Team Nursing vs Primary Nursing

[michelle999]

I am currently investigating the possibility of reintroducing team nursing to our ward. Does anyone have any research or information on team nursing V primary nursing??

[outbackannie]

I have worked under both systems and find that the Modified Team Concept (a little of both) works best. For example, a team of 1 RN, 1 LPN and 1 CNA cares for a block of 10 patients.

The RN and LPN divide up the patients for charting purposes, the RN takes care of the IV's, IV meds,assessments,and new admits. LPN does other meds, treatments, etc. CNA takes vs, I&O's, baths, etc. With difficult pts to bathe, nurse and CNA do together, or dificult treatment like a complex dressing change, RN and LPN perform together. Of course, the team is only effective as its members, but I have always had a good team to work with and usually get to take lunch, go home on time, and feel like our job was done to satisfaction.

[P_RN, ADN, RN]

That's just about exactly how we did.

The greatest benefit is you never had more than a team full. All the patients were in one block. Another was that you always had a relief person as the RN and LPN took separate breaks and lunches. And I always hoped NOT to get a smoker as a partner.....too many breaks there.

Of course that would be WHEN and IF a full staff was on.

P

[CEN35]

d/t the lack of available nurses.......we are contmplating team nursing in the ER with paramedics. depends on what we can lock up with contracts through agency and travel stuff.....until/if our positions get filled.

[OC_An Khe]

When someone suggest going back to team nursing I have bad thoughts. It says to me we don"t have enough staff, probably won't have enough RN staff in near future so we are going to fill void with LPN and aides. Thereby reducing the number of RN's per patient. All studies show that when you reduce the number of RNs per patient the morbidity and mortality increae. And with the increased acuity we seeing and projecting further increases do to aging population we should be advocating for increased RNs per patient not decreasing it.

[fiestynurse]

Today's team nursing is different from the team nursing of the past. Patients are more acute, because of decreased hospital stays. In the past you had a group of patients in various stages of recovery. Now, they are mostly in the acute stage. This has changed the staffing mix considerably in regards to team nursing. It's important to have enough licensed nurses to cover the patient load. I think the modified team approach is best, as outbackannie has mentioned.

[CEN35]

Where do you get the RN's though?

[fiestynurse]

Good point! CEN35--Where do we get the nurses to lead these teams!? It all falls apart without the nurses there to keep it together.

[goofyrocky]

Yes, I certainly do believe in team nursing!

A few years back, I worked at a large hospital in an oncology unit where we had a nurse manager who was very prostaff involvement. We pioneered the concept of the RN/CNA team with the RN actually interviewing and hiring her/his own partner. each team worked the same schedule.

The RN was then responsible for training/orienting her CNA. As the team grew together, they became a very strong unit, knowing precisely what each other was responsible for and communicating each other's and the patients' needs in a very accurate and proficient manner. Average patient load per team was 8.

It was so successful that other units adapted our RN/CNA concept. However, when the rns were not allowed to select their own permanent team member, the results were no where near the same. personality and responsibility problems were abundant!

I currently work in a hospital that has no CNA's, only licensed staff. "teams" are made up of rns and lvns, but there is no continuity to these teams. each pair is responsible for 10-12 patients, with one doing meds/assessments/admits/discharges, and the other doing adl's/vs/I&o. So, you have two licensed nurses per team, but they are so busy trying to get the basics done, that they do not have time to learn the other's strengths and weaknesses. Thereby preventing the formation of a more effective, cohesive team. it does not work!

Un summary: the team concept is great! However, it must be a well-thought out plan with consideration for both staff and patients.

[P_RN, ADN, RN]

Whoh!!!!!!...the LPN is a vital part of the modified team.

In primary as we did it, the RN had his/her x number of patients...alone...the LPN had xx number alone....the techs kinda floated helping here and there maybe a bath or for each nurse.

With the TEAM, EVERY patient gets an RN.

With the team, EVERY patient also gets the LPN.

With the team, EVERT patient gets the care of the tech.

It's a Win:Win situation. Each member has their allocated duties......specific to their place in the team.....all the same for all the teams.

P

[leesonlpn]

this could be a prickly subject.I'll try to keep it warm and fuzzy. I was involved in our hospitals skills task force group. This group was created to address the under-utilization of licensed practical nurses, and whether or not nurses' aides have a roll in acute care.The pros and cons of primary vs team nursing were addressed. On our task force were new rn's, seasoned rn's new lpn's and seasoned lpn's (that would be me). Also on board was our nursing officer and two unit managers from surgery, medical, and two nearby hospitals. After much research it has been decided to upgrade all LPN's( that require it) in our hospital (100), and to utilize them to their full scope of practice.Nurse's aides in BC have a 2 month course, are not taught to do vital signs or care for the acutely ill patient. They work mostly as caregivers in private homes, or extended care facilities. I realize nurses aides in other parts of the country are trained and competant to do more than ours, but I am referring to the situation in British Columbia.Also in British Columbia, only Rn's and Lpn's and psychiatric nurses are legally allowed to use the term "nurse". We are from a professional licensed body. Nurses aides are not part of any profession licensing body in BC. Having said that.... We have documentation that shows skills between RN's and LPN's are 70% combined (overlapping)knowledge. I realize that there is a wide range of skills and scopes of practice between Canadian and American LPN's. It varies greatly even between province to province. The results clearly indicated Rn's and Lpn's are a preferred team in the health care system. LPN's in British columbia are throughly trained and compentant in their dispensing of meds, monitoring IV's, dressings and wound management, head to toe assessments, patient teaching, family support etc. etc. etc. I agree the team is only as good as the workers. A patient can only benefit from an RN and LPN dedicated to care for their patients the best way they can, and dedicated to work together as a team, the best way that they can. Primary nursing is no longer functional in todays health care crisis. As for the increase in mortality rates, when a patient isn't cared for by and RN, when would that happen, if Rn's and LPN's work together?. Your statement would not sit well with the College of Licensed Practical Nurses of BC. I believe they would have documentation to disprove your information. Hope no toes were stepped on, you have to be totally informed before you make a decision. If patient care is our primary focus, why can't RN's and LPN's work side by side in a nursing partnership. It does work, believe me. It certainly won't work if you don't let it.

[debbyed]

In our ER it is always team nursing. To actually do primary nursing would be impossible.

We have a Clinical Coordinator (usually a Senior Clinical Nurse -Me) who over see's the entire ER, keeps the flow moving in the right direction, assigns patients to rooms, and puts out fires.

There is also a triage nurse 0700-2300, as well a triage this nurse also does equipment rounds and patient call backs when time allows. The clinical coordinator is responsible for triage 2300-0700

Urgent Care (which is out "fast track" area) has a P.A., an RN and an Emergency Room Tech. When patients are triaged appropriately this team usually has no problems. Urgent Care is open from 1100 to 0200.

Major Care is divided into "A" side and "B" side. During peak hours (1100-2300) each side has a team of 3 RN's (we don't use LPN's) and an ERT to care for 10 patients (when no one is in the hallway or in the Trauma/Code room). New patients are assigned to the nurse who is either caught up or has the lower acuity patients by the C.C.. Our ERT's do standard nursing assistant tasks as well as starting IV's, phlebotomy, EKG's, splints and patient teaching R/T ortho equipment. The nurses cover each other for breaks (sometimes we forget what breaks are) and when one team member has a high acuity (Trauma/Code/Acute MI/Head bleed, etc.) patient.

From 0700-1100 there are 2 R.N.'s and an ERT to each side, from 2300 to 0200 Urgent Care has it's full staff and Major care has 2 RN's and and ERT on both sides. From 0200-0700 Urgent care closed, Major care has 2 RN's and an ERT for each side and the clinical Coordinator does triage and everything else.

The hospital also has a Resource Nurse who floats the hospital. This nurse has basic training is all areas and responds to the ER when we have a code, a trauma or just happen to be drowning.