What does "primary care" mean?

Nurses General Nursing

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My hospital is thinking of getting rid of CNA's and go to primary care. What does that mean exactly? If it means what I think it means, it means we are in for PURE HELL!!

I had a feeling the "not liking CNA work" comment was coming. I don't think anyone actually *enjoys* changing incontinent briefs, but it's part of the job and you'll do plenty of it even with PCTs. Scratch the "probably not possible" - it's definitely not possible if you have more than 4 patients and more than 1 or 2 of them is dependent. The only times I've seen primary care somewhat work was on nights with mostly continent, mostly ambulatory patients who did not require extensive treatments, such as dressing changes.

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Our hospital has moved in this direction also. I was a CNA for 16 yrs, 12 of that in my current hospital. I am now an RN (since Feb) and have been working on a busy medical floor doing primary care for 4-5 pts. As a whole, I don't mind doing everything because I absolutely love patient care. What does bother me is during busy times like assessments and med passes, I wish there was at least someone to help answer lights when I can't. It never fails, I will be in the middle of a bed change or an admission and I have a couple lights ringing forever that I can't get to for a while. Then when I do finally get to them, they are angry because of course "they are the only patient I have, so what in the world was I doing?"

It just gets frustrating sometimes. Some days are better than others.

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Specializes in Transitional Nursing.

Right. Hence the comment about having a patient load one could handle.

Ok, so its not possible, (to have a lot of patient interaction with a heavy patient load) doesn't mean I don't wish it were. As I said before --- with a decent patient load I can't understand why it wouldn't work. We've already covered the fact that it doesn't work with too many patients. I hope OP's facility lets her/him have a patient load that will be tolerable.

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Right. Hence the comment about having a patient load one could handle.

Ok, so its not possible, (to have a lot of patient interaction with a heavy patient load) doesn't mean I don't wish it were. As I said before --- with a decent patient load I can't understand why it wouldn't work. We've already covered the fact that it doesn't work with too many patients. I hope OP's facility lets her/him have a patient load that will be tolerable.

I agree. In my experience, I think 3-4 pts would be more ideal than 4-5, but for the most part it does work out on my unit. We all work as a team and help answer each other's lights when possible, but there are times when we ALL are busy and some lights don't get answered in a timely manner.

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See, if we were kept at 4 patients, fine. But from what I hear (I just started this job two weeks ago) and from what I have seen, they do not have the staff to keep nurses at just 4 patients. My preceptor was assigned 6 patients with no CNA. Even with me helping her, we still only had time to bath one patient! It was crazy! If I wasn't there helping her, I do not think anyone would have been bathed. I'm understanding now why this hospital had such a high turn over rate for nursing staff. I would rather have a CNA and be able to actually talk to my patients then have Zero CNA and have to rush through everything to get everything done. Rushing will cause lack of compassionate care and can cause errors, they are just asking for it in my opinion.. I really hope they change their minds!!

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See if we were kept at 4 patients, fine. But from what I hear (I just started this job two weeks ago) and from what I have seen, they do not have the staff to keep nurses at just 4 patients. My preceptor was assigned 6 patients with no CNA. Even with me helping her, we still only had time to bath one patient! It was crazy! If I wasn't there helping her, I do not think anyone would have been bathed. I'm understanding now why this hospital had such a high turn over rate for nursing staff. I would rather have a CNA and be able to actually talk to my patients then have Zero CNA and have to rush through everything to get everything done. Rushing will cause lack of compassionate care and can cause errors, they are just asking for it in my opinion.. I really hope they change their minds!![/quote']

I don't think it's right that your preceptor had 6 pts. How are you going to be able to learn your job effectively when you're just there helping her out? While I was orienting, we were assigned 4 pts tops in the first couple weeks. That way, I could do most of the work while she was there to to help me if needed. I sure hope it gets better for you.

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Specializes in Gerontology.

Let me preface this by saying I'm Canadian, and from I can see there are huge differences between the way health care is delivered in Canada as compared to the USA.

I really don't understand why American nurses hate Primary Care so much. How do you do your assessments with providing direct care?

While I help my pt wash, I am assessing their skin condition, their mobility, their ROM. How is the pt with a CVA functioning today? Is their affected side worse? better? Are there signs of pressure ulcers developing? How are they walking, transferring While toileting them I can assess their hydration - what does their urine look like? What are their bowel movements like? I talk to them while doing care and can assess their alertness, orientation, memory, etc. Respiratory - I can see how they are breathing and auscultate their lungs if necessary. Cardiovascular - any signs of edema? Basically, I can assess everything during a 15 minute bath.

I care for 5 pts on a day shift on a Rehab floor. I do everything for my pt. I can't imagine giving insulin based on a result someone else obtained, or an anti-hypertensive based on a BP taken by someone else. We have 1 PSW (similar to a CNA) for the entire floor, but she just provides basic care for 1 pt off of each nurses' assignment.

