AHS - replacing nurses with HCA's?

Fiona59 · Jun 13, 2013

If it's going to be a transitional/ltc unit with stable patients, I can see it.

daily vitals, routine care, incontinence care, ostomy care. Anything outside "normal" vitals would be reported to the Charge Nurse (they have to have someone with a license on the floor).

Think about it, most of these patients would be waiting placement at home. Their unlicensed family members would be doing the same care as our unlicensed NAs. Home Support Workers do many of these tasks in the community.

Being the devil's advocate here. They are bedblocking pure and simple. The family won't take them home and know it's faster to have granny placed from hospital than from the community. Many people don't want to deal with the intimate needs of family members and expect hospital staff to do so.

Do I agree with AHS's decision, No.

Do I agree with warehousing people in acute care beds who don't need to be there, No.

dayshiftnurse · Jun 13, 2013

agree with above post...but i've been in the position of being the "charge nurse" nurse (RN) that the aides and lpn's go to on a transitional-type unit...the role is exhausting, you can't focus on your own assignment and often there is no one for you to go to because the MRP (most responsible nurse, RN) often also has a small assignment and is zooming around the unit managing complex md orders, transfers, tests, management, etc. so its all on you....and things do come up beyond just routine stuff, even with the "routine" patients the aides are taking care of. i can only speak for here in the GTA, but if patients are sick enough to stay in hospital to wait it out for LTC, they are often not just simple patients...or else the hospital would definitely have sent them home with homecare.

lilaclover6984 · Jun 13, 2013

I work on a transitional care unit where Pts are supposedly waiting for placement. There is no way my unit could be run by HCAs. We have Pts with IV's, tube feeds, trachs, 02, palliative Pts, foleys etc. We are frequently giving IV meds, narcotics, even blood transfusions. We see Pts with wounds that require advanced care as well. Most of our Pts also have frequent ( daily and weekly) blood work that requires follow up. We also have many Pts with advanced dementias, even suicicial Pts that require close monitoring and behaviour management.

loriangel14, RN · Jun 13, 2013

I work ona Complex Continuing Care floor. We have a mix of acute care, rehab and palliative patients.We have several patients waiting for a nursing home bed. Ironically, in Ontario seniors waiting for beds get placed faster if they are at home waiting. If they, or the families aren't coping then they are treated as urgent placements and get a bed faster. If we are caring for them then they take longer. We have some patients for months. Our floor employs PSWs and we would be sunk without them.I makes a big difference if you have good PSWs. Ours are awesome.They do most of the cares, answer most of the bells and are an excellent second set of eyes. They alert us to changes in people's behaviour, skin condition,eating and drinking routines, ambulate patients,feed patients and provide monitoring for confused patients.They also assist with making sure the rehab patient maintain the level of activity they are recommended by PT and OT.

lilaclover6984 · Jun 13, 2013

I wasn't saying we don't need out HCA's, just saying they can't replace nurses

joanna73, BSN, RN · Jun 14, 2013

HCA's are valuable and their role is important. However, HCA's do not posess the knowledge to care for complex patients....and frankly, I would not trust some of my HCA's with vitals. Some are awesome, but others are barely meeting the standards.

AHS and other health authorities are concerned with cost saving measures only, and health care costs will continue to skyrocket with an aging population. Do I agree with their mentality? No. However, I understand it. Business is always about the bottom line and many of the current exceutives have no clue of front line roles. Nor do they care.

You will probably see more downsizing and shuffling around as the years progress.

Fiona59 · Jun 14, 2013

agree with above post...but i've been in the position of being the "charge nurse" nurse (RN) that the aides and lpn's go to on a transitional-type unit...the role is exhausting, you can't focus on your own assignment and often there is no one for you to go to because the MRP (most responsible nurse, RN) often also has a small assignment and is zooming around the unit managing complex md orders, transfers, tests, management, etc. so its all on you....and things do come up beyond just routine stuff, even with the "routine" patients the aides are taking care of. i can only speak for here in the GTA, but if patients are sick enough to stay in hospital to wait it out for LTC, they are often not just simple patients...or else the hospital would definitely have sent them home with homecare.

