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Team nursing?

I am wondering if anyone has any experience (positive or negative) with team nursing. I am on a transitional care unit that takes care of post-CABG, critical drips, general cardiac patients, and ICU stepdown. We currently run 4-5:1, with 1-3 CNAs to 33 pts. With 4 days notice and no training, management is about to roll out team nursing consisting of 2 RNs and 1 CNA to 11 patients. This just seems very unsafe to me, but trying to get feedback before I start stressing too much.

Thanks!

Team nursing has been around for decades and decades. Just like anything else it has its pluses and minuses. If executed as intended it isn't any more dangerous than any other model. I will admit that the ratios you are describing seem a little optimistic however you and your teammates will likely find a rhythm that works for you.

What is the goal and/or the purported benefit--from management's perspective? Why do they want to do this?

I have remote experience with team nursing, but not with 2 RNs on the team. I'm not sure how that would work, since it seems like it would be a little uncomfortable to function as an RN who is only doing part of the RN role...so it seems that naturally people would just say "I'll take these 6, you take those 5..." What else are you gonna do? You can't be just the med nurse or just the assessment nurse very easily...those things go together and our role is to bring the various elements together and have them all in consideration.

Interested to hear how people actually do this 2 RN team thing.

56 minutes ago, JKL33 said:

What is the goal and/or the purported benefit--from management's perspective? Why do they want to do this?

I have remote experience with team nursing, but not with 2 RNs on the team. I'm not sure how that would work, since it seems like it would be a little uncomfortable to function as an RN who is only doing part of the RN role...so it seems that naturally people would just say "I'll take these 6, you take those 5..." What else are you gonna do? You can't be just the med nurse or just the assessment nurse very easily...those things go together and our role is to bring the various elements together and have them all in consideration.

Interested to hear how people actually do this 2 RN team thing.

From what I've been told, their goal is to try to make things more efficient and smooth since we have massive staffing shortages right now. It's a hard unit and we have a ridiculously high turnover rate. I havent seen any documentation of a 2 RN team, just RN/LPN so I'm not sure how it will go. We have had zero education or notice of this so nobody has a clue. I'm guessing it will be 1 person has 5 the other has 6 and we will just buddy for tasks, but the only way this is different from the primary nursing we are doing is increasing our patient ratio.

So really they are looking to reduce the RNs and increase ratios?

It doesn’t sound like there is clearly defined roles. I think one is supposed to be assessments/tasks and another is like meds/some other tasks.

Zone nursing never works in my experience in the ED which is the closest I can think of

3 hours ago, emergencynurse2011 said:

but the only way this is different from the primary nursing we are doing is increasing our patient ratio.

That was certainly my thought when reading your post. But 🤷🏻‍♀️

4 hours ago, emergencynurse2011 said:

I am wondering if anyone has any experience (positive or negative) with team nursing. I am on a transitional care unit that takes care of post-CABG, critical drips, general cardiac patients, and ICU stepdown. We currently run 4-5:1, with 1-3 CNAs to 33 pts. With 4 days notice and no training, management is about to roll out team nursing consisting of 2 RNs and 1 CNA to 11 patients. This just seems very unsafe to me, but trying to get feedback before I start stressing too much.

Thanks!

My first nursing job had "team nursing" that consisted of one RN, one LVN, and maybe half of a CNA for 16 acute care patients. The RN was required to get report on all 16 patients (bedside report, as if). When the slightest thing went wrong, the "supervising RN" was hunted with a torch and a sharp stick.

It was NOT a good experience.

We did usually divide the patients in half and work more independently than as a team. It's just not possible to keep close, ongoing tabs on 16 acute care patients. It's not even possible to do with eight.

Edited by Sour Lemon

LibraNurse27, BSN, RN

Specializes in Community Health, Med/Surg, ICU Stepdown.

OMG. 5 or 6 sick step-down patients?? How do you do it?

DavidFR, BSN, MSN, RN

Specializes in Oncology, ID, Hepatology, Occy Health.

Sounds like just an excuse to up your ratios. Resist, resist, resist.

Are you unionised?

