Thursday, December 4, 2008

Team Nursing - who came up with this crappy idea?

Anyone ever had to do team nursing before? Does it ever work? At the other hospital I work at PRN, they decided to try this concept (yet again) starting last August or so. I think it's the main reason why I don't work there very often. This is the scenario:

One RN, another RN or an LPN and one care for up to 12 patients. The RN does all of the assessments and all of the charting. The other RN or LPN does the meds, dressing changes, etc. And the PCT does the patient care. Now it sounds ideal on paper, but in reality, it's a lot of responsibility for the RN. So on the night shift, we tend to cheat a little bit...instead of one nurse assessing 12 patients, we split the patient load and make it 6 patients for one nurse, 6 patients for the other nurse. You know....what normal nursing take care of your patients, I'll take care of mine. If you need any help, let me know. Well, seems administration has caught on to this & wants it stopped. They want us to follow the exact model they have laid out.

I just don't think my brain has the ability &/or the capacity to take care of 12 patients. 5 seems to be my limit, but I can adjust to 6 if I absolutely have to...but that's pushing it. I am willing to bet that I wouldn't even be able to remember 12 patients names & room numbers - much less why they are here, what the treatment plan is, how they are doing, assessments, meeting their needs, etc. At first I thought maybe I was getting old & alzheimers (or mad cow if you're a Boston Legal fan) was kicking in...but there have been about 10 staff RN's at that hospital that have quit due to the stress of being forced to take care of up to 12 patients at a time. Something like 5 of them are now hired at my usual hospital - because we do normal nursing with a max patient load of 5 per nurse.

I think if we were well-staffed, it could maybeeeeeeee work...but how often is a hospital well-staffed? For instance, the other night we had one patient care tech for almost 30 patients. That is insane. This isn't a nursing home we are running - it's an acute care hospital. So all the tech was capable of doing was vital signs. The rest of the patient care fell on us...the nurses. It's impossible to do what they require us to do. And it's unfortunate because administration is determined to make it work. Hence, I will not be working there all that often unless things improve. Not only is my nursing license at risk, but patient care is also risky. I wish that the administrators would come to the floor & work as a nurse even if for only one shift. Yes...I know, I'm dreaming. That would never happen.

I also wish that instead of administration looking for ways to cut costs, that they'd instead focus on finding ways to increase revenue. I know...yet another dream of mine.

I can see why so many nurses leave bedside nursing these days. So much responsibility and stress falls on us....we can't please administration, we can't please the doctors, we can't please the patients....we can't even do the true job of nursing the way it should be done.

I had to call a doctor last night at 2:30 in the morning because my patient's heart rate was sustaining 140's-150's. This is not a pleasant doctor, but I had to make the call. I wake him up & he's trying to figure out who the patient is that I'm calling about. He says to me "Isn't she a DNR?" Even if she was.....we still treat the elevated heart rate. DNR does not mean do not treat. Anyways, I assure him that no...there is no order in her chart saying she is a DNR. He says "Well, make her one." What? No. I'm not taking that order considering the circumstances...I just woke him up, he isn't even sure which patient this is or what her code status no, I'm not taking that order over the phone. He can write it when he comes in.............really though, out of all the forms we make patients sign while they are in the hospital - I don't understand why we don't have a mandatory code status type form - so there is no doubt whatsoever. Nope, all a doctor has to do is write DNR and it's an order. We don't truly know if the patient or their family has consented to it - we're just supposed to take the doctor's word for it. Kind of ridiculous, if you ask me.

So, after refusing - politely of course - to take that order....he starts to order a medication to treat her heart rate. He has this accent that makes it nearly impossible for me to understand what he's saying & add into it that he's still half asleep. So I keep trying to repeat what I think he might be saying...which annoys him even more. I mean how awful of me to want to confirm the order to make sure it's correct. What's wrong with me? So half way thru that order he says forget it & starts ordering another medication. He was making me mad because he was ordering Cardizem...which is fine....but by mouth. How long will that take to kick in & lower her heart rate? A few hours? I looked it up on the drug handbook & sure said it takes 2 to 3 hours to start working. Ugh....I don't like seeing my patients heart rate tacking away at 150 for 3 hours waiting for the medicine to take effect. I don't know if the doctor was just an idiot & didn't know to order something IV or he was just going along in his mind that she was a DNR & there was no real rush to do anything to help her. So aggravating. By the time I left, her heart rate was still in the 120's.

I'm working 3 more shifts this week - need to make a little extra money for Christmas. I'm at my usual hospital - so even if things are awful - it's still ok. We don't have team nursing there, but we work together a zillion times better than this other hospital. Someone is always willing to help...most times without you even having to ask. I think it's because as staff...we get along well & it makes us want to help each other - as opposed to being forced into it.

I have a travel nurse recruiter offering me a job in West Palm Beach. There are some days I feel like I should take it....


Fairy said...

Thanks for the great post, I started my career in nursing after finishing a associate degree in nursing from associate degree nursing schools

Julie said...

After being a nurse for 29 years I have seen this concept come and go. I have been the LPN and the RN. People sitting in offices who could never do our jobs telling us how to do it and with how much help. It is always a disaster. Teamed with a lazy LPN or RN you get stuck trying to do good care for 14 to 16 patients. One bad clog you know. The less actual RN staff the higher the errors. It has been proven over and over. But budget rules the hospitals. And the nurse pays for it.

Now to the doc deciding the DNR. Boy is that a recipe for a law suit. It should always be up to the patient first, DPA next and then the doc and nurses following their wishes. We haven't started practicing euthenazia yet but I bet its coming. And I hope I am retired when it does.

Good luck to you.

Amanda said...

So, this is my question- If another nurse is doing the dressing changes/wound care, how is the other nurse doing a proper assessment? Doesn't that require you to remove the dressing and packing to see the wound? And who gives report? AND...whose license is in jeopardy if the patient crashes? Cause I love some of my co-workers, but I don't trust them with my license!