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!!

[Sunflowerinsc, ADN, RN]

You have it right,pure hell. One RN assigned to 4 or 5 or who knows how many ,you do it all, assessment, meds, vitals, baths, I&O,and then everything else. In my nursing life primary care has come and gone more than once over the years.

[ComeTogether, LPN]

I would love this. As it stands now I dread becoming a nurse because of the lack of patie t care. Would it really be so bad if you had less patients. I would think it would make it so the patie ts got better care. If you are doing everything for them you know everything thats going on with them also.

[carolinapooh, BSN, RN]

Not trying to be a jerk, but my guess is you have no idea about how time consuming doing everything is. Five patients, total care? Oh my God. The first time you're on a busy floor in nursing school you'll see very quickly why this is pretty much impossible and what drives a lot of very wonderful RNs from the bedside.

[nursel56]

Glycerin when they started this you got fewer patients so the benefits were as you describe. Sounds like the Greed Factor has run it into the ground.

[VANurse2010]

Feeding and changing patients does not require the skills/education of an RN. All primary care does is stress out and **** off good RNs and distract from the tasks that cannot be delegated.

I would love this. As it stands now I dread becoming a nurse because of the lack of patie t care. Would it really be so bad if you had less patients. I would think it would make it so the patie ts got better care. If you are doing everything for them you know everything thats going on with them also.

[lynds80]

Not trying to be a jerk but my guess is you have no idea about how time consuming doing everything is. Five patients, total care? Oh my God. The first time you're on a busy floor in nursing school you'll see very quickly why this is pretty much impossible and what drives a lot of very wonderful RNs from the bedside.[/quote']

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.

[ComeTogether, LPN]

I don't know first hand what its like, no. In theory, it sounds good but I can understand how it would be overwhelming with 5 patients. We have two floors in my department, and one of them is usually assigned RN's with no CNAs. Most of the RNs request this assignment. They usually have 4 patients a piece sometimes 3. They do everything for them and have said they like it better because they don't have to hunt down the CNAs to do things for them. *shrugs* There aren't many CNAs where I work who give a crap and to me, Id rather do it myself but I am sure that could change once I am responsible for everything the RN is responsible for. :-)

[nurseprnRN, BSN, RN]

If you want to do primary care, get a good ICU job. I always said I didn't mind working hard but I hated running up and down corridors all day long. And I hated not knowing everything about my patients if I had 6-8 of them, and being rsponsible for a CNA's work or lack thereof. In the ICU I knew damn near everything about 1 or 2 people, got to spend quality time c their families, and got to stay pretty much put all shift. Terrific.

[ComeTogether, LPN]

Feeding and changing patients does not require the skills/education of an RN. All primary care does is stress out and **** off good RNs and distract from the tasks that cannot be delegated.

No, it doesn't require the skills of an RN, BUT, I enjoy doing those things for my patients and I enjoy the quality time I get with them. I like the conversations I get to have with them during said tasks and I would like to continue doing them even when I am qualified to do more than that. I know its probably not possible, especially with the patient load nurses have now. That's why, to me, primary care sounds like it could work. Of course I don't know first hand and I won't know until I get there myself, but in theory, i like the idea.

I certainly wouldn't like it if It meant I was jeopardizing the well being of my other patients, which it sounds like that's the case in the facilities that do this. Just saying, If the patient load were do-able I think I would like it.

I cant help but wonder if nurses in general would also like it if the patient load were do-able, or if they just don't like the idea of doing "CNA work".

[ComeTogether, LPN]

GrnTea,

Thats a really good point! :)

[nurseprnRN, BSN, RN]

Feeding and changing patients does not require the skills/education of an RN. All primary care does is stress out and **** off good RNs and distract from the tasks that cannot be delegated.

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.