I work in a small community hospital on a med- surg floor where our total capacity for pts is 26. Our nurse manager wants us to change our nursing model from primary nursing to team nursing. She is looking for a model and I have been selected to research what works. I am originally from ma where a small community hospital consisted of 240 beds (this hospital consists of 40 beds). Anyways, from my understanding ma is struggling and I want to submit info on a team model that works. I am looking for teams of 13 patients a piece -- need numbers that work as well as how tasks are delegated among the team. We have a rate opportunity in that it will be the staff nurses that make the determination (within reason) so I want to submit information for success.
I have worked in facilities using primary and team nursing, of course, I love team nursing, but as someone else mentioned, the team has to be strong and work as a team to do a good job. Primary nursing is great if you have some assistance, like a charge nurse, lift team, traction team, transport team, or aides, but primary nursing is difficult when there are only your hands and nurse/patient ratio is high. This how we staffed team: 26 patients = 2 RN's, 2 LPN's, and 2 or 3 CNA's. Each RN=13 pts, did assessments, Dr. orders, IV pushes, IVPB, complicated wound care in some cases, admits, some discharges, all check-in's from RR, ER, Peds. LPN's did po meds, maintance IV's, simple dressings, accuchecks and coverage, some discharges, CNA's did baths, beds, walked patients, assisted with feedings, and maintained I & O records, yes, they checked IV pumps and wrote down cc's on sheet, so it was necessary the LPN and the RN check the pumps each shift as well. Usually the RN checked when she made assessment rounds, the LPN when she hung a new bag of fluids, and of course in early afternoon, the CNA then took the total before the end of the shift. Seems complicated but every unit I worked with team nursing was always a better unit than primary. We learned to get along, do the work, and cover and assist each other when needed and the patients got much better care and the doctors seemed to be better satisfied that patients were getting good care.
I have worked in facilities using primary and team nursing, of course, I love team nursing, but as someone else mentioned, the team has to be strong and work as a team to do a good job. Primary nursing is great if you have some assistance, like a charge nurse, lift team, traction team, transport team, or aides, but primary nursing is difficult when there are only your hands and nurse/patient ratio is high. This how we staffed team: 26 patients = 2 RN's, 2 LPN's, and 2 or 3 CNA's. Each RN=13 pts, did assessments, Dr. orders, IV pushes, IVPB, complicated wound care in some cases, admits, some discharges, all check-in's from RR, ER, Peds. LPN's did po meds, maintance IV's, simple dressings, accuchecks and coverage, some discharges, CNA's did baths, beds, walked patients, assisted with feedings, and maintained I & O records, yes, they checked IV pumps and wrote down cc's on sheet, so it was necessary the LPN and the RN check the pumps each shift as well. Usually the RN checked when she made assessment rounds, the LPN when she hung a new bag of fluids, and of course in early afternoon, the CNA then took the total before the end of the shift. Seems complicated but every unit I worked with team nursing was always a better unit than primary. We learned to get along, do the work, and cover and assist each other when needed and the patients got much better care and the doctors seemed to be better satisfied that patients were getting good care.
I'd love team nursing better if they gave us the staff for it. 16 beds per team...yechh. Tonight had 16 patients but it broke down to 3 admits, 1 discharge, 3 in restraints, 1 Kcl by scale, 1 TPN/lipids, 8 total care patients, 2 tube feeders, 3 that needed IV's started at beginning of shift, 1 dementia with delirium that required 10 mg Haldol and 2 mg ativan to quiet down, 1 seizure precautions/etoh detox on ward restrictions who disappeared and was found in the smoking are, way too many code browns and 1 RN, 1 LPN, and 1 CNA.
It's too hard to be a good nurse to total care patients when you have to team lead, and it's hard to effectively team lead when you have too many total care patients and not enough staff.
I agree that your assignment sounds like another team needed to be formed and staffed. I did not say team nursing was easy but it is doable. I just like the team approach. You are right, facilities do not staff for emergencies, heavy acuity, or with regards for patient or staff safety. It sounds like you had a rough assignment, too little help, and too much responsibility. I hope you speak to the HN, DON, and even the CEO to bring these types of issues to their attention. Let the HN know a call to her for assistance may happen, middle of the night or not, if this heavy a load continues. She may get angry, may give excuses, but in the end she has 24 hour accountability for that unit and needs to be reminded of her duty to the unit and the staff. Good luck. Is a new job being considered?
The matter at heart right now is no staff...we are incredibly short staffed on all shifts. Also being a govt hospital, the hiring process is very long. No one wants to work straight evenings...and because of the union, if someone is hired for evenings and then decides to do days with evening relief, they can. We have more staff hired, but they are in clinical ed at this time. No float pool. We have a new nurse manager, and she is supposedly going to rotate to all shifts to help fine tune assignments and to see what is really happening, which is good, the old nurse manager was gone by 1600 everyday.
She's trying to staff us with 1-2 more people per evening, but everytime we have extra, someone is pulled to cover another floor due to call ins. It's an ongoing war between the NM and the house super. The super thinks that because we don't have many surgery pts, we don't need to be staffed as well as the other floors...but we have palliative care pt's that are in need of a higher level of care/IV meds that can't be offered at home or in a NH/SNF. I don't think the super realizes those patients/families need MORE interventions, she's of the mindframe that they need less than the average pt. :angryfire :angryfire
We have just recently changed from team nursing to primary. On our surgical floor the LPN's are working at full scope,and assess, give all meds, including IV, insert IV, NG's, give blood, take orders from the doctors,process their orders, and monitor lab results and if something is of concern contact resident or doctor in regards. Team nursing worked well for us in this regard, because if you had someone who was slightly weaker in their skills, either RN or LPN the continuence of care for the patient was not affected. One worker complimented the other in some wayor another. Now we are finding with primary care, the team member who may have been the weaker of the two is not providing that continuence of care that is very much needed for that recovering patient. Less people are aware of what is going on with other patients,and thus resulting in frustration by surgeons,and other members of the team in finding out how their patient is faring in their recovery.
I don't know if any others have found the same issues, but in regards Team vs Primary, I have found that Team is much better in making sure the patient is provided with continuence of care resulting in possibly a shorter stay,and less risk of any adverse issues that can arise from not providing that continuence of care. I love nursing alot, and do love to hear my patients call us angels of care, and its sad to think that a ward or hospital that maybe thinks that by switching to primary may be more cost effective, isn't so concerned what is best for the patient. My pay is the simple words spoken by my patient " Thankyou so much your and angel" need I say more.
Eithia,
We have just recently changed from team nursing to primary. On our surgical floor the LPN's are working at full scope,and assess, give all meds, including IV, insert IV, NG's, give blood, take orders from the doctors,process their orders, and monitor lab results and if something is of concern contact resident or doctor in regards. Team nursing worked well for us in this regard, because if you had someone who was slightly weaker in their skills, either RN or LPN the continuence of care for the patient was not affected. One worker complimented the other in some wayor another. Now we are finding with primary care, the team member who may have been the weaker of the two is not providing that continuence of care that is very much needed for that recovering patient. Less people are aware of what is going on with other patients,and thus resulting in frustration by surgeons,and other members of the team in finding out how their patient is faring in their recovery.
charlleana
1 Post
in our hospiutal, san pedro hospital, we tried all the modalities of rendering nursing care. and they all work. we use whatever modality we want.