ALL-RN Care model

Hello,

I graduated in December, passed NCLEX in February and have been on 3 interviews since then. My 3rd interview was yesterday, at a major magnet hospital. All applicants are offered a shadow experience, which I am doing next week. I got along well with the nurse manager and i am really hoping I get the job.

The only thing that concerns me is that this hospital has an "All-RN care model." They do not have ANY CNAs, techs, or phlebotomy team. I have been a tech at a different hospital for 5 years now and it is hard for me to imagine doing everything I do, plus a million times more with the added RN responsibilities. She said they try to keep it at 3 to 4 patients per nurse, but it does often go up to 5. She said teamwork is they key to success in this model.

I'm not opposed to doing "extra" work, I guess I just get concerned about keeping up and having time. Or if all the nurses are with patients, who would help me change a large patient, or leave the floor to get supplies, or assist with feedings if I have 3 patients who needed help at the same time? Little things like that?

I have researched and found this model actually improves patient outcomes, which ultimately sells me on the idea. I'm really excited to see what it is like at my shadow experience.

Anyone have experience working under this model? Thoughts?

Thank you for taking your time to read my post!

What specialty is it? If you have a lot of walky talky patients and not much full care it can be ok - but if you have all full care or jumper (out of bed jumping disoriented sundown/dementia/brain injury...) it can be tough.

I once worked on a floor with SDU and the SDU had not always a PCA. In that case, 2 RN would share 6 patients. That usually meant not much time for washing up or other basic care.

I may be jaded, but it's my experience that every time this theory of nursing comes round yet again, it is accompanied by the release of all assistive personnel with no adjustment in nurse/patient ratios.

No doubt this could be an ideal nursing care delivery system, but I've never seen it appropriately implemented.

The "studies show" better outcomes with the all nursing model due to the ratio of LESS PATIENTS; it doesn't work if you have more workload, that increases mortality.

I love how management/corporate loves to say "studies show" without explaining all the variables of studies-that's why it's so important to know how to analyze research and advocate and challenge their intentions behind it.

"they try to keep it at 3 to 4 patients per nurse, but it does often go up to 5. "

Meaning ...expect five patients. Major magnet means NOTHING, especially when the Major is working you to death. You cannot be in 5 places at once.. and THAT scenario will happen.

Observe carefully when you shadow.. get back to us.

Our hospital lasted a year when they adopted this theory. Then they rehired aides.

I reeeaaaaly like comment by Been there, done that. So true.

Thanks for all the input, I'm glad to know some of my concerns are valid!

I am hoping the nurses I see during shadowing will give me some insight. I'll update on Wednesday!

I worked on a Med-Surg unit that was total nurse care. We had 5 patients each. I liked it. I didn't need to rely on another person to check my patients blood glucose or vital signs. I didn't have to "make sure" care was preformed. If I had a total care patient I asked for help. Most people were helpful.

I see many posts by nurses that have 8+ patients and no help because the tech was unavailable, lazy, absent or floated to another area.

I worked on a Med-Surg unit that was total nurse care. We had 5 patients each. I liked it. I didn't need to rely on another person to check my patients blood glucose or vital signs. I didn't have to "make sure" care was preformed. If I had a total care patient I asked for help. Most people were helpful.

I see many posts by nurses that have 8+ patients and no help because the tech was unavailable, lazy, absent or floated to another area.

Were you responsible for drawing labs?

Like the OP said. Teamwork is critical. I have been there done that with this model at some point in my career. I remember standing by the door looking for help only to wait or just do it myself. It sucked big time.

However, I do like to wash up and do ADL for my own patients. I glean a lot of information about their personal life and health status.

I worked in a hospital that tried this. It wasn't so bad when acuity was lower or ratios were lower. The nurses I worked with weren't thrilled about it, but we made it work. I think some of the RN-RN or LPN-RN and LPN-LPN teamwork was better than what we tended to get from unlicensed assistants on the other unit I worked on. As another poster mentioned, *I* was obtaining information about my patients, and there was no delay handling it all, if there was an abnormal value I could handle it then, I was not dependent on someone else telling me or checking their charting because they couldn't be bothered to tell me. With *some* of the unlicensed staff I worked with I had to hunt them down to be informed of things. Also it made sense in some ways - if my assistant would get vitals between 0700-0730 on my patient and they needed meds (BP, etc) at 0900, I could give them at 0830 with a 0730 BP but after that time I needed a new value and had to get a new set of vitals anyways.

Neither system is perfect - you can point out flaws with either method very easily. I think it depends more on how they handle the implementation and staffing than the model. Like another poster suggested - observe very carefully what happens when you shadow!