ALL-RN Care model

nutella, MSN, RN · Mar 24, 2016

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.

OCNRN63, RN · Mar 24, 2016

"Run, Forrest, run!"

roser13, ASN, RN · Mar 24, 2016

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.

LadyFree28, BSN, LPN, RN · Mar 24, 2016

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.

Been there,done that, ASN, RN · Mar 25, 2016

"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.

BittyBabyGrower, MSN, RN · Mar 25, 2016

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

amoLucia · Mar 25, 2016

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

Reds5588, BSN · Mar 25, 2016

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!

Bo,RN · Mar 25, 2016

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.

TheCommuter, BSN, RN · Mar 26, 2016

Anyone have experience working under this model? Thoughts?

I despise total care models and will not work at any facility that utilizes them.

I'm not going to bathe, dress, feed, toilet, groom, transfer, medicate, assess, make beds, draw blood, perform masses of procedural skills, and document for four to five patients. Some of these tasks need to be delegated.

tokmom, BSN, RN · Mar 26, 2016

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.