Team Nursing

My hospital plans to change from primary nursing to team nursing later in the year. As an RN, I will be responsible for all members of the team, which I am definitely NOT looking forward to. I LOVE primary nursing.

As it is now, I take care of all my own patients, plus I "cover" 1-2 patents assigned to an LVN (meaning I give all IV meds and assess them). I don't even like doing this - I often go to give medications at 11am, and the LVN hasn't documented ANYTHING yet, other than the meds given. This is so unlike my own style! And don't even get me started on having to delegate the giving of all oral meds to someone else, whose judgement I am forced to trust. Although most of the nurses are fine, I am sorry to say that there are a couple that I think are lazy, with sloppy practice, and who are sometimes rude to patients, which I know because our hospital has shared rooms, so I see how other people practice first hand. Of course, I am worried that I will end up with them working on my team. (Of course I will.)

I can't imagine how I can continue providing the same level of care to my patients when I will be responsible for twice as many.

Does anyone have any experience with team nursing? Are my concerns justified?
Your last line "I can't imagine how I can continue providing the same level of care to my patients when I will be responsible for twice as many" is a legitimate concern. I work at a facility that practices team nursing. Every once in a while I get a primary and I love it. Both styles have their positives and negatives but you definitely don't spend as much time with your patients on a team as you would on a primary. Thankfully, your team members also spend time with them, so the patients usually feel that they received good care. Sometimes your team makes you and sometimes they break you, depending on who you're working with. I believe your concerns are justified, but it looks like you'll have to suck it up and make the best of it. I'm actually surprised that your facility is going to utilize this practice as I believe our facility plans to do away with it. They are pushing all LVNs to obtain their RN, etc. Teams really can be good and bad depending on who's on your team (both the employees and the patients). Thankfully I work with a bunch of great staff and it isn't often that my team is a problem. Good luck to you! Try hard to keep an open mind as you go through this. Just remember that life is all about change and try to roll with the punches.

I can't provide the first hand experience you want, but I can say that every nurse I've encountered who worked in a hospital that employed "Team" Nursing no longer works at that hospital.In fact, they say they'll never work in a team nursing environment. I've gotten the impression that it's a system that looks fantastic on paper but fails miserably in practice. Mostly due to members of the team being lazy or, worse, incompetent. But, this is only what I've heard, and I've never heard a good thing said about team nursing.

i've worked as an aide with team nursing, and I am definitely NOT a fan (sorry to say to your sake). I also just graduated and had clinicals in a primary nursing care hospital, so I've experienced both settings. Based on personal experience, the RNs think they rule the world and seemed to delegate anything and everything they could to LPNs/aides with team nursing. I understand RNs must do certain things, such as teaching, assessment, etc. but that does not give them the right to delegate every single other task that needs to be done. I was in the middle of a complete bed bath, by myself of course, and the RN interrupts me, not to help, but rather to tell me that another patient needed a urinal. First of all, the RN had delegated that patient's basic care to the LPN for the day, and second of all, I do believe that she had legs and could very well walk over and get them one. So, instead of getting the urinal from the RN, the patient had to wait 30 min. until I was done with my bed bath. The best part, she asked me to get them the urinal so that she could take her break. I tell this story, partially to vent, but more-so as an example of what NOT to do. It actually seems to be the case that RN become too trusting of the other staff and expect them to do a lot of the work. But I also agree, its very hard for the RNs to cover so many patients at once. Always write things down even if you think you will remember it b/c with so many pts, they get all jumbled together. Another thing I think is hard is that as the RN, you can be very disconnected as to what medications the patients are on, which can create a problems during assessments, like not thinking about med. SE, and then connecting the dots. The docs are always calling to talk to the RN, but then during the convo, the RN is always putting the doc on hold to confirm info with the LPN. So again, write everything down. My advice is be nice to the aids/LPNs and they will be nice to you. Do a complete bed bath or check a patient's blood sugar and give them the insulin once in a while, it goes a long way.

My experience with team nursing is very old...like 30 or so years ago but it worked really well. An RN team leader, LPN med nurse and one or two CNAs depending on the pt load. The RN and aides did pt care while the LPN passed meds, then the LPN was expected to help with pt care. RN did rounds with dr and IVs (back then LPNs weren't allowed to touch an IV!) The big issue was weekends. If one LPN was off the other one had to do meds for both teams or the RN team leader had to do meds for one team. RNs didn't like this cause since they didn't do meds routinely they felt they didn't know the meds well enough. It was the best system I have ever seen for team nursing. I think it would work today but everyone has to be on board and understand what each team member's duties are for it to work. Change is soooo hard but it is easiest when we go into it with a positive mindset. Hopefully your facility will allow for constructive feedback. Give it at least 6 months before you decide it isn't working. Best of luck!

Quote from FribbletI've gotten the impression that it's a system that looks fantastic on paper but fails miserably in practice. Mostly due to members of the team being lazy or, worse, incompetent.

Quote from birdie22I agree that it fails mostly due to the members being lazy/incompetent, but just to clarify, the RNs are included as a member of that team, and sometimes are just as incompetent as the other team members.

I worked at the ICU as a tech partner, the RN's were very comfortable because they knew everything that was going on and they only had two patients. When I became an LVN, I worked at a SNF full time, and at an RCFE part time. Both jobs, I got in trouble because CNA's and caregivers did not do their job and I was their supervisor. Too many loose ends. Your leadership abilities will be tested. Too hard, you wont have a team, too soft, they get lazy. Good luck.

We are going the opposite way, in the last few years they have been phasing out LPNs at our facility and going to primary nursing. In Sept we going to a new staffing model of 1:5 for RNs and 1:12 for techs/aides (we currently don't have techs/aides on the floor, so this will be new). There are only a few of the nurses who will voluntarily still do team nursing, which we sometimes have to do. I will do it depending on who the LPN is. Most of them are great and I can trust that they will do what they say they are going to do and they very rarely have to be delegated to becuase they know their role/job well. I don't really have a preference for which - as long as I have a good LPN.Emily

I also do not prefer team nursing although I can't say I have any major disaster stories to relate. Like with anything, it all depends on the team. My biggest concern is continuity of care especially with regard to medication administration because I think it requires increased communication which we all know can be the open door for mistakes in a busy understaffed atmosphere. It seems to me that we work well as a team helping out at my job that does not use team nursing anyway. Unfortunately no one asked me, they have done it like this for years and so I just do what I need to do.

Quote from shanyone you definitely don't spend as much time with your patients on a team as you would on a primary.

Quote from neutrophilI worked at the ICU as a tech partner, the RN's were very comfortable because they knew everything that was going on and they only had two patients. When I became an LVN, I worked at a SNF full time, and at an RCFE part time. Both jobs, I got in trouble because CNA's and caregivers did not do their job and I was their supervisor. Too many loose ends. Your leadership abilities will be tested. Too hard, you wont have a team, too soft, they get lazy. Good luck.

I know nothing about it and feel your concerns. I would have the same.I like owning my patients!!