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?
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!
That "All RN Care" model always sounds like a brilliant idea when some consultant is selling it to the suits in Admin. Then one day some bean counter plugs it all into an Excel spreadsheet and figures out, "Yikes! We're now paying RN rates for work that used to be accomplished at PCT rates!", and it all goes back to the way it was before. It doesn't usually take a scholarly, peer-reviewed study to convince Admin that saving money is a pretty good thing after all.
I think they are just trying to work their nurses to death to save money on assistants. I would never work at such a place and 5 patients is too much for no aide etc, no way! Maybe 3 patients, but not 5 and they are already admitting they don't staff adequately. I would run! Heck if you want to work without help just work in the ICU then you have your 2-3 patients and do everything yourself.
Specