RN total patient care...

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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 hate the fact that when I'm busy in a patient's room and I have other call lights going off, there is no one to answer them. The unit clerk will sometimes answer lights but they can't do patient care and usually page me to tell me someone needs to go to the bathroom. It's just very frustrating.

Specializes in Medical Oncology, Alzheimer/dementia.

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.

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! : )

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...

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.

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.

Specializes in LTC, med/surg, hospice.

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.

Specializes in Critical Care, Education.

Very interesting discussion. In response to the "Canadian model" of having LPNs & RNs both doing total patient care... Most American nurse practice acts would not support this because there are clinical responsibilities that are RN-only. So the poor RN would end up having to perform these activities for the LPN's patients as well as his own. Not a good situation at all. It would be preferable for them to combine the load and divide responsibilities accordingly.

The current trend in American nursing is to explore staffing models that support differentiated practice. Utilizing RNs to perform RN-only and higher level activities as well as assume responsibility for overall patient care management & supervising unlicensed or LPNs to perform tasks within their scopes of practice. This is a much wiser use of increasingly scarce labor dollars - more staff at the bedside for far less $ than an all-RN staff. All-RN staff will be limited to those areas in which patients are unstable &/or have unpredictable courses of treatment. It just does not make economic sense to pay RN wages for tasks that can be accomplished just as well by lower paid staff.

LPNs in Canada (RPNs) have a VERY wide scope of practice here. In fact, I could probably count on one hand the things an RPN wouldn't be allowed to do on a med-surg unit. They are becoming more popular, and are much cheaper, thus utilizing the scarce dollars.

Specializes in Acute Care, Rehab, Palliative.

Up here RNs don't supervise PNs or assume responsibility for overall patient care. PNs are responsible for their own practice.

It should be pointed out, however, that the PN program in Canada is a two year associate's degree. Thus the Canadian LPN is equivalent to the American ADN. That explains their wide scope of practice, relative to most American LPNs.

Perhaps we (in the US) should somehow combine the LPN and ADN into some sort of two-year degreed "technical nurse".

Of course, this would be a huge slap in the face to currently practicing ADN RNs. I'm not sure how you could merge the two roles without causing a lot of hard feelings.

I can tell you I'm not being slapped with a "technical" nurse label when I passed the same boards and already have a four year degree (albeit not in nursing) and only missing a few fluff courses in community health and "leadership"

Specializes in Hospital Education Coordinator.

in our facility the floors have CNA's, but not 24 hours. If census and acuity demands, the CNA may be subbed for another RN. We do not hire LVN's. Pedi and ICU and PACU have never had CNA's (in our facility)

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