1. do you delegate your basic care to cna's?
The system here is a little different that in the US. On my ward we have a patient care attendant on weekday mornings to help with hygeine. She's employed through an agency rather than directly through the hospital, although we consider her to be part of the team like everyone else. She does some showers, and assists the RNs with bed baths. She is not authorised to do any other patient care.
2. what area of nursing are you in and what is a typical nurse/pt ratio?
I work on medical specialty ward in a tertiary metropolitan hospital - out patent mix in neurology, stroke service, endocrinology, rheumatology and renal medicine. Patient ratios are mandated - 1:4 on AM and PM shifts + resource/in-charge nurse + unit manager, 1:8 on nights.
3. how do you feel about delegating out work?
I believe that one of the unique elements of nursing care is that it is holistic. I have often said that, while many people can do the things tht we do, nobody but a nurse can do the totality of what we do. In other words, the tasks can be done by a variety of people (eg med administration by pharmacists, care plans
by administrators), but what makes nursing both special and valuable is that we're the only ones who see the whole patient. My concern is that as we see the 'tasks' of nursing as disposable, menial, and below us, and therefore delegate them away to less qualified staff, we will lose what it is to be a nurse. In addition, the patients' outcomes will deteriorate. It is too easy to see the performance of the task and overlook the assessment that goes along with it.
This is not to say that I am adverse to having help with washes, for example. However, I prefer to be directly involved with all the aspects of my patients' care. This is not only because it gives me a boader, deeper picture of the totality of my patients, but also because it allows the patient to establish a better rapport with me.
I have had patients tell me things that they've never confided in another soul - women in their 80s who were sexually abused, for example - and ask me questions they were afreaid to ask anyone else. Ths often happens when we're alone and I am, or have just finished, performing intimate care. Even if they felt comfortable speaking like this to our PCA, she isn't equipped to give advice or information.
4. have things changed since you entered the nursing profession until now and how?
I work at the hospital I was educated at. When I started, the wards were staffed primarily with students, and there were only a couple of RNs (if that) on any shift. The then-DON believed that tertiary hospitals should be all division 1, so there were no division 2 nurses on the wards. (Div 2 nurses have a level III or IV certificate and are taught through the vocational education and training, Div 1 have a university degree; they have different, though overlapping, scopes of practice). The patients were significantly less sick, and had lengthy admissions, so there was a greater range of acuity. We had a similar patient ratio then as now, but it wasn't mandated - in theory it was determined by a patient dependency score, but our staffing didn't change based on our workload.
There is now a lot more emphasis on management that there was - charge nurses used to have the time to be more involved in the day-to-day running of the ward, but now have greater financial and management responsibilities. The associate charge nurses have now largely taken that role, which has delegated discharge care planning to the bedside nurses.
With more emphasis on speedy through put, there are significantly more services available to support patients at home, both in the post-acute phase and ongoing suports. Patient admissions are more strictly regulated (I can't remember the last time a patient was admitted with 'acopia', but this used to be common) and significantly shorter, which has ramped up ward acuity.
Reading this over, I don't know if I've actually answered your questions - I think I just got on a bit of a roll! Hopefully some of this has been helpful!
Good luck with your assignment