Team nursing

[SMK1211]

Hi, I work on a tele/cardiac stepdown unit and there is a rumor that we might be going from primary nursing with 4-5 patients to team nursing. I was wondering if anyone had any opinions about this. I mean, I am still on orientation and trying to get used to being a nurse, and now they might switch to team nursing. So, has anyone done both and like one more then the other? After listening to how it would work it doesn't seem so bad, but a lot of the nurses on my floor are absolutely against it. Any thoughts?

[HouTx, BSN, MSN, EdD]

Hmm - have any of the nurses who are "absolutely against it" actually worked in a team nursing model? I have (yep, I'm THAT old - LOL).

By my definition, team nursing means one RN + 'others' (LP/VN, CNA, etc) taking care of a patient load. There are a lot of models out there, so it's important to have a common definition.

Team nursing works very well if each team member has a clear understanding of his/her role & accountabilities -- and does the job their supposed to. If everyone ends up carping about how the RN 'just does paperwork' or the licensed staff try to dump everything on the CNA -- it doesn't work so well. It requires good communication & trust. In 'my day', we even got to participate in the interview & hiring of new team members so we could be sure of the team 'fit'.

The practical differences can be dramatic. Think about admitting a new patient. In primary nursing, you have to run around 'hunting & gathering' to get all the stuff; orient to the unit; physical assessment; check orders & do STATs; start the IV, foley, etc.. by yourself. "Team" admissions are easier on everyone - CNA does the 'hotel' stuff (assist with gown; put to bed; orient to room, get water, organize meal or snack, etc) The LVN starts with the vitals, & admission 'interview'. The RN (team leader) reviews & notes orders, completes physical assessment, does the IV/foley, etc. Then they all collaborate with the RN to put together the initial plan of care. Everyone knows what their supposed to do - and does it... it is a synchronized effort that takes much less time.

Becoming a good team leader takes effort. You have to spend a lot more time on communication - including team 'huddles' when needed and following up to make sure all your team members are on task. You'll also have to learn how to have 'awkward conversations' about team member performance when needed . . not fun.

With shrinking healthcare reimbursement, we have to be able to provide the same care for less $. For most patient populations, team nursing provides an opportunity to actually put more people at the bedside without increasing the labor budget - It's working for my organization. Don't be afraid!