team nursing

I worked in a Pulmonary/HIV unit several years ago. We tried team nursing in 1998. RN was team leader with LPN. Theoretically, each team had a CNA, but often we had 4 teams and only 3 CNA's (night shift 11 - 7). Sometimes 2 RN''s would share 1 LPN.

The RN was responsible for organizing how the team woulde function. Most RN's simply took the assigned patients (12 or 13) and divided them by room numbers with RN taking 1 - 6 and LPN taking 7 - 12 or 7 - 13. The RN was responsible for LPN's pt assessments, but LPN could "collect data" for the assessment. RN's did the IV push drugs and hung blood. At first only RN's did vent pts, but that changed.

I was not confortable with the above procedure. I preferred to assign pts based on accuity--which meant the LPN's pts would not be all next to each other. I tended to work more closely with the LPN, whereas others had the LPN work independently on her assigned pts and simply signed off on assessments. The LPNs were fond of saying that they did everything the RNs did. Needless to say, the LPNs preferred to work with the RNs who operated as 2 mini teams and left the LPNs to themselves.

At one time, I tried splitting team by function with LPN being the medication nurse, but this didn't work well.

Under our units rules, it was up to each RN to decide how to organize his/her team. This may be one reason that our experiment in team nursing lasted only 1 year.

In my SICU I work in we do team nursing there with RN's, LPN'S, and CNA's.

It works out pretty well to the RN's are charges and team leaders and we do the assesments, IV pushes, Titrate sedation and crit. care meds, we also hang blood. The LPN's have to be IV-cert. and they start IV's, draw labs, hang primary fluids, do thier own assesment as well as the RN does there own, they also do foley care and insert and DC them, we also have an RN or LPN who is trained in recognizing heart rythems who watches the monitors and the telemetary monitors and that is there only duty and yes we use an actuall nurse for this RN/LPN we dont use a tech, we feel this is a very important responsibility, the LPN also gives the majority of PO,PR,IM,and Sub-q, meds. The LPN also does dressing change and can push some Iv meds in our state if there Iv-cert. some not all, I think there limited to pain meds anti-emetics and a couple of others they only have certain ones, they definately cant do crit care meds, oxytocin toxic drugs, antiarrythmics ( sorry I suck at spelling) (lol), and they take vitals and help the RN transport people and assist the RN with anything complex. The CNA does basic tasks can take vitals also ( well we call them a pct), they can draw blood ( periph. stick), and foley care, bed baths, feeding of stable pts who arent vented or are otherwise able to take food and fluids po. they also change beds and babysit.

The RN's also draw ABG's and draw from the A-Lines and do all stuff dealing with central lines and piccs, we the Rn's also do everything else to if need be, suction pts. they LPN's also do some suctioning, now when I float to the med surg unit it works the same way but they have alot of LPN's so does ortho because generally on the floors the docs order there meds mostly PO,PR,IM,Sub-q, which the LPN's give alot of the LPN's are probablly better with IM's then I am considering I usually am doing IV meds. And I know alot of the ortho docs will order pain meds IM or Sub-q or PO so that also why the majority of there nurses are LPN's and most of there pts on the floors are relatively stable, now when I float to er we use LPN's and Paramedics down there instead of techs. Good Luck

Sincerely ROD:balloons: