Team Nursing...yay or nay

DutchgirlRN, ASN, RN · Nov 13, 2005

They have tried it a couple of times in the hospital where I work and both times it was a disaster and as you say, most quit, they have vowed never to try team nursing again. I'm relieved.

pedinurse05 · Nov 13, 2005

I'm becoming a bit worried about this team nursing thing. My hospital is threatening to change to teams and get rid of CNA's. I work on a Telemetry floor where the ratio is normally 1:5. With team nursing, one RN and one LVN take care of the same 10 patients with the RN being responsible for assessments, charting, IV's, new admits, discharges, and calls to doctors. The LVN responsibilities are PO medications and dressing changes. Does this sound feasible to anyone. I kinda want to be an LVN if we change to team nursing.
This is the rumor that I hear about teams. I know that there are hospitals that use this type of nursing and I wanted to hear what you think of this type of situation. I am a new grad (I graduated in December) and the thought of having 10 patients terrifies me. I just now got the hang of 5 patients.
If you like the way your unit runs, if you could let me know I would appreciate it because my director says if we can come up with a better plan, maybe we could stay away from teams. Just a side note...there are two med-surg floors that use team nursing where most of the nurses have quit :angryfire .
Thanks in advance for any suggestions or advice.:)

My friend works in a hospital that does team nursing and says it is hard to have 10 patients...even with the LVN. The RN is still ultimately responsible for that team. The RN also has to do certain IV tasks, initial assessments, M.D. calls, etc. That is a heavy responsibility. I personally would not like to do it.

Missy

allnurses Guide · Nov 13, 2005

Simply nay.

steph

ZASHAGALKA, RN · Nov 13, 2005

Nay.

I'd quit first. It's a nurse's market out there, you don't have to work in sweatshop conditions.

~faith,

Timothy.

nurse4theplanet, RN · Nov 13, 2005

This bothers me for several different reasons...

I have worked with some GREAT CNAs, and it seems like they are seen as despensible. That bothers me. On our med/surg floor they take a tremendous load off the LPNs and RNs by handling all the pt hygeine care, linens, screening call lights for the nurses (ie, "i need somebody to move my bedside table closer"etc.)

Second, team would infer a number of people that would work together to provide pt care. Two is a couple. Do they want couple nursing? A nursing Duo? The RN brothers? hahaha:rotfl: A patient load of ten is too much for two people to handle alone and will lead to burnout, and what if someone can't come in/the floor is short/large influx of critical pts like with a natural disaster/25 car pile up, etc.etc.etc. Dangerous, IMO

And finally, they are placing too much responsibility on the RN. Too make "team nursing" a success the whole process needs to be re-examined.

Just my suggestion, so feel free to add or change:

10 pt to 2 RNs, 1 LPN, 1 CNA- this would be a team. And even then it may become overwhelming depending on pts needs.

All this team nursing boils down to is more profit for the hospital because of less staffing. They have to pay RNs more than what they like, but they can't get by without us, so their solution is to get rid of everyone else they can, and let the RNs pick up all the slack! IGNORANT!

:smiley_ab

flashpoint · Nov 13, 2005

Our day shoft on med/surg does team nursing...night shift on med/surg does primary nursing. The night shift hears a lot of complaints that there were so many people in the room throughout the day and that none of them really did anything. They have an RN do assessments and IV meds, CNA does vital signs and makes beds, LPN does all meds except IV and gives baths. They have 1 RN, 1 LPN, and 1 CNA on each team. The charge nurse makes all doctors calls and supervises the floor. The night shift does primary nursing with a charge nurse to call doctors and supervise. The CNA helps with call lights and HS cares. The day shift often hears how "that one poor nurse" had to do everything and "she was run so ragged." LOL...seems like we can't win.

I like team nursing when the other people on my team have the same work ethic that I do. I am very much a "get in and get it done" type of person...sure I take time to visit and do all of the TLC stuff, but I hate being behind...I hate not having things caught up and a lot of the people I work with like to spread things out so there is always something to do. I would much rather have everything done and have down time than end up behind the eight ball if something goes wrong. We also have a lot of nurses who like to chart everything at the end of the shift...that drives me nuts...I try to make some sort of entry every time I come out of a room or every two hours if my patient is stable and sleeping well.