OK, Toronto isn't Alberta.

In Alberta, a Charge Nurse rarely has an assignment. Usually they only have one if they have multiple sick calls that aren't replaced. The Charge is responsible for staffing, med re-orders, liasing with the doctors, families, social workers. No physical interaction with the patients.

In Alberta, it's very common to have patients that should be home with additional care or in sub-acute sitting in Acute beds. We wound up having transitional care units in my hospital (which have now been eliminated). Most of the patients there were either demented, waiting for a LTC bed or their family simply refused to take them home. Families know that if they refuse to take their elders home, beds in LTC become available faster. These units were highly staffed by LPNs and NAs. These patients would go home on pass to visit family. No IVs, no central lines, often no wounds. Bed blocking, pure and simple.

So no, the RN would not have the weight of the world on his/er shoulders.

dayshiftnurse · Jun 16, 2013

OK, Toronto isn't Alberta.
In Alberta, a Charge Nurse rarely has an assignment. Usually they only have one if they have multiple sick calls that aren't replaced. The Charge is responsible for staffing, med re-orders, liasing with the doctors, families, social workers. No physical interaction with the patients.
In Alberta, it's very common to have patients that should be home with additional care or in sub-acute sitting in Acute beds. We wound up having transitional care units in my hospital (which have now been eliminated). Most of the patients there were either demented, waiting for a LTC bed or their family simply refused to take them home. Families know that if they refuse to take their elders home, beds in LTC become available faster. These units were highly staffed by LPNs and NAs. These patients would go home on pass to visit family. No IVs, no central lines, often no wounds. Bed blocking, pure and simple.
So no, the RN would not have the weight of the world on his/er shoulders.

umm...of course toronto and alberta are two different places!

I was offering a general comment about this thread...just giving my point of view and my experience from working on these types of units...of course there may be some differences from unit to unit, but underlying issues are similar wherever you go... and yes, in my unit the RN's were carrying a lot of weight on their shoulders, too much responsibility and generally unsafe.

lilaclover6984 · Jun 16, 2013

OK, Toronto isn't Alberta.
In Alberta, a Charge Nurse rarely has an assignment. Usually they only have one if they have multiple sick calls that aren't replaced. The Charge is responsible for staffing, med re-orders, liasing with the doctors, families, social workers. No physical interaction with the patients.
In Alberta, it's very common to have patients that should be home with additional care or in sub-acute sitting in Acute beds. We wound up having transitional care units in my hospital (which have now been eliminated). Most of the patients there were either demented, waiting for a LTC bed or their family simply refused to take them home. Families know that if they refuse to take their elders home, beds in LTC become available faster. These units were highly staffed by LPNs and NAs. These patients would go home on pass to visit family. No IVs, no central lines, often no wounds. Bed blocking, pure and simple.
So no, the RN would not have the weight of the world on his/er shoulders.

I work on a a transition unit in Alberta and we do have plenty of IVs, wounds, PICCs, NG's, O2 etc. So I think it must really vary hugely from hospital to hospital even within Alberta. The charge nurses on our unit carry a HUGE responsibility.

alberta.student · Jun 16, 2013

I work at one of the facilities that this "Care Transformation' is going to be started on Sept 9. At our hospital it is going to be demoed on one acute medicine unit and one acute surgical unit. The surgical unit it is being initiated on it typically sent the most acute post op patients that do not go to icu/step down. These are not transitional units at all and it's really alarming. On the surgical unit the RN and LPN complement was cut by almost 40%.

Pediatric Critical Care Columnist · Jun 16, 2013

The two units at the U of A that they're "piloting" this on are the ones with the most MET team calls. What does that tell you?? People are gonna die.