RN total patient care... - page 3

by julz68

13,479 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. 7
    Since RNs (deservedly so) make substantially more than CNAs and LPNs, any possible "all RN" staffing model will result in less nursing staff on the floor no matter how you look at it. That's just an economic reality.

    Yes, maybe an ICU level acuity floor can get away with this due to the fact that their acuity level already demands a 1:2 RN ratio. So the ICU is irrelevant to the subject at hand. We're talking about med/surg floors here.

    Less hands on the floor is never a good thing. A 30 bed unit would need at least ten RNs per shift for this to be safely doable. Maybe an ultra posh, metropolitan hospital that caters to rich and powerful clientele could afford such staffing. But most hospitals in America? No, not doable.

    Now, take that 30 bed unit and add some LPNs/CNAs. For the same amount of money you could have 5 RNs, 5 LPNs and 3 CNAs. More hands on the floor is safer. And, for the record, I'm not saying these LPNs should take their own pt assignment. They should work in a team with the RN. In this model, each RN would get 6 pts. This is VERY doable when each of these RNs has their own LPN working next to them. The LPN could pass most meds, do the treatments and scads of tasky stuff. Think how much time that would free up for the RN. And, on top of all that, there'd STILL be 3 CNAs running around the floor to boot.
    silverbat, HouTx, linzjane88, and 4 others like this.
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    It is so not doable! I worked on a busy Onc floor. RN assignment was 5 patients. Went in one day and without any warning, they announced that they did away with the CNA's and we were to do total care. It was a nightmare! I couldn't get most of my nursing tasks done because I was so busy toileting, etc. Had a patient code while I had another one on the toilet and couldn't get to her, so she tried to get up on her own and fell. I could go on and on about that shift. It was so unsafe! I quit after my shift and so did two other nurses.
    NBMom1225 and weemsp like this.
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    Last night wasn't doable! Got slammed with admits, was a full moon, and I didn't sit down once! No break whatsoever! Sorry...had to vent. "/
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    Quote from weemsp
    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.
    I also want to add that even if all nurses aren't busy with patients, we are required to do charting. If I don't carve 10 minutes here, 5 minutes there, out of my day to go brain dead at the computer doing the required charting, I will NEVER get it done. Where I work, the phones we carry are constantly ringing...so much so that my patients have commented on it repeatedly.

    The unit secretaries (especially one of them) are usually wonderful about answering from the desk, discerning needs, and fulfilling needs if a nurse isn't required to carry out the task. One unit secretary, however, is awful, and she "protects" the CNAs. A patient needs water? The nurse is called. A patient needs toileting? The nurse is called. She always starts out with, "All the CNAs are busy." RNs work 12s, CNAs work 8s. This particular unit secretary has actually called to tell us of these minor needs not requiring an RN DURING SHIFT CHANGE and stating "All the CNAs are busy."

    Phlebotomy also has issues. They come to the floor, a pt is out for a quick diagnostic, and they will call to ask us to call them when the patient comes back. I have said no every single time, but I give them an ETA based on the diagnostic and the time of departure. Your workload, you manage it.

    Sorry, this turned into a rant!
    anotherone likes this.
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    In my hospital, the house sup will put a cap on the unit at 10 patients (5 each nurse) if we have to be the primary nurse, no new admits. Normally the noc shift assignment can be as high as 7 patients each. It is very hectic, and running all noc to help your co-worker. Our PCA's do a lot, so to not have a PCA really puts us in a bind.
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    I have 6 patients most of the time and 1 CNA for 28 beds. No LPNS, so it is basically full care. It is difficult when you have patients who are turners or bedfast and incontinent. I might have an admission to do and then have a patient who is wet in bed, and another who is crying with pain and desperately needs medication... those are fun times!!!! haha, but if you work well with your team and do one thing at a time with a great attitude...it can be done! : )
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    My hospital is getting rid of LPNs, but there are no plans to get rid of CNAs. They are moving in the direction of having CNAs only on the private halls. Nurses on the semi-private halls will be doing total care with a proposed 4:1 ratio. I have a feeling that ratio won't stick...
  8. 1
    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.
    I'm in Ontario. I've been in 3 different hospitals and never seen CNAs. We do have LPNs but they take their own assignments. So RNs and LPNs are both doing total cares.
    Fiona59 likes this.
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    Yep, same here. Also in Ontario, and each nurse here (whether RN or RPN) has their own load of pts, no help. If you're one of the 4-5 (days) or 6-8 (evenings/nights) pts assigned to me on my shift, I do it all. Vitals, glucs, physical assessments, meds, baths, toileting, attends changes, linen changes, feeding, communicating with docs or others, arranging for services, discharge planning/discharges, admissions, managing crises, etc, etc, it's all on one person. It's a lot, but we get it done. In fact, I kinda wonder if I might actually like this job if I worked somewhere that I didn't always feel pulled in 100 different directions.
    Fiona59 likes this.
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    I don't like that idea especially on med surg with 5+ patients per nurse.


    I prefer having a nursing assistant to fall back on if I put someone on the bedpan and they ring to get off, if someone is a 2 person assist etc.

    I have worked without an assistant before when they fired 2 at the same time and it was horrendous. Bed alarms going on, constant running. We had to take our own patients to xray, ct, etc. We barely had time to chart. We didn't bathe anyone. There was no time.


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