Team Nursing

I have not seen team nursing in practice, but heard the same thing. I may not see it as a bad deal, but it depends on the patient load. I'd rather that the RNs pick up and check orders anyway, to be honest, because it is a pain in the rear in hospital settings. The orders change too often for me, and if she has that headache, then, she has to answer to and correct that rather than me. Or, you may have a good RN that may assist you. If she is going to do the paperwork, then, you may expect that the only charting you may do is if there is a reason why you are holding medications or if there is a significant change in the status of the client and you want to document that you reported it to the RN. I'd also like to hear how others find team nursing.

I worked at a hospital that did "team nursing" for about 2 months. HATED IT! You do all of the CNA work & 1/2 of the RN work. I didn't get to sit in on report, I was expected to pass meds, without any kind of report! Our shift started at 7 and I wouldn't see the RN until 9 or later. Meanwhile I am doing meds and cares on people that I know nothing about! It felt extremely unsafe and I feel that patient care really suffered! I would be very vocal and organized with your concerns right from the beginning and hopefully your hospital will not slip in to this mess.

I worked at a hospital that did "team nursing" for about 2 months. HATED IT! You do all of the CNA work & 1/2 of the RN work. I didn't get to sit in on report, I was expected to pass meds, without any kind of report! Our shift started at 7 and I wouldn't see the RN until 9 or later. Meanwhile I am doing meds and cares on people that I know nothing about! It felt extremely unsafe and I feel that patient care really suffered! I would be very vocal and organized with your concerns right from the beginning and hopefully your hospital will not slip in to this mess.

That sounds like the nursing I did as and LVN in the hospital I used to work in. I had to pass meds, perform IV therapy, and most of the patient care. Then I had to do the same for any ER patients that came in. I absolutely hated it. I didnt have access to the charts, I had to ask the RN to check the chart to check if a med or procedure was safe. I hated it, and I quit after a couple months.

We're supposed to start as a "trial" in our hospital. The PNs AND the RNs don't want it. Management does.

We've heard that the RN's will process all orders for "their" team. The PNs will also be required to start IVs and administer the meds (previously an RN duty). No increase in pay for us.

All the nurses I know are looking for another job. Nobody but administration wants it.

I really do not think Team nursing will ever become a national trend in hospitals because of the big push for mandatory nurse to patient ratios...

I am really learning something new here about the disadvantages of team nursing. My hospital practices a hodge podge of nursing. We have a 30 bed unit, about 5 RNs and one LPN. The LPN will be double assigned with someone and that RN will be responsible to document on 10-12 patients. The LPN will medicate them, and it is not required for her/him to document (which I find strange). The RN will perform other functions such as pic lines, TPN, suctioning, catherization and such. If the LPN is finished on time, she would assist with some of the things within her scope of practice. The rest of the nurses may have about 4-5 patients depending on the census. I have one friend that is an LPN that feels this is not fair because she always has to medicate 10 to 12 patients no matter what the floor census is. I feel she does not really have an argument per se because once she finishes medicating, fingersticks and coverage, she is not responsible for notes unless there is something unusual; while the RN has a truckload of patients. In fact, the RN that is double assigned usually has more paperwork than the other nurses that are working independently. This LPN is quick and is usually finished with her meds in about an hour.

I work in a hospital clinic, so, we all basically work the same way, but I do plan to work per diem on med-surg in a few weeks, so, I am watching closely to be sure that I can actually keep up.

There are some floors where the RNs will write notes and the LPN will medicate the entire floor, as well as pick up orders. That would frustrate me to no end, because when I did work med-surg for 6 weeks, my major pet peeve was the constant changing of orders within minutes. Made me want to pass out, because it was hard to get from the flow of medicating to checking orders every 5 minutes and searching for doctors. I can see why a nurse would be pissed off if there are 5 of them sitting at a desk and no one is picking up orders while I run insane.

I guess it just looks nice on paper...

