Switching from Team Nursing to Modified Primary Care

[jodi_cmsrn]

Our med-surg unit (22 bed) is considering switching from team nursing (1 RN and 1 LPN for 10 - 12 patients - sometimes one CNA for all) to some form of primary care system where hopefully each nurse will have 5 - 6 patients. Our biggest issue is how to utilize the LPN's the best way possibe. Just wondering if anyone else had experience with this, or how your unit does it? Thanks for the help.

[GooeyRN, ADN, BSN, CNA, LPN, RN]

The RN and LPN both will take 5-6 patients, and the RN does charge duties as well. AND they (RN's) do the push meds, and hang blood for all of the patients. It sucks for the RN. It's how things are done at my hospital. The CNA does all vitals and I+O's. The CNA gets as many call bells as possible, and is responsible for all turning and toileting/depends changes. The CNA and RN end up grossly over worked.

[jodi_cmsrn]

Thanks for the reply. We are trying to prevent the RN's being run ragged, and unfortunately are REALLY short on CNA's, so someone has to pick up that piece too. We are just looking for ideas at this point.

[barefootlady, ADN, RN]

The staffing is off. RN with charge, push meds, orders, blood and her own patients cannot take a load like you describe and do a fair job.

[GooeyRN, ADN, BSN, CNA, LPN, RN]

ITA! You said it!

[MedicalLPN, LPN]

That isn't fair for the RN's to be responsible for all those additional things. Where I work we do primary care, each RN or LPN takes 5-6 patients. The LPN's do their own assessments, meds, etc. There are certain IV Drugs can't push mainly cardiac drugs, the exception is if the patient is coding, the LPN is ACLS certified and there is an RN or MD in the room then we can push drugs according to the ACLS protocols. An RN also has to hang blood, but we can monitor and increase the rate.

For the most part things work well, if I have IV Lopressor that needs to be pushed then one of the RN's will push it for me and while she's doing that I'll do something for her. The only thing that's irritating is the fact that the acuity of our patients has dramatically increased the past several months.

[jmgrn65, RN]

MedicalLPN said:

That isn't fair for the RN's to be responsible for all those additional things. Where I work we do primary care, each RN or LPN takes 5-6 patients. The LPN's do their own assessments, meds, etc. There are certain IV Drugs can't push mainly cardiac drugs, the exception is if the patient is coding, the LPN is ACLS certified and there is an RN or MD in the room then we can push drugs according to the ACLS protocols. An RN also has to hang blood, but we can monitor and increase the rate.

For the most part things work well, if I have IV Lopressor that needs to be pushed then one of the RN's will push it for me and while she's doing that I'll do something for her. The only thing that's irritating is the fact that the acuity of our patients has dramatically increased the past several months.

This is how our facility does it as well.