Team Nursing

Christie RN2006 · Mar 8, 2009

I'm not familiar with the "team nursing" concept. How does it work? The only "team nursing" I am familiar with is when you have a team containing a RN and LPN.

dcurry · Mar 8, 2009

Christie, I think that may be part of the problem. No one seems to really know what "team nursing" is all about. We try to pair up an RN, LPN and CNA, or inexperienced nurse with an experienced one. But we're not sure how to really make it work. We are trying to get away from the "my patient, your patient" concept. Trying to create more of a team working environment on the unit. The weekend team works great together. We communicate all day long with each other. As soon as one of us gets caught up, we offer help to anyone else who needs it, even if its changing a bed, or getting a pt out of bed. But the midweek crew seems to have a harder time working together as team members. It is more like "my rooms, my patients, hands off! Don't bother me and I won't bother you."

Christie RN2006 · Mar 8, 2009

Oh ok, I see what you mean... Like I said, we do have teams consisting of a RN and LPN occasionally in the ICU, but generally one RN is assigned to 1-2 patients and occasionally we will have a PCA (aka CNA) to help us out. On step-down we usually have teams consisting of a RN and LPN with 4-8 patients and we have one PCA that covers the floor (15 beds). My group is always really good about helping each other out. It is not uncommon to see us giving meds, or just helping in one of the other nurses rooms. For example, I was working on step down and we were having a decent night for once, but it was crazy in the unit so I went over and helped in the unit for a while doing all of the EKG strips, cleaning patients up, etc. We have also started having "team meetings" at the beginning of each shift in the ICU where we meet in the back hallway before our shift starts and they give us a quick summary of every patient in the unit and let us know where potential problems may occur and which nurse is going to be needing help the most, etc.

dcurry · Mar 8, 2009

I really like the idea of "team meetings" before each shift. We don't really need full report on every patient - just the basics. Like you said, who might have problems, which patients are more at risk. What I observe happening on our floor during the week is that when nurses get caught up they SIT DOWN (but not where they can be seen …or found). Many of them feel like it is beneath them to carry ice to a patient or help them to the bathroom or wipe up a spill. It's really all about attitudes, isn't it?

suni, BSN, RN · Mar 8, 2009

We do team nursing on certain days. An Rn and an LPN plus a CNA are on the team.

Generally the RN will do all the assessments and the LPN will do all the VS and meds. We help with ADL's, accuchecks , ambulation etc when we are done with assessments and meds.

This way both the RN and LPN have seen each patient on the team and can accurately answer questions from family or physician. Plus since all admits and discharges have to be seen by an RN it works out well.

There is an article in the August 2008 Nursing Management called Meeting of the minds that you may find beneficial. It discusses huddling on each shift, just as teams huddle in a game, it really has some good information.

lcprnc · Mar 8, 2009

Back in the 80's team nursing was when a nurse, an LPN and a NA were asigned to work as a "team" for a group of patients, like th eentire hallway. The RN will make assignments, call docotrs and take orders, admissions, IVs, and mostly paperwork. The the LPN wil give out all meds (except IVs). and simple treatments like dsg changes. Then the NA will answer call bells. Sometimes, there are 2 NAs to turn and reposition patients and do call lights. It's a huge responsibilty for the RN bec she is ultimately accountable for many more patients so it is best if you have a team of LPNs and NAs who are truly responsible/reliable and will appropriately communicate any issues with the RN.

nurseshepherd · Mar 8, 2009

Our small OB/MOBA unit does team nursing, but only on nights. We take report on everyone, the charge nurse makes assignments, but if someone needs something the nurse at the desk takes care of it whether it is her patient or not. Same thing when we get an outpatient in, one nurse writes while the other nurse does the hands-on part of the assessment so we are done very quickly and efficiently. Our day shift does the opposite, spending 5 minutes to find 'that patient's nurse' in order to refill their water pitcher or some other task that would take just a minute of their time. Team nursing works and keeps individuals from feeling too overwhelmed, IMHO. :twocents:

SmilesHeal101 · Mar 9, 2009

I currently accepted a positions that participates in team nursing. I was told that it is a team of a RN, LVN, CNA. I am excited about this concept because I am a big team player. I just hope that others execute teamwork as much as I do!

HouTx, BSN, MSN, EdD · Mar 9, 2009

"Tenured" nurse here -- one who actually functioned in team nursing as part of nursing school practicum. Team Nursing is a name that can be applied to just about any care delivery model that isn't primary or 'total care'.

Old style team nursing was actually a functional model with multiple people working with a group of patients and each team member knowing exactly what tasks they were responsible for. Delegation was not only a concept talked about in a lecture, but also a competency that was included in our school clinicals.

I worked my way through my BSN as the (LVN) 3-11 'med nurse' for a 67 bed Neuro/Ortho unit in 1979-1980. My sole job was meds & it kept me running! The patients were divided into 4 geographic zones, each with an RN Team Leader who did assessments, care plans/discharge planning, physician orders, IV Meds, first doses, physician rounds & 'complex' treatments and made a point to actually look at each patient's wound/dressing even if they were handled by someone else. Each Team Leader had a treatment nurse (usually an LVN) & CNA. If census dropped (a rare event), CNA's or tx nurses were shared among teams.

Only the RN Team leaders took report. They were then responsible for providing report to their teams & making assignments - who did what. By the time the oncoming Team Leader got out of report, VS had usually been done by the other team members. Team leaders circled back and 'met' at least every 2 hours with team members to make sure everything was proceding according to plan. Everyone made notes on a common 'events' worksheet that was similar to a Kardex- VS, blood sugars, I&O, OOB, etc. - so the Team Leader could tell at a glance how things were going. Team members immediately reported anything 'unusual' or abnormal to the leader. The med nurse was responsible for all non-IV meds. There was a log taped to the med cart on which PRN requests were entered, along with the time of the request - these had to be administered (or responded to) within 15 minutes.

This may seem a bit regimented to today's nurse, but it was very efficient and organized. Overtime just didn't happen unless it was due to a call-in. Nursing students actually functioned in a team role as part of their training, so starting that first job was easier. They normally eased into the 'treatment' nurse role & were usually ready for a Team Leader role in 3 months or so.

And that's the way it was. . . . (so long Paul Harvey)