I really do not think Team nursing will ever become a national trend in hospitals because of the big push for mandatory nurse to patient ratios...

Yeah, I think so, because then, they would have to hire too many nurses; and of course, the powers that be want to save money and kill us...:angryfire

While we do primary care nursing at the hospital I work at here a few weeks ago we had a full unit and were short staffed as hell so the RN that was working on the same hall as me and I decided to kick it old school, she did the assessments, chart checks etc and I did the meds, IV's and wound tx, It worked out very well and the night went by a lot smoother in fact we got finished with all our work about half an hour early. I think it would really depend on how you or administration divide up the work and if you have a good team.

We used to do it at my hospital prior to me becoming a LPN, but it has since been faded out along with LPN's. I personally wouldn't work in a hospital as a LPN if my life depended on it. Every RN that I've asked about why there are no longer LPN's have made it loud and clear that we are not an asset but extra responsibility for them. The whole lack of chamaradoree (sp) is the whole bad part about it. If RN's and LPN's could work together as a team instead of against each other it would be great. If hospitals and the state could define the roles of LPN's better and let us work to our full potential then maybe we wouldn't be such burdens to the RN's. If the states and hospitals would remember that we carry our own license and insurance and are responsible for our work, then maybe team nursing might work. Until we as nurses except all levels of nursing then team nursing will not work. I refuse to work in an environment where I'm made to feel imcompetent and less than a nurse.

Just a question for Fiona 59, how do you do team nursing in your province. I have only seen a few hospitals during my clinical time as I am a new grad but the way it worked was you were paired up with an RN, the RN does the orders, IV sticks, IV pushes, IV meds, peritoneal dialysis etc while the LPN does the CNA work, (no CNA's anymore in most hospitals here), the meds, charts what she does and observations, new admits, changes dressings, monitors IV's, removes stitches if on surgery, inserts and d/c catheters. It is a very heavy load and it can be sometimes difficult to get help with transfers depending on who you work with. I hope that you guys get your way, good luck and thanks for standing up to the suits, keeps the rest of us inspired.

"Back in the day" when I was an LPN we did team nursing.

The RN did meds, IVs and orders. The LPNs and CNAs did patient care (bathe, change, feed, ambulate, etc). The LPNs also did dressing changes, trach care, foleys, and so forth. We also charted on all our patients.

You could, after a certain period of time, take a class to become an LPN II and team lead. LPN IIs could give meds and hang IVs but no IV push, blood, etc.

It worked OK if you had a good team. If not, well... There were quite a few nights when I had to listen to the RNs complain about having to chart on the CNA's patients, but they still managed to make it to the time clock ahead of anyone else. We had a pretty good weekend staff but weekdays was another story!

This was back in the early 1980's.

We used to do it at my hospital prior to me becoming a LPN, but it has since been faded out along with LPN's. I personally wouldn't work in a hospital as a LPN if my life depended on it. Every RN that I've asked about why there are no longer LPN's have made it loud and clear that we are not an asset but extra responsibility for them. The whole lack of chamaradoree (sp) is the whole bad part about it. If RN's and LPN's could work together as a team instead of against each other it would be great. If hospitals and the state could define the roles of LPN's better and let us work to our full potential then maybe we wouldn't be such burdens to the RN's. If the states and hospitals would remember that we carry our own license and insurance and are responsible for our work, then maybe team nursing might work. Until we as nurses except all levels of nursing then team nursing will not work. I refuse to work in an environment where I'm made to feel imcompetent and less than a nurse.

The reason why RN's can feel this way is because they are still ultimately responsible for overall patient care, and if they are stuck with an LPN or CNA who does a rather inadequate job, it means having to back track to ensure the work was actually done. It also may depend on what the hospital allows the LPN to actually do, if LPNs are not allowed to do Assessments or push IV medications then why bother having an LPN on the team... Regardless team nursing is too stressful on RN's and costs the hospitals more because of the need to hire more staff..