RN total patient care... - page 2

by julz68 14,078 Views | 47 Comments

I'm just curious how many of you work in hospitals that has gotten rid of all LPNs and CNAs. My hospital is moving in this direction and a few floors have went to RN total patient care. I don't mind doing everything myself, but I... Read More


  1. 5
    You know what it is like when you go into a patient's room to do one thing, and end up taking them to potty, cleaning their bed, getting them some ice, etc.? Well, that is what primary nursing care is, or total patient care, whatever you want to call it. You can't just go in and get vitals, because they always want something and you can't leave. It is much, much better having someone to delegate to, and leave the RN free to do RN stuff, like answer calls from doctors, call doctors, respond to emergencies, etc. Rather difficult to do that when you have your patient half-way to the toilet, or have them naked, getting a bath.
    NBMom1225, goalienrse, TheCommuter, and 2 others like this.
  2. 2
    We have something like that, but there are 2 CNAs on the floor for 30 patients. They take vitals a d do I & Os, occasionally change or bed or two. They Help as needed but have no direct responsibility for any of the patients. Most of the time they only do vitals. It is not a good system.

    Sent from my iPhone using allnurses.com
    Despareux and WunMsJayLPNtoRN like this.
  3. 6
    Easily two-thirds or more of the patients on the floor I work the most are total care. For hospital floors to even think about RN total care, the ratios MUST go down and the redundant or just plain stupid charting must be eliminated. It's that simple.
  4. 5
    Quote from OCRN3
    We have something like that, but there are 2 CNAs on the floor for 30 patients. They take vitals a d do I & Os, occasionally change or bed or two. They Help as needed but have no direct responsibility for any of the patients. Most of the time they only do vitals. It is not a good system.

    Sent from my iPhone using allnurses.com
    I'd happily do my own vitals and I&Os. I just wish we had CNAs to answer lights when we are busy with other patients. I felt so bad the other night when I was tied up in an isolation room and I could here one of my other pts call lights ringing forever. I finally was able to get to it and it was a lol who peed her bed because I wasn't able to get to her in time. She felt ashamed and I felt HORRIBLE! Like I said in my original post, I don't mind doing primary care, but I just hate in when my other patients get neglected while I'm busy with someone else.
  5. 4
    This is something I just don't understand about American nursing, don't you help each other out?

    If the call bells are ringing in other rooms and I'm free, I answer them as does everybody on my unit. The unit clerk isn't allowed to answer them and heaven help you if the Unit Manager finds out you're ignoring the bells.

    On surgical units it's 3 RNs, 3 LPNs, 2 NAs, and a Charge RN. Every nurse is responsible for their patient's care. The NA is there for two person care and if you are really lucky they'll shower your patients. Depending on the NA, they might empy your colostomies and foley's..

    It's five patients, their care, their meds, their dressings for each nurse.
  6. 1
    We don't have LPNs but we do have CNAs and I would be lost without them. I couldn't imagine doing everything I do now PLUS bathing, toileting, VS, feeding.. and so on. I could do it with 3 patients but not with the current 5 I have with admits and discharges.
    sistasoul likes this.
  7. 6
    Fiona59, maybe American patients are just demanding. Half of the time all of the nurses and all of the CNAs on my floor are tied up in patient rooms. When there is no one at the nurses' station at all, there is no one to answer call lights, answer phone calls, call the MDs, etc. There is a reason I'm not working on my floor when I get my first RN job. We help each other when we can, but there is usually too much to do with too few staff. No one has free time to help anyone else. There have been lots of days as a CNA where I don't get a lunch at all on a 12 hour shift and I have held my bladder the entire 12 hours because there was just too much to do to "waste" time urinating. It sucks.

    I would only be a fan of total care in an ICU setting, which is where I am doing my preceptorship. For one, most of the patients are unconscious so you can't get stuck in a room because the patient keeps asking for things, and secondly there are only a couple of patients per nurse. Any floor where the patients aren't sedated should not have total care, IMO.
    Despareux, anotherone, goalienrse, and 3 others like this.
  8. 1
    Quote from brithoover
    Total care is the norm in Canada.

    I'm wondering where in Canada this is the norm??? I've worked in hospital settings for more than 21 years...in ALL that time I've NEVER seen any unit without LPNs and CNAs.
    kthln1234 likes this.
  9. 1
    Quote from Fiona59
    This is something I just don't understand about American nursing, don't you help each other out?

    If the call bells are ringing in other rooms and I'm free, I answer them as does everybody on my unit. The unit clerk isn't allowed to answer them and heaven help you if the Unit Manager finds out you're ignoring the bells.

    On surgical units it's 3 RNs, 3 LPNs, 2 NAs, and a Charge RN. Every nurse is responsible for their patient's care. The NA is there for two person care and if you are really lucky they'll shower your patients. Depending on the NA, they might empy your colostomies and foley's..

    It's five patients, their care, their meds, their dressings for each nurse.

    Fiona...
    Honestly, it's not a matter of the other nurses not " helping each other out".
    I think the point is..if 1 nurse is busy with an iso pt, total care...they can't just leave that pt to go answer a bell...( we agree on this point) But the real issue is...if 1 nurse is busy then it stands to reason that ALL nurses will have this problem. It's not a crazy notion to assume that ALL nurses can be occupied with one of their pts at the same time....THIS is what leads to call bells not being answered.
    And I've worked on many units where I've had more than 5 pts in one assignment.
    I would be careful with making the statement ".....American nursing"....
    We face the same challenges in Canada!!!!
    anotherone likes this.
  10. 2
    Quote from weemsp
    I'm wondering where in Canada this is the norm??? I've worked in hospital settings for more than 21 years...in ALL that time I've NEVER seen any unit without LPNs and CNAs.
    But even if you have PNs on the floor, they have their own assignment. They aren't there to be handmaidens to the RNs.
    Many hospitals in Canada don't have aides and the RNs and PNs do their own cares.
    Annabell0719 and Fiona59 like this.


Top