Team nursing?

[emergencynurse2011]

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!

[OUxPhys, BSN, RN]

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]

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]

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]

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]

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

[emergencynurse2011]

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.