Despite all this, I still get all care done, all charting done and still get out on time.

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Specializes in Transitional Nursing.

Im going to catch heat for this, but I think a lot of the time management issues are because as a rule RNs don't perform the tasks that the CNAs do and aren't able to do them in a timely manner. I've seen nurses take 4x as long as I do while changing a brief because its not something they have to do very often and its more time consuming for them. I would think the same would be true for bed baths, toileting, etc. at first.

I know a lot of tricks and short cuts that let me get my job done faster since i have so many patients that need me. I would be willing to bet 5 patients would be manageable once time management was mastered and tasks could be done together.

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I think you're quite wrongly assuming that I don't do skin assessments because I don't do the majority of the baths - as though they can only be done during bath time. Wrongly assuming that I don't assist patients with feeding and thus can't do a dysphagia screen and wrongly assuming that home situation and discharge needs aren't discussed with patient because I don't do all the ADLs. Just because I do not wish to it all alone without help, doesn't make me short-sighted and unprofessional.

See, this is a very short-sighted, and in my opinion, unprofessional, view. Think of all the things a well-educated, perceptive nurse can learn while doing a bed bath. Your conversation can range to who else is in the home, who does the cooking, how many steps to get in the front door, and how will you get to follow-up appointments, for example. Say, did you know that recent research indicates that the answers to those very four simple questions are huge predictors of readmission?

And you can observe bruising or skin tears and ask about abuse. You can ask about medication and treatment plan adherence. You can find out about fears and false hopes. You can look at real range of motion, sensory deficits, joint impairments, cognition... if you care.

As to feeding, who better than the registered nurse to fully evaluate swallow and pocketing and vallecular pooling (by asking for a vocalization-- does the voice sound wet?)? And see whether calories are being consumed can give you hints about endurance, wound healing, and suchlike. Ask whether there's a full larder at home, a functioning kitchen or the ability to use one, or whether it's just common crackers and milk most days.

Or you can see these as mere tasks on a par with, oh, mopping the floor, and abrogate your responsibility under the ANA Scope and Standards of Nursing Practice. Your call.

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Let me preface this by saying I'm Canadian, and from I can see there are huge differences between the way health care is delivered in Canada as compared to the USA.

I really don't understand why American nurses hate Primary Care so much. How do you do your assessments with providing direct care?

I care for 5 pts on a day shift on a Rehab floor. I do everything for my pt. I can't imagine giving insulin based on a result someone else obtained, or an anti-hypertensive based on a BP taken by someone else. We have 1 PSW (similar to a CNA) for the entire floor, but she just provides basic care for 1 pt off of each nurses' assignment.

Despite all this, I still get all care done, all charting done and still get out on time.

Let me tell you why American nurses "hate" primary care in a nutshell. On my rehab floor I have 14 patients not 5. The acuity is higher than you would imagine. Plus, the US facilities get reimbursed based on medicaid/medicare guidelines. That means we have tons of redundant paperwork and protocols. Oh, and we have eight hours to get it done- overtime is deemed "poor time management."

Would I love total patient care in an ideal world - yes. It would be wonderful to actually get to know my patients. But, it is not feasible. When I do cares instead of delegating, my charting suffers and my eight hour shifts easily turn into 10 or 11 hour shifts.

I am jealous of your work environment! Enjoy the time you spend with your patients- that was the main reason I got into nursing and I miss it.

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Primary care only works when there is common sense used with staffing ratios. Otherwise it is just a cheaper way to provide patient care.

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I'll piggyback off this:

I'd like someone to explain to me how I am supposed to take 6 patients in the morning, do all am care, discharge 4 of them, pick up an existing patient at 3 PM, and take 3 fresh admissions - some of whom may be serious stroke cases - do all the paperwork, med recs, appointments, and teaching involved in all that - and answer all call lights, change briefs, ambulate, and toilet everyone during all that without help. If you (the general you) can do all that safely, good for you, but I doubt you can and I refuse to try.

Let me tell you why American nurses "hate" primary care in a nutshell. On my rehab floor I have 14 patients not 5. The acuity is higher than you would imagine. Plus, the US facilities get reimbursed based on medicaid/medicare guidelines. That means we have tons of redundant paperwork and protocols. Oh, and we have eight hours to get it done- overtime is deemed "poor time management."

Would I love total patient care in an ideal world - yes. It would be wonderful to actually get to know my patients. But, it is not feasible. When I do cares instead of delegating, my charting suffers and my eight hour shifts easily turn into 10 or 11 hour shifts.

I am jealous of your work environment! Enjoy the time you spend with your patients- that was the main reason I got into nursing and I miss it.

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