What does "primary care" mean?

Nurses General Nursing

Published

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 guess one good thing resulted in my hospital going to RN total patient care: it forced me to go back to school and get my RN license!

Up Vote Up Vote ×

Magnet status: repel as many nurses as possible from ALL poles.

**OMG. Cynical much, Carolina? :)

Up Vote Up Vote ×
Specializes in ICU.

I hate it when people say you have to do primary care to do assessments and such. Hello, you do not have to bathe a person to see their skin, just pull back the gown and ask them to roll both ways so you can see everything. That takes 30 seconds; a bath probably takes at least 10 minutes and maybe more depending on the acuity of the patient and whether supplies are already in the room. Besides, if there are no CNAs, who is helping you slide people up in bed? Aren't the other nurses too busy? Your mileage may vary, but I'm not getting paid enough to risk major disability and lots of time off work because I need to have back surgery. I've had patients where it took 3 people just to roll the patient on his or her side... how do you manage to get that many nurses in a room at the same time when there are no CNAs to watch the other patients? It's much easier to pull two floor CNAs to help a nurse than it is to take other nurses away from their patients.

Up Vote Up Vote ×

My facility has just started this for occasional assignments in times of lower census. The assignment is 4 patients, days. I do not care for it at all. I find it impossible to meet everyone's needs! I had bed alarms going off, people were waiting to use the bathroom, patients calling for pain meds, telemetry alarms ringing all at once! I felt extremely unsafe. On top of this, if one went home, I had to do an admission, which took me away from the other patients for a good hour. I even had to wheel one patient out to her car at discharge, which took me totally off the floor for a good ten minutes. Part of my assignment was a bariatric patient. I had to ask for help from the other busy nurses to change her Depends, strained my back just trying to reposition her. I don't want to live through another day like that!

Up Vote Up Vote ×
Specializes in TELE, CVU, ICU.

all of these comments and the articles praising primary care do not mention how many patients these "all RN" staff members have. the studies show that no nurse should ever have more than 4 patients, and that means with assistants. sounds like some overpaid CEO is trying to weasel out of mandatory safe staffing ratios by firing all LVNs and CNAs, and hoping nurses are too stupid to notice his salary is paid with their backs.

Up Vote Up Vote ×
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.

Obviously true. I was responding to someone who gave the impression that these total care "tasks" were beneath the RN; since a CNA can do them, they must be pretty minor in the scheme of things. I tried to point out the advantage to the RN doing them from a professional point of view. Kudos is* due to the Canadian nurse who understood what I mean about the higher level of care and satisfaction in primary care, and another kudos to you for pointing out what I took for granted in the discussion: if RNs do total care, there have to be enough of them to do it.

*"Kudos," although ending with an "s," is a singular noun. :)

Up Vote Up Vote ×

I work in an ICU, 1-2 patients,and we essentially do total care. We do have nurse assistants, though, thank the heavens!!! In our unit the culture isn't so much to delegate as it is asking for help. Instead of saying "room 2 needs a bath," it's "I was going to start washing up room 2, I'll do the front, can you stop by in 20 minutes and help me turn and change the sheets?" Giving a bed bath really is the best way to get a great assessment! On the other hand, I just don't think it's good for patient satisfaction or even safe for nurses to be solely responsible for all of the nursing and aide duties. I will gladly assume all the ADL/patient care tasks that I can, but when I'm in an emergency with one of my patients and the other and their family is jamming on the call bell, there's nothing better than having a good aide go in and give a little TLC so that we can all keep the peace. It's a team effort.

Up Vote Up Vote ×

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

It was too much! And I heard they were going to make the night shift give full bed baths ***! Come on! So I lasted there a whole 2.5 months feel like a failure but that type of environment is way to demanding.

Up Vote Up Vote ×
Specializes in ICU.

It isn't that nursing assistant duties are "beneath" the RN; it is that there are many things that only the RN can do. If I am giving baths, cleaning up patients, etc., who is doing the RN's job? I can't be in the middle of a bath and have a new admission come in that needs me, or stop in the middle of hanging blood to take someone to the bathroom. I have worked it both ways, and it just isn't realistic. And yes, someone invariably calls out and then you are short-staffed even more.

Up Vote Up Vote ×
all of these comments and the articles praising primary care do not mention how many patients these "all RN" staff members have. the studies show that no nurse should ever have more than 4 patients, and that means with assistants. sounds like some overpaid CEO is trying to weasel out of mandatory safe staffing ratios by firing all LVNs and CNAs, and hoping nurses are too stupid to notice his salary is paid with their backs.

Just to be clear primary nursing and total, all nurse, all RN, primary care are two different models.

With the former the RN in charge of patient care can delegate various tasks and or functions to LPNs and or UAPs. Total care OTHO means just that with a RN doing *everything* up to and including planning, managing, implementing, and evaluating care.

Total care *can* work on certain floors/units but not others as there many factors to consider including patient acuity and overall nurse/pt ratio.

Up Vote Up Vote ×
It isn't that nursing assistant duties are "beneath" the RN; it is that there are many things that only the RN can do. If I am giving baths, cleaning up patients, etc., who is doing the RN's job? I can't be in the middle of a bath and have a new admission come in that needs me, or stop in the middle of hanging blood to take someone to the bathroom. I have worked it both ways, and it just isn't realistic. And yes, someone invariably calls out and then you are short-staffed even more.

For most of modern nursing practice history there has been a shortage of nurses. Most of the time these shortages were papered over with students performing quite allot of work the floors as part of their "training". Gradually as that model was phased out there came the increased use of nursing assistants/aides, techs, UAPs, etc... These situations all address one crucial question; what is the best use of a professional nurse's time and skills?

During the old days of team nursing it was not uncommon to have all hands on deck for AM/PM care and meal times. Yes you had nurses doing bed baths, making beds and so forth, but you also had one or two RNs doing meds, another one or two doing treatments and or procedures all with or without the help of assistants.

In theory total patient care by a RN sounds wonderful, but again much is going to depend upon how many patients that nurse is given for her or his shift and their conditions.

You will get much more accomplished with less problems for both the patients and nurses if you give the latter *good* support staff. Just as the executive is more efficient with good secretary/assistant the same applies to nurses.

Up Vote Up Vote ×
+ Add a Comment