Primary Nursing is for the BIRDS

[mindlor]

So I am a relatively new RN.....maybe 15 shifts or so being on my own......I get in to work yesterday and see thy have made me "primary" for 4 very sick patients. All 4 strict contact iso, extensive IV therapy, diuretics, laxatives, to the second pain management...the whole nine yards......vents, trachs, dead weight unable to help with their care at all....

I found that during the shift I was basically a half-a__ed CNA and a half-a__d nurse.

Anyone else have experience being a "primary" nurse?

What are your thoughts?

Personally I told them that I won't do it again until I have more experience and that when I do I think 3 pts would be much more doable......

The good news is that I probably lost 5 pounds worth of sweat

[CrunchRN, ADN, RN]

You really made an important distinction there Hou TX.

[KSU-SN]

I really thought that primary nursing was what nursing as a whole was changing over to...I thought team nursing was basically a thing of the past. I work on a busy med/surg unit in a large hospital and 90% of the time we do primary nursing with 3-6 patients. I would say the average is 4-5 patients. We do not always have a CNA so sometimes we are the only staff member assigned to that group of patients. It can get busy at times but I definitely prefer it over team nursing where we have 10-14 patients with an LPN. It is entirely too hard to spend any time with any of the patients, you're constantly rushed. They want us to do hourly rounding on these patients and even if we have the minimum of 10 patients that only allows you 6 minutes an hour per patient. Thats just not do-able. Not to mention the piles of new orders you have for 10-14 patients....doesn't feel safe trying to keep track of them and make sure they all get done.

[BrandonLPN, LPN]

As someone said earlier, I think when Primary Nursing was first envisioned it was meant to be a system where a single RN took responsibility for the management of a pt throughout his hospitalization. Even when the nurse was off duty. Like a doctor. This never really took hold, I'm guessing it's logistically a nightmare, though it's a nice concept. When people talk about "primary nursing" these days, they almost invariably mean a RN taking a pt assignment with no LPN or aide working with them.

When I worked in the hospital as an aide some nurses would get 5 pts each and share an aide or LPN (LPNs functioned as aides there) between them. Other nurses would have 3 pts and no aide. This was referred to as a primary assignment.

[BrandonLPN, LPN]

KSU-SN said:

I really thought that primary nursing was what nursing as a whole was changing over to...I thought team nursing was basically a thing of the past. I work on a busy med/surg unit in a large hospital and 90% of the time we do primary nursingwith 3-6 patients. I would say the average is 4-5 patients. We do not always have a CNA so sometimes we are the only staff member assigned to that group of patients. It can get busy at times but I definitely prefer it over team nursing where we have 10-14 patients with an LPN. It is entirely too hard to spend any time with any of the patients, you're constantly rushed. They want us to do hourly rounding on thesepatients and even if we have the minimum of 10 patients that only allows you 6 minutes an hour per patient. Thats just not do-able. Not to mention the piles of new orders you have for 10-14 patients....doesn't feel safe trying to keep track of them and make sure they all get done.

It seems to me your hospital isn't using it's LPNs efficiently. If you have a LPN on your team you shouldn't have to do hourly rounds yourself. Also, at 10-14 pts you should have 2 LPNs on your team. I worked with a RN who came from a hospital down south that uses exclusively team nursing. She said the staffing model was 1 RN, 2 LPNs and 1 CNA per 12 pts on a med surg floor. That sounds ideal to me.

[RN In FL]

KSU-SN said:

I really thought that primary nursing was what nursing as a whole was changing over to...I thought team nursing was basically a thing of the past. I work on a busy med/surg unit in a large hospital and 90% of the time we do primary nursing with 3-6 patients. I would say the average is 4-5 patients. We do not always have a CNA so sometimes we are the only staff member assigned to that group of patients. It can get busy at times but I definitely prefer it over team nursing where we have 10-14 patients with an LPN. It is entirely too hard to spend any time with any of the patients, you're constantly rushed. They want us to do hourly rounding on these patients and even if we have the minimum of 10 patients that only allows you 6 minutes an hour per patient. Thats just not do-able. Not to mention the piles of new orders you have for 10-14 patients....doesn't feel safe trying to keep track of them and make sure they all get done.

The way your unit does primary nursing is the way it should be. I love it!

[anotherone, BSN, RN]

The team is only as strong as the weakest link. But I hate playing team sports on my own., but expected to do as well as the team from Utopia General . LOL