Team vs Primary Care Nursing

The ED where I currently work, has used the "team nursing" approach for years. Now, they have decided that we are going to change to a "primary care nursing" approach, to add accountability for some nurses in our department.

My question is, what type of approach do you guys use in your ED? This is the first ER that I have ever worked where we do team nursing, it seems like it has worked well in the past, but now we have a lot of new people who like to turf work to others, therefore requiring a change in the approach for the nurses.

What do you guys prefer? Primary care or team nursing?

[Brownms46]

I have worked where they have done team, and where they did primary. And it depends on who I'm working with...no matter what the area, as to whether I like team or primary care. If the person I'm working with is a team player...then I like team. If they're someone who likes to direct while they sit on their bonbons..then I prefer primary care.

[jeannet83]

Veetach! Believe it or not, I have never done team nursing. I can understand how it would be done on the floors but I can't imagine how it's done in the busy ER? Hate to be ignorant but please enlighten me! Very curious-Jeanne

[veetach]

Hi Jeannet;

We have a 21 bed ER, 4 dedicated cardiac, 3 dedicated trauma, and 12 observation (4 of those with cardiac monitors) 1 psych room, and 1 ortho room. These rooms are divided into 2 teams. on each team you have 2 RN's and either an LPN (for the cardiac side) or an ER tech (for the obs side) it is the responsibility of everyone to make sure all the orders get done. As per their job requirement, the techs usually draw most of the blood, and try to do ekgs, RN's and LPN's do all of the assessments, and everything else.

Of course, if there is an EKG to do or a splint to apply, who ever grabs the chart is obligated to do it....and only Rn's and LPN's do discharges

It seems to work well for us, but the element of accountability is just not there, this is becoming a problem now with so many new grad nurses and new employees to the ER.

we run between 45,000 and 50,000 patients per year, so very often the charge nurse does not have time to follow up with who is not pulling their share of the load.

[AngelGirl]

We tried "team nursing" for a short peiod, but didn't have a good definition of what it should be, so we quit.

The charge nurse who brought this idea, wanted two nurses to share 6 patients, knowing all that was going on with each one and accomplishing all of the orders. I found this extremely confusing. It led to a total fiasco Perhaps it's because this was my first day off of orientation and I was linked with a nurse who was greatly against the team nursing approach. Anyway, it was a disaster.

In another setting, however, I had a nurse as a buddy. We checked on each other to offer or ask for help, reported off to each other for breaks and were aware of the other's needs throughout the shift. That was GREAT.

If that is team nursing, I highly recommend it.

In our ER presently, we each take 3 or 4 beds and are responsible for EVERYTHING that gets ordered. If there is another dept to be called (X-ray, Resp. Therapy, EKG), it is our responsibility to make sure that it gets done. We draw nearly all of the labs, and send them.

The clerks are great in making sure that the orders are entered into the computer, which alerts the other depts to come to our patients.

We then use a large communication board to note what's been ordered, then cross it off once it's completed. The charge nurse keeps an eye on the board for items that are not crossed off, then checks the chart to see if the order still needs to be done. He or she is usually good at helping where needed.

I keep an eye on the fax machine for returned lab results (Our lab is a very slow dept). If they're not there within a resonable amount of time, I call the lab.

If things don't move smoothly, I am held accountable for everything re: my patients. Period.

[veetach]

Angel, how big is the ER you work in?? In the primary nursing approach at our hospital, we would be responsible for 5 beds per RN, an LPN or a tech would be a "float" between 2 modules (5 bed modules were established) The RN would be responsible for everything for that patient. We do all of the lab draws, all of the ABG's and keep an eye on the bi-paps after Respiratory sets them up... Our senior(day) nurses in the department have already decided that they wont do primary nursing and that is that!!!

It is making things very difficult for our new manager, but I think she will eventually "win". haha

The one thing that primary nursing is going to do in my opinion is to establish accountability for each RN. We have a few who like to "coast" as it were, instead of taking responsibility of patients.

[AngelGirl]

veetach

Our County hospital has 10 monitored beds, and 9 single rooms without monitors, six of which are in a clinic setting (3 of them are pelvic beds).

There is one ER tech for all 19 beds, a position that often goes unfilled.

Sounds like I've got it better than I'd thought. Team work is always essential, however. Just one non-team player can throw the whole place into an upheaval. I can certainly sympathize with you as you deal with "coasters."