I wish we were unionized! The CNO managed to chase the reps off, unfortunately. Yeah I'm not sure how they think this will help, I'm starting to lose faith that my management has my back (they honestly used to, the new CNO has changed things) and am thinking about jumping ship. Very discouraged right now.

Also, they are zoning the unit, so your assignment is based on your zone. Not by acuity. We get such a variety from immunocompromised, to CABG, to medical with cdiff and VRE. This isn't a safe way to make assignments

3 hours ago, emergencynurse2011 said:

Also, they are zoning the unit, so your assignment is based on your zone. Not by acuity. We get such a variety from immunocompromised, to CABG, to medical with cdiff and VRE. This isn't a safe way to make assignments

I’m sure CT will love the cdiff patients next to their cabg patients.

OUxPhys, BSN, RN

Specializes in Cardiology.

I work on a PCU and this sounds unsafe. If you are managing true step-down pt's with drips then it should be no more than 3:1. If they are unwilling to do this then I would start looking for a different job in the system or look for another employer.

Sweetheart2005, ASN

Specializes in Med surg/tele.

This sounds unsafe. I’ve done a team nursing approach recently. Our pediatric nurses have been redeployed and I am a med surg nurse. Med surg has a 1:4-1:5 ratio and with team nursing I was doing up to 8 patients, but I had a pediatric RN and an aide (the aide sometimes had up to 11, with the others with another nurse. I enjoyed my first 8 hours. The pediatric nurses were giving meds, answering basic questions, helping with IV placement, beeping pumps, and the little things, I did assessments and pages and communicated with care team: social work, doctors etc. and managed the tele stuff. The last 8 hours of my shift didn’t go as smoothly. (The daytime peds nurse was awesome, evenings needed too much direction). I’d had a 1:6 ratio on this unit before where the aide had 15-20 (very unsafe of course).

most nurses on my unit haded the team nursing because you still had to keep track of eight patients. I think with the right team it works these ratios on med surg, but I wouldn’t have been comfortable taking another patient in that mix... scary to have those ratios on higher accuity

EDNURSE20, BSN

Specializes in ED, med-surg, peri op.

My old hospital did something similar. 2-3 RNs would get a pt load, we would get handover for all pts. Then between us decide what RN would take what pt. So we had pts we were responsible for, but would help each other out when needed, Answer there call bells if we could, help w/ pt that were 2x assist, and Also cover Each other’s breaks. I really like this method, worked well.

FolksBtrippin, BSN, RN

Specializes in Psychiatry, Pediatrics, Public Health.

We do team nursing where I am working now, in the state psych hospital.

One nurse does meds and treatments (LPN or RN), one or two do assessments and assignments for the support staff and pretty much everything else (RN).

It works reasonably well for long term care patients who are mostly stable. I would not think it would work well at all for acutely ill patients. You need someone to look at the whole picture for each patient.

Also, for what it's worth, I don't like it. This is a temporary job for me.

Hoosier_RN, MSN

Specializes in dialysis.

On 8/20/2020 at 12:42 PM, emergencynurse2011 said:

I am wondering if anyone has any experience (positive or negative) with team nursing. I am on a transitional care unit that takes care of post-CABG, critical drips, general cardiac patients, and ICU stepdown. We currently run 4-5:1, with 1-3 CNAs to 33 pts. With 4 days notice and no training, management is about to roll out team nursing consisting of 2 RNs and 1 CNA to 11 patients. This just seems very unsafe to me, but trying to get feedback before I start stressing too much.

Thanks!

Was how the last hospital I worked for was doing it-except no CNAs or nurse externs. They bled nurses. Finally got nursing students for tech work, but still no CNAs. They are magnet, and every nurse that I know that works there, counts the days until they can go elsewhere

Thank y'all so much for the feedback! My manager pulled me aside and explained what they are planning on doing (baffles me why they didn't do this in the staff meeting, but whatever). She mistyped the ratio, we will be staying at 4-5. And it is not true 'team nursing,' it will be more of a buddy system, so you take your zone with absolutely no regard for acuity or patient load, and you communicate with your buddy what is going on with your patients so that we can help each other throughout the shift. We will see how it goes. It did worry me when I asked if they would adjust the zones if you have an immunocompromised patient and a cdiff patient and they said no.

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