Team nursing...thoughts?

Orange Tree · Nov 6, 2010

I think it's super-scary. For a team to be efficient, you need a strong, competent leader and a team that's actually willing to follow. Newer RNs may not have the experience or confidence to pull it off.....and experienced LVNs may not like being directed by an RN after they've been working independently for seven years. Then there's the issue of responsibility when you're the "team leader". It's just too difficult to keep up with 12 patients- any way you look at it!

RaeRN30, BSN, RN · Nov 6, 2010

Exactly my thoughts....my last shift I really believe team nursing led to the amptation of pt's leg. Seems like the nurses I work with don't care anymore and are more concerned with eating their lunch then caring for the pts. The first pt I assessed had discoloration to his leg--you think I got this in report (which is complete chaos btw)?? When I assessed the pt noticed his leg was mottled and cold....

ughhhhh.....HATE team nursing.

Feeling like an incompetent nurse at this point. I'm a NEW grad I don't have the experience and I definately doubt myself. The stress of assessing up to 12 pts and documenting is unreal and too much for me at this point. I have been told that as long as RN has assessed in past 24 hours I can just "concur" with assessment and add addendums as needed to another RN's note...well I just can't do that, I don't have confidence in some of the other RNs so I would rather do the full assessments and document my own findings.

I appreciate the response I will definately be talking to my nurse manager about my concerns....

General E. Speaking, RN, RN · Nov 6, 2010

Haven't done team nursing for years. When I did, I was a LVN. Our team consisted of a RN and LVN and we had to share one tech with the entire unit (about 40 beds). I think we had about 10-12 patients. I was a strong LVN so I carried my load and worked well with the RNs (at least that's how I recall it :)).

The RN and I would start doing our vitals together, bag up our linens and toss them into the rooms. After report I would get the med cart ready and loaded up. This was pre-pyxis days! I would pass all the meds and do dressing changes and treatments. The RN would start assessments. We met up together later in the shift to get baths done and then charting. It was hard work.

I'm not sure how I would feel about doing it again. For one thing, the acuity of patients nowadays is much higher. Many of these patients that nurses get on the floor used to be in ICU 15 years ago. You really are only as good as the people on your team. Like I said, I was a LVN back then. I would like to think that these RNs respected the work that I did. Of course, I understand now about being more responsible since I would be the RN in charge of delegation.

If you used to have a 5:1 ratio and now are getting 12 patients with you and a LVN and no tech, you are getting screwed. I do think being a new grad plays into the factor. Being a new grad is hard. I cannot imagine having to worry about an extra 7 patients and a LVN.

How do the others feel? Is this a trial run?

RaeRN30, BSN, RN · Nov 7, 2010

All the other nurses I have spoken to hate it as well. I'm not sure if it is a trial run or not...I HOPE SO! I literally came into work one evening and noticed the "funky" looking assignment...no warning whatsoever. I just don't see a lot of team work between the RNs, LPNs and CNAs. It seems that everyone hates each other! I thought about filling out refusal of assignment forms to cover myself? I dread going into work...I try to pump myself up on the drive to work saying "its going to be a great night!"...well that night has yet to come....

Well I'm off for a whole week! Gonna try NOT to think about work at all! We'll see how that goes...lol

I'll definately keep you guys updated on how this plays out....I'm so thankful for this forum!!:heartbeat:redbeathe

elkpark · Nov 7, 2010

There is always an advantage to having been "around" long enough to have seen things change a few times already. :) When I was in nursing school a kazillion years ago, team nursing had been the standard nursing model in most-if-not-all facilities for many years, and primary nursing was the new, innovative, cutting-edge approach that was just starting to be talked about and introduced in the most prestigious and progressive facilities. Most working nurses at the time thought that this (primary nursing) was a terrible idea and it would never work and awful things were going to happen to clients if we went to this. Guess what? It worked out well enough (as team nursing had worked "well enough" before that) -- some places really took the idea and ran with it, nursing staff in some places had to be dragged into it kicking and screaming, some facilities ended up developing their own model that combined aspects of both team and primary nursing, etc., etc. My observation over the years (decades) is that most of this comes down to the attitudes of the individual nurses. If you start out believing that team nursing (or primary nursing, or functional nursing, or any of the other delivery models) is a terrible idea and isn't going to work, you're probably going to end up thinking it isn't working. If you give it a fair chance and are open to trying something different than what you're used to, you're likely to find it isn't so bad after all. In any case, things will change again after a while, so, in the long run, it won't really matter.

HouTx, BSN, MSN, EdD · Nov 8, 2010

As usual, elkpark is right on the money!

I would only like to add - new grads should never be expected to lead teams. That's insane. Back in 'my day', we got team leading experience in nursing school but grads to day have not had that type of experience. They should not be expected to assume this role until they have become more confident in their patient care abilities.

As reimbursement rates continue to tighten up, nurses are going have to accept 'budget neutral' models of nursing care that can maintain adequate bedside resources. This can only be achieved through a differentiated practice model - with each level of provider performing tasks within their scope of practice - under the direction of an RN. With the fiscal realities we have to face, all licensed (or all RN) staffs are simply unaffordable.

ReWritten · Nov 11, 2010

My floor does team nursing, but to me it doesn't really function as one. What I mean is, I don't really see a difference between our team nursing and any other floor I've ever been on. Each nurse gets his/her own set of patients... the RNs do the admissions for the LVNs, but as soon as the orders are put in and the initial assessments are completed, the LVN takes care of the patient entirely on his/her own. We all pass our own meds, and unfortunately there's only one aide if we're lucky, and she helps everyone out.

The catch is, we don't have a charge nurse, but the most experienced RN is the "team leader", and is suppose to monitor all the LVN admissions and kind of make sure things run smoothly.

I'm a new grad and have 3 months of experience. I'm not suppose to be a team leader until 6 months, but my manager wants to go ahead and train me early for the role. I work nights, so if anything comes up that I'm unsure about, I'll call the house supervisor and collaborate with him. (that being said, most of the LVNs on my floor have been a nurse for years and have excellent judgement about things, so I often ask them for advice).