What does "primary care" mean?

[Rn4life27]

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!!

[avaloncar, BSN, RN]

Primary care can be great in areas such as nursery and pediatrics. I worked in those departments and depending on your case load you may not need a CNA, maybe to do BP's or blood sugars. But I still liked to do it for myself because sometimes CNA's ignore alarming levels or numbers, they may not say anything and then I am caught trying to fix the situation. (I was a CNA before for 10 years so I am not undermining aides) I still think even in the ICU nurses should have CNA's, maybe for assistance with bed baths and such, just my opinion. Although I would love to be able to spend an hour in a patients room, feeding, bathing and the like, but when you have 7-8 patients its really difficult to do primary care and to do it without being drenched in sweat for the whole shift. But that is why we have literature on delegation and we just have to swallow our "analities" and do our best. But good luck.

[MunoRN, RN]

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.

This all sounds well and good, but your logic is fatally flawed. In the few years I worked only ICU, floor patients became much more acute, treatments became more complex and time consuming, and the demands grew. It's not as though these things weren't increasing at the same rate they always had been, I just hadn't noticed as much until I had was completely off the floor for a while.

So the problem with you logic, is that while the RN can absolutely have a better picture of the patient when they do their own bed baths, feedings, toileting, etc, the reality is that these things just fall off the list. What really happens is that instead of the primary RN getting a great opportunity for a more thorough assessment by doing their own bath, the patient gets no bath at all, there's simply no time given the total time demands of the workload and the time available.

In a fantasy world where time is not a fixed measurement this sounds great, in a world where time is fixed and you go from a total of 6 hours of patient care per day with a saturated workload to 4 hours a day/patient, the reality is that not as much patient care will happen.

[Pepper The Cat, BSN, RN]

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.

Thank you Drowning, that does help.

The more time I spend on this forum, the more I realize that American nursing and Canadian Nursing are very, very different.

I think we Canadians have a lot more time to focus on our patients because we don't have to worry about the positive feedback that you Americans have to worry about. It is just so hard for me to wrap my brain around the fact that most American nurses do not provide the total pt care that I provide.

I wish you guys could follow me around for a day! And I wish I could follow you around for a day. It would be very elightening!

[MunoRN, RN]

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.

I realized I got a little wordy in my last attempt to reply to this, try #2:

Cutting support staff without adding enough RN hours to produce the same number of patient care hours doesn't produce a situation where the RN's will now get experience the undeniable advantages of doing their own baths and other tasks, it means baths and tasks now just won't get done.

[DoeRN]

Primary care means be prepared to run your butt off and have your patient satisfaction scores drop.

The hospital I used to work at tried this on one of the floors. They hired 43 new grads who only had 4-5 patients. The floor held around 50 or so patients And guess what? I worked there about 8 months later and out of the 43 only 6 remained.

Oh I forgot to add those 4-5 patients quickly turned into 6-7 patients because this floor was constantly short staffed. So imagine being a new grad with up to 7 patients and doing all their care?

Sent from my iPhone using allnurses.com

[julz68]

Primary care means be prepared to run your butt off and have your patient satisfaction scores drop.

The hospital I used to work at tried this on one of the floors. They hired 43 new grads who only had 4-5 patients. The floor held around 50 or so patients And guess what? I worked there about 8 months later and out of the 43 only 6 remained.

Oh I forgot to add those 4-5 patients quickly turned into 6-7 patients because this floor was constantly short staffed. So imagine being a new grad with up to 7 patients and doing all their care?

Sent from my iPhone using allnurses.com

Yes! And not only do pt satisfaction scores drop, but incidences of falls and injuries rise. Why? Because there is no one to help answer lights when the RN is doing the primary care and pts will try to crawl out of bed on their own to get to the bathroom. And that's even with the use of bed alarms!

[carolinapooh, BSN, RN]

I just left med surg floor we did primary care. 4 PTs the RN had no pca. This met I did it all, lab draws, sugars, vitals, admits, brief changing, q2 turns I was in nights, meds, assessments, weights. This was not for me....it's a lot when you have total care, it's very time consuming.

God bless you. Seriously. Ten minutes in that environment and I'd stop wasting meds and start diverting.

[Esme12, ASN, BSN, RN]

So that's coming back now.......everything in nursing is cyclical. From someone who did primary care.....they called it "Modular nursing" or "Pod" nursing....as long as they kept to 4 patients per nurse, sometimes 5, it is doable. You will work your behind off...but it is doable. I worked on a Step down high acuity ICU/telemetry that took vents.

They eventually got rid of it....tons of OT for no paperwork can get done until later...however 12 hour shifts woulkd help on that for we only worked 8 hours then.....patient satisfaction fell...it was soon forgotten.

So what is primary care? You will run your behind off and not have a CNA. I enjoyed it actually. I liked giving my patients care.....but on four patients it was tough if you didn't have any partials....I would be finishing baths at 2 in the afternoon.......so I transferred to ICU.

[carolinapooh, BSN, RN]

Primary care = "we're broke and need to cut costs"

Nursing math: 32 bed unit + 8 RNs - 3 CNAs + (-1 callout) = 7 PO'd RNs/32 equally annoyed pts (+ or - a mean of 2 resignations within 30 days)*.

*One of which would be me

[cdsga]

Primary care is a joke. Why do people keep bringing up the same tired processes that don't work? Team nursing is the only one that had any viability-you can't be everywhere, and people do need urgent things at the same time. Good luck, I'd be looking for some other dept to work at

[CrazierThanYou]

I can't even imagine doing primary care. At my hospital, they are clearly making a shift toward higher patient loads. When I first started back in September, we had 3-4 patients. Now? 5-6 and I'm told that once they achieve magnet status, we'll move to 7-8. I'll be moving to another job.

I don't know about you guys but we have some pretty high acuity patients at my hospital. I get patients on the floor that my friend in ICU would have at another hospital (we've compared notes). I'm on night shift and there have been many nights where I was going non-stop to hang and take down multiple IV antibiotics, insulin drips, heparin drips, frequent PO meds, blood draws, transfusions, wound care, dressing changes, you name it. There LITERALLY would have been NO time on those nights for me to take people to the bathroom, change people, check CBGs, and all the other things CNAs do.

[applewhitern, BSN, RN]

I have done primary care and it is a LOT of work. If you are tied up, in one room with a doctor doing a procedure at bedside, who is going to take your other patients to the bathroom, etc? You have nobody to delegate tasks to. Of course it is easier in an ICU when you have maybe 2 patients each. (I have worked ICU's where we had 4 patients each.) On the floor, our nurses take up to 8 patients each. If you are starting an IV, assisting with a thoracentesis/paracentesis/spinal tap, chest tube, etc, you can't be free to go help another patient go to the bathroom. Or invariably, a doctor or family member or somebody will want to talk to you on the phone, while you are wiping hiney or starting a blood transfusion. I agree it doesn't take an RN to do everything. Someone else needs to free the RN up to do the RN job that other's can't do.