All nursing floor - with no nursing assistants???

Kymmi · Oct 31, 2009

I work in CVICU and we do not have CNA's. The poster that commented that she works in ICU and could not imagine doing all that she does plus clean patients apparently works in a ICU that does use CNA's. I do however do all of the things she listed alone on fresh CABG patients which do include hourly accuchecks, drips etc etc. We do however have a 1:1 ratio on post op day then go to 1:2 post op day 1. Our unit does primary care and I like it because I always know what's going on with my patient/s because Im the only one doing any care on them.

I dont know how other hospitals figure staffing but ours figures it by FTE's. In other words if we did have a CNA we would lose a RN. Our unit clerks are also figured in as a FTE which means when she is not here we have a extra RN. That part I do not like. I like having a unit clerk to do orders, enter labs, run to the blood bank and such.

Virgo_RN, BSN, RN · Oct 31, 2009

I like the idea in theory. In practice, I have no idea what it's like, since I've always worked with CNAs and techs.

jamieann.rn · Oct 31, 2009

I work on a IMC primary care unit for large hospital in Southern California. My unit went primary care some years ago and has had great success! We average 2-3 patients depdending on acuity and although it can busy, all the nurses on the floor band together to help other nurses clean patients, etc.

I've been on other units that have CNA's and I feel that a transition to a primary care floor has helped me connect with patients because I am just that...the primary care giver.

I encourage you to try it! As long as the patient-nurse ratios are manageable (2-3/RN), it would be a welcoming challenge and I think you'll find it rewarding.

Good luck

SoundofMusic · Oct 31, 2009

If they would reduce the patient load? Fine. I can't imagine, though, how it would save costs??

loriangel14, RN · Oct 31, 2009

I work in a primary care facility, we have no aids anywhere in the hospital. I like providing all the care. Every task is an opportunity for assessment.

Otessa, BSN, RN · Oct 31, 2009

I have worked on a floor like this. It was on a Telemetry floor where I had 4 patients and I did all the baths, walking of patients, passing meds, orders, etc. You had to rely on the other nurses when there was a 2 -person transfer or need help turning. When I worked in the ICU I had 2 patients-total care without CNAs and the nurses helped each other-both scenarios worked really well because you were teamed up with a 'partner' for the day. You were there to help each other and cover for breaks or time off floor to transport patients.

otessa

Otessa, BSN, RN · Oct 31, 2009

OMG-What you describe was back-in-day called primary nursing. It was the nursing model of care that I was taught-back in the 80s-that was the best for the patients and the best use of our nursing skills.
I didn't think anyone did it anymore!!
KJ

Yep, it still occurs-especially in Magnet hospitals.

otessa

jmtndl · Oct 31, 2009

I actually work on a primary nursing floor and the lot of us who started there did so because we liked the idea *in* *theory*. In theory, it's the best way to provide care because there is so much assessment data that you glean from doing complete care for a patient. Unfortunately, I don't think we are staffed properly and our ratios are way too high to do it right. As a result, it's like working a regular floor where the tech has permanently called in. Sometimes it's great, but that's only when we get a low ratio by a fluke (and by "low," I mean 4 patients, sometimes 5 if they're all pretty stable and ambulatory). Many times, we have 6 patients, and the acuity of patients on our unit can run pretty high (we generally have 1-2 "complete cares" each on a shift). It just doesn't feel safe and we have no time to do the "nursey" nursing things, it's all cleaning up poop, answering call lights, and passing meds. To sum, primary nursing = great, but only if the ratio is low.

This is the way it usually is...someone sells the nurses the idea of primary care, and all that really happens is now you have no help. I understand the concept, and can see where it sounds fulfilling or something, to some, but I don't like it. I view myself as a highly skilled professional. What I bring to the patient is the ability to think critically, to review their care, to plan their care, and to provide skilled care. I do not see an advantage in stopping my med pass to clean poop, or empty a urinal.I don't want to leave the desk where I am waiting for an MD callback about a low HGB or out of control blood pressure to take someone a Coke.I don't want to stop my chart review,where I am checking to see that all that was ordered was done, and all the results are known by those who need to know them to change a wet bed or pass ice water, then try to regroup and find my place and continue my review.Maybe I am wrong, but I feel that nurses are best utilized as critical,professional thinkers, not unskilled workers.

