or doesn't work in the ICU.

sunnycalifRN · May 8, 2011

I don't see how team nursing could work in ICU because each patient has his/her own particular issues/problems and each patient may have particular goals for the shift, e.g., MAP goals, fluid balance, vent management, sedation level, pain management, etc. And, there are sometimes 1:1 patients with 15 gtts, on the vent, IABP, nitric oxide and CVVH . . . how can a team handle such patients? It can take 20 mins to report off to the oncoming nurse on one patient . . . I just don't see how a team approach could work.

thehutz · May 8, 2011

I agree. But the acquity is generally that if a step down unit but we have the ability to rake drips and vents. Anything more gets transferred. But I struggle with having 5 "icu" patients and 3 m/s patients because there is obviously a reason the md wrote for icu care but the patients aren't really getting any different care and the are getting charges icu charges...... I have heard of team nursing in an icu -- they have a rn that does the rounds, assessments and the lpn does cares and meds. But having been a nurse in a larger icu for the last 7 years I am trying to figure out how to reprogram my thinking/practice. Any suggestions are greatly welcomed.

sunnycalifRN · May 8, 2011

Can't help you because I don't see how it could work.

RN1980 · May 9, 2011

i dislike team approach. there has to be one nurse in charge of one pt in the icu..this idea of team approach nursing has been studied for many yrs and even tried at larger teaching facilities that have been funded by the aacn and sorts..i cant recall their officail stance on it and cant seem to locate it on the net but i do recall reading about it a few yrs ago. just like stated above how can you properly manage a critical low sick pt with multiple gtts and vent trials along with other monitoring with 4-5 nurses with their hands in the pot? but i refer to team nursing by using the simple term of team work by assisting eachother with their pt or pts by their request. now i worked in a er many yrs ago in columbus ms where they used team nursing in the er...talk about almost complete chaos..you would have 3-4 pts but other nurses would grab your charts and give meds and tx's but would forget to sign off on the chart...almost complete disaster at times. several times almost doubled dosed pts and other nurses would d/c your pt before you could finish charting on said pt, so you would find yourself scrambling around like a idoit half the shift. nope i dont like it.

Nccity2002, MSN, RN · May 12, 2011

I worked as a traveler in a facility that used this approach in the ICU. Basically, the LVN/LPN would care for two "stable" patients, while her "assigned" RN would take care of the drips/IVPB/IVPs. Personally, hate it, but for some reason, it worked for them. That facility was fortunate that the LPN/LVN were excellent nurses, still, sometimes it felt like I had more patients than what I was assigned to. To answer your question, a "Team Nursing" model of care is not safe or practical in the ICU setting.

HazelLPN, LPN · May 20, 2011

I worked as a traveler in a facility that used this approach in the ICU. Basically, the LVN/LPN would care for two "stable" patients, while her "assigned" RN would take care of the drips/IVPB/IVPs. Personally, hate it, but for some reason, it worked for them. That facility was fortunate that the LPN/LVN were excellent nurses, still, sometimes it felt like I had more patients than what I was assigned to. To answer your question, a "Team Nursing" model of care is not safe or practical in the ICU setting.

We did very limited "team nursing" but we mainly used the primary nursing model in most of the units where I worked. The team approach was normally used with an RN and a student enrolled in nursing school which was called an "NA II". The NA II and the RN took three patients on 1:2 care or sometimes a 1:1 paired with a 1:2. The NA II did not give any meds or dressing changes around central lines, but could write a "data collection" (an assessment but you couldn't call it that) and could do many tasks under the immediate supervision of that RN. Most of the NA IIs became nurses in the unit when they graduated and it was a great way to learn critical care nursing for them.

The LPNs in the unit had a full scope of practice. We took our own patients titrated our own drips, pushed our own meds etc. We were limited only that an RN had to check blood products and several IVP meds with us and we didn't take new admits as the initial assessment was not in our scope of practice. The charge nurse, who took no pt assignment, covered whatever was outside of our scope...which usually meant she was the one to check blood with us.

I agree that the best model for critical care is primary care, yet the Nursing Assistant II (NAII) was a great way for these kids to learn and it was not much extra work for the RN supervising them.

Best to you,

Mrs H.

armyicurn · May 26, 2011

i dislike team approach. there has to be one nurse in charge of one pt in the icu..this idea of team approach nursing has been studied for many yrs and even tried at larger teaching facilities that have been funded by the aacn and sorts..i cant recall their officail stance on it and cant seem to locate it on the net but i do recall reading about it a few yrs ago. just like stated above how can you properly manage a critical low sick pt with multiple gtts and vent trials along with other monitoring with 4-5 nurses with their hands in the pot? but i refer to team nursing by using the simple term of team work by assisting eachother with their pt or pts by their request. now i worked in a er many yrs ago in columbus ms where they used team nursing in the er...talk about almost complete chaos..you would have 3-4 pts but other nurses would grab your charts and give meds and tx's but would forget to sign off on the chart...almost complete disaster at times. several times almost doubled dosed pts and other nurses would d/c your pt before you could finish charting on said pt, so you would find yourself scrambling around like a idoit half the shift. nope i dont like it.

This place sounds like a complete gaggle &**($%^! I hope you are not longer there. :crying2: :uhoh3:

RN1980 · May 28, 2011

unfortunately im still prn there, about 24 hrs per pay period. just cant walk away from the money.

littleneoRN · Jun 2, 2011

the Nursing Assistant II (NAII) was a great way for these kids to learn and it was not much extra work for the RN supervising them.
Best to you,
Mrs H.

This sounds like a cool program. However, as an RN I would not be excited about taking on extra patients above the normal assignment while also supervising a student. Everything they do is on my license, so the last thing I need is an excessively busy patient load.

I also feel that team nursing is generally not practical but specifically unsafe in the ICU. ICU level care requires someone who "owns" the patient and is responsible for seeing and assessing the whole picture continuously. The same person giving sedation meds needs to be aware of the ventilation goals and be the one watching vitals. etc. etc. etc. Everything affects everything in a critically ill patient, and the possibility of doing interventions without knowing the entire picture in detail....or possibly repeating something another co-worker just did...sounds like a recipe for disaster. And inefficient too, with all the time spent checking in with your team to keep each other up to date.