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.:)
Specializes in med/surg, telemetry, IV therapy, mgmt.
I worked on a stepdown unit for 5 years where we did exactly what your hospital is proposing. We had not one CNA at all doing patient care in our hospital. It was only RNs and LPNs. We RNs were responsible for 10 patients and we had an LPN working with us. It went very well. Actually, I'll tell you at the risk of offending CNAs and LPNs that you will like this setup much better because your LPNs will be doing a lot of the work that a CNA would have done--and much better because an LPN is going to report things to you that a CNA wouldn't even consider important. Unless you're working with a really stupid LPN your patients are always going to be safe and things are going to get done. A lousy CNA can walk away and refuse or just not do some things, but an LPN won't. The way we worked it was at the beginning of the shift the LPN and I decided which 5 patients we would do the initial shift assessment on. I usually did the assessments on the sicker patients. I also had to pass all meds and do IVs (the LPNs didn't do meds in this hospital). The LPN pretty much acted as the CNA for the rest of the shift although I gotta tell you that you have to work with them. If your LPN thinks you're shoving off all your patient care onto them, they get mad--and they know how to sabotage you where it hurts! But the really good thing here is that if you have a patient going bad, the LPN understands what your responsiblity is and is going cover the rest of the patients in your team and make sure they get taken care of. You're less likely to hear "but it wasn't my patient" from an LPN.
So, what I'm saying is don't knock it just yet. I went to a stepdown where we each had 4 patients to care for. When I had a patient go bad, no one else came to my rescue to ask what they could do to help me out. I had to go to them and ask for specific help. It was a nightmare!
Well Ive done it both ways. When we did team nursing, we had 12 pts. One Rn and one LPN and maybe a NA, maybe not. The RN did all the assessments and the 10am meds. The LPN did the meds for the rest of the day. And in MY experience, the RNs typically didnt get very involved with pt. care..but they did many times ask for help from the LPN to get the am meds finished lol.
Then we went to primary nursing and the RNs and LPNs all had 6 pts. The LPNs were trained to do their own assessments and everyone seemed happier. In fact, the RNs use to say "if they make us go back to team nursing Im quiting!"
NA's? I swear they make or break my day. I can't work without having the help of an aide, and I always told them how much I appreciated them working with me.
Since Im trained to take care of pts on my own, I personally wouldnt like being made to only give pt. care. Of course, Im in school for my RN now, so hopefully it wont be an issue oneday!!!
Nay. We tried "team nursing" in our clinic when it opened. Needless to say, it lasted about 4 weeks. The managers decided to keep the "team" happy by going back to 1 on 1 nursing, rather than loosing all of the nursing staff. We felt that too many things were being missed and no one would take responsibility for any of the MD's afterwork. There were just too many hands in the cookie jar as all of the nurses agreed to. We are back to 1 on 1 nursing and enjoying our jobs again.
Thank you to everyone who gave their opinion on this matter. If we do go to teams I will give it a try unless I feel my patient's safety or my license is in jeopardy.
we do team nursing at our hospital. this is the only place i've ever worked and they've done it since before i started. i like having an rn that knows my patients and that i can ask questions if necessary. i've only been a nurse for a year and a half and i don't know how i would feel about having patients on my own. as an lpn, i am responsible for all meds except iv, dressings, accuchecks, tube feedings, charting. the rn is responsible for iv meds, initial assessments, hanging blood. lpns at our hospital are allowed to take verbal/phone orders. the rns take care of the ivs mostly but we assist in hanging fluids, pbs, monitoring ivs. usually there is 1rn, 1lpn, and 1 cna per 15 patients. sometimes for 23 patients, there are 2 rns, 1 lpn, and 2 cnas. i personally feel that this is too much responsibility for one lpn. with that patient load, i am very lucky if my patients get their meds on time and wind up doing dressings late into the night. luckily, everyone on our shift works together and pitches in when anyone needs help. i think this is the only way team nursing can work.
Daytonite, BSN, RN
1 Article; 14,604 Posts
I worked on a stepdown unit for 5 years where we did exactly what your hospital is proposing. We had not one CNA at all doing patient care in our hospital. It was only RNs and LPNs. We RNs were responsible for 10 patients and we had an LPN working with us. It went very well. Actually, I'll tell you at the risk of offending CNAs and LPNs that you will like this setup much better because your LPNs will be doing a lot of the work that a CNA would have done--and much better because an LPN is going to report things to you that a CNA wouldn't even consider important. Unless you're working with a really stupid LPN your patients are always going to be safe and things are going to get done. A lousy CNA can walk away and refuse or just not do some things, but an LPN won't. The way we worked it was at the beginning of the shift the LPN and I decided which 5 patients we would do the initial shift assessment on. I usually did the assessments on the sicker patients. I also had to pass all meds and do IVs (the LPNs didn't do meds in this hospital). The LPN pretty much acted as the CNA for the rest of the shift although I gotta tell you that you have to work with them. If your LPN thinks you're shoving off all your patient care onto them, they get mad--and they know how to sabotage you where it hurts! But the really good thing here is that if you have a patient going bad, the LPN understands what your responsiblity is and is going cover the rest of the patients in your team and make sure they get taken care of. You're less likely to hear "but it wasn't my patient" from an LPN.
So, what I'm saying is don't knock it just yet. I went to a stepdown where we each had 4 patients to care for. When I had a patient go bad, no one else came to my rescue to ask what they could do to help me out. I had to go to them and ask for specific help. It was a nightmare!