Lacie, BSN, RN · Oct 31, 2009

I would jump on a primary nursing position if they keep the staff/pt ratios appropriate. I started out in primary nursing within the ICU's and CVICU. We never had more than 2 pts sometimes only 1 if a fresh post-op. If IABP it was 1:1. I ended up taking a clinical manager position on the telemetry step-down unit which also was primary care we had a 4:1 ratio dependant on acuity. No CNA's so we did our own baths, I&O's, bed changes, etc. We had regular careplan meetings for our longer term pts such as those with GB etc of which the primary care nurse always attended and was responsible for that particular pt 24/7. We got our breaks and we got our lunches!!! I loved it!! When I later went to team nursing with all the various roles by personel then came the drama and the staff feeling slighted by one or the other. Either the CNA felt offended by the RN or vice versa. Give me primary any day. We utilized unit clerks and they were our life savers!!!! If they were off then another RN was assigned and would either take a much smaller load and function as the clerk that shift.

catshowlady · Oct 31, 2009

My hospital has a mix of primary nursing and team nursing. For example, the med-surg floor I started out on had two RN's in team nursing with either an LPN or an aide with a 7-pt assignment. If you had the LPN with you, you had the choice to delegate all ADL's and VS and maybe PO meds to the LPN and do your own assessments and meds. The alternative was to split the assignment with the LPN, each do your own assessments, meds, ADL's, and VS, and the RN would cover the LPN's IV pushes, line draws, etc. Because of this, the LPN often took 4 pts and the RN 3, but it would depend on acuity & needs of the pts. I usually split with the LPN, as I felt that was a more appropriate use of their skills that to have them work as a glorified nurses' aide. Then, we had a 3rd RN in primary care with a 3- or 4-pt assignment.

I didn't mind either way, as long as I didn't have the one LPN with a chip on her shoulder on my team. The rest of the LPN's and aides on that floor were great to work with. If I was in primary care and needed help for a clean-up job, one of the aides or others nurses would help me. If the aides weren't busy, they'd answer my call lights too. That being said, none of the other nurses on my floor liked primary care at all, and I was scheduled for that primary care assignment 95% of the days that I worked. I did appreciate the opportunity to have more time with fewer pts, as PP have noted.

In my ICU, we generally have two techs, although sometimes its only one. About 75% of our aides do a good job, but we have a couple that I'd just as soon have two pts in primary care, rather than three with tech, because the tech thinks she's being put upon if she has to do anything more than take VS.

I think it all comes down to how well the staff are able to work as a team, and if the ratios are appropriate. I would not want to have any more than 4 in primary care, unless they were all alert, oriented, and ambulatory.

:paw:

GLORIAmunchkin72 · Oct 31, 2009

It would be ideal for the patient but in today's nursing environment it would be almost impossible. Nurses are expected to do a lot besides direct patient care and if they don't reduce the patient load you are going to see nurses pulling their hair out.

DogWmn · Oct 31, 2009

This is an interesting read for me as a returning LPN. I worked on total patient care floors ('70's & 80's) and as LPN's we did everything but as one poster stated IV pushes etc. We had a floor supervisor RN who did those and made assignments, helped out as needed if a patient went sour or Doc's were there at the time I got the impression the RN's loved it as they were utilizing their skills and felt secure that the patients were well taken care of. I worked Ortho and Medical floors and ICU and loved every minute of it. It's sad that LPN's are being relegated to LTC's now. We have a lot to offer as a skilled care givers. At my school we actually had more clinical hours than an ADN program at the time and we took the same science pre-reqs. Of course years later my school is now an ADN program.