Admin Cuts PCTs in ICU

[Nurse Beth, MSN]

Dear Nurse Beth,

I work in a20 bed MICU that decided to lay off our PCT and only have one unit secretary. This means the RNs have to transfer patients, wash down the monitor leads, restock our nurse supply chart, remove the linen and garbage. We have a tight RN staff according to the number of patients. That means more responsibility for the RN that the PCT did for patient care, blood draws, blood sugars, help with turns, wound dressing changes, Of course we can do this, but it gave us time to spend more time with the patient and their family. Is this the future of nursing? What can we as the RN staff do to make the administration understand this is not working and need our valuable PCTs back?

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Dear No PCTs,

Every RN knows the value of PCTs and CNAs. We love them. They keep our patients clean and cared for. They assist RNs so we can work at the top of our licensure. No good can come of getting rid of PCTs. It's a shame when admin sees them as disposable and an extra cost.

Admin looks at the bottom line and is concerned about quality measures to the extent that they affect reimbursement. Often decisions are made that are short-sighted and costly in the long run but money is "saved" in the short term. It flies in the face of logic to enlist the highest-paid employees (RNs) to empty trash and stock supplies.

As my Dad would say, it's stepping over a dollar to pick up a dime.

Cutting support staff can result in higher RN turnover and lower patient satisfaction scores. Pressure injuries can develop from lack of turning-all to save the cost of paying a PCT's salary. One complex pressure injury can cost the equivalent of a year's salary.

Nursing leaders have a responsibility to advocate for their staff and for patients, but this can fall on deaf ears, and some leaders are afraid to speak up. The structure and politics of a hospital can mean that the PCE's vote is not equal to the CFO or CEO's vote. Eager CFOs rush to show that they can save the organization money, and nursing concerns are trumped.

Historically, poor decisions like this are reversed when poor outcomes start to happen, and the pendulum swings. Again, it is driven by the bottom line.

Let your manager know your concerns. If you have a unit based council or shared governance, express your concerns through that structure. Be specific about tasks that are not getting done, such as regular turning or mobility.

Use any change in metrics to show that care has suffered, such as pressure injury prevalence or falls. Best wishes.

Nurse Beth

Author, "Your Last Nursing Class: How to Land Your First Nursing Job"...and your next!

[sepulveda]

I'd say that it's unfortunate that PCTs have been cut. I also work in an ICU and though we have PCTs, I would say that they are rarely used. This is probably due to us recently getting them only 6 months or so ago. We are so accustomed to providing full patient care that we often forget that they are available. I mostly give them stuff to do, such as EKGs, because they are bored and begging to do something.

I guess what I am trying to get at is that you will get accustomed to not having them. I compare it to dishwashers. If you've never had a dish washer and move into a place that has one, you might ignore it and continue to wash dishes by hand. However, if you've always used a dishwasher, you may find the transition to washing dishes by hand a little unconvenient.

The transition is more difficult when going from having to not having than the other way around. I'm not saying that it doesn't suck that you lost the support you're accustomed to having; I'm saying you work with what you have and it'll get easier.

[JKL33]

Dear Nurse Beth,

I work in a20 bed MICU that decided to lay off our PCT and only have one unit secretary. This means the RNs have to transfer patients, wash down the monitor leads, restock our nurse supply chart, remove the linen and garbage. We have a tight RN staff according to the number of patients. That means more responsibility for the RN that the PCT did for patient care, blood draws, blood sugars, help with turns, wound dressing changes, Of course we can do this, but it gave us time to spend more time with the patient and their family. Is this the future of nursing? What can we as the RN staff do to make the administration understand this is not working and need our valuable PCTs back?

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There's nothing wrong with calmly and completely sans drama letting your manager know of your concern. But in reality, the only thing that works is waiting for natural consequences to declare themselves.

Pointing out negatives that will flow from this decision will instantly be written off as belly-aching, complaining, and not being a team player since that is the lazy and easy way to create a problem and then blame it on others. In a way, the complaints are a boon to those making changes because they can immediately claim those complaints (and the attitudes behind them) are the cause of the problem.

Therefore, think carefully before complaining (and by "complaining" I mean bringing any facts to light).

I've come to prefer the tack of registering my opinion and then just quietly doing the best I can in situations like this and waiting for the chips to fall where they may - mostly because although I don't like these situations any more than anyone else, being subsequently blamed for "complaining" is an intolerable insult to injury in my book. I despise descending into drama based on someone else's dumb decisions. I like to leave things so that the decision-makers are the only ones who can own the negative results of their choices. I see my ethical duty as involving doing the absolute best I can within the limitations of the situation. If that is not acceptable then I would look for a more reasonable employer.