DutchgirlRN, ASN, RN · Nov 13, 2005

The CNT's that I work with are wonderful. I cannot imagine working without them. Besides we only have 2 LPN's on the day shift. They are awesome and to reduce them to meds and baths would be a shame.

RN34TX · Nov 13, 2005

Nay.

It's an outdated idea that shows up at every hospital time after time when some manager/administrator at a meeting comes up with some "new" idea to cut costs.

The "team" concept is nothing more than a way to pay fewer staff to care for more patients than they originally were responsible for prior to team nursing.

Plus you run the risk of ending up with someone who is either lazy or just plain dangerous to work with no matter which end of it you are on, be it RN or LPN, and now you have to share patients with them.

As an LPN/LVN, you could get stuck doing everything while the RN sits at the desk saying that they have to "assess all these patients" as if that takes 12 hours to do for a group of 10.

Then on top of it, your patients haven't seen another nurse besides you all day so you wonder how the RN is able to assess from the desk.

As an RN, you could get stuck signing off LPN charts for things that you don't really know whether or not got done and are basically trusting an LPN that you may not think is a nurse that you'd want taking care of you.

They disappear off the floor on smoke break number 8 and are still somehow able to pass all meds and change every dressing on every patient before 7 pm. Yeah right.

Team nursing seldom results in any type of quality care.

miphillli · Nov 13, 2005

Nay.
It's an outdated idea that shows up at every hospital time after time when some manager/administrator at a meeting comes up with some "new" idea to cut costs.
The "team" concept is nothing more than a way to pay fewer staff to care for more patients than they originally were responsible for prior to team nursing.
Plus you run the risk of ending up with someone who is either lazy or just plain dangerous to work with no matter which end of it you are on, be it RN or LPN, and now you have to share patients with them.
As an LPN/LVN, you could get stuck doing everything while the RN sits at the desk saying that they have to "assess all these patients" as if that takes 12 hours to do for a group of 10.
Then on top of it, your patients haven't seen another nurse besides you all day so you wonder how the RN is able to assess from the desk.
As an RN, you could get stuck signing off LPN charts for things that you don't really know whether or not got done and are basically trusting an LPN that you may not think is a nurse that you'd want taking care of you.
They disappear off the floor on smoke break number 8 and are still somehow able to pass all meds and change every dressing on every patient before 7 pm. Yeah right.
Team nursing seldom results in any type of quality care.

We have primary care where we work....but it does sound alot like team nursing,RN usually have 3-4 pt's and oversee the 3-4 pt's assigned to LPN..they do own assessments,charting,they always mention that the RN collaborated in the care. Rn calls docs,signs orders off,iv meds...all new adm.are assessed by RN. CNA usually 1 to 3 on day shift,do 6 baths/per cna,vs,I/Os and answer call lights...now,haveing said that,some of cnas are the salt of the earth,some are not going to do anymore than they have to.I would rather have 0 cnas and more RN's Their are days{many} that we start with 3 pt's and end with 5...........plus all the LPN pt's...

nursemaa · Nov 14, 2005

We have primary care where we work....but it does sound alot like team nursing,RN usually have 3-4 pt's and oversee the 3-4 pt's assigned to LPN..they do own assessments,charting,they always mention that the RN collaborated in the care. Rn calls docs,signs orders off,iv meds...all new adm.are assessed by RN. CNA usually 1 to 3 on day shift,do 6 baths/per cna,vs,I/Os and answer call lights...now,haveing said that,some of cnas are the salt of the earth,some are not going to do anymore than they have to.I would rather have 0 cnas and more RN's Their are days{many} that we start with 3 pt's and end with 5...........plus all the LPN pt's...

See, that's just it...those who say they are doing primary nursing really aren't unless it's an all-RN staff. Because the RN is responsible for overseeing the LPN's patients whether you call it team nursing or not. At least in my area that's the case.

KatieBell · Nov 14, 2005

I don't know how that would work in the ED, but I'll say I will never ever do anything like that. Too confusing, and really fragmented care- in my opinion.

I did a clinical on a floor like that in school- half the time the nurses didn't know the full information on a patient because "The nurse doing vitals has that, I don't know, I guess her vitals are ok" It felt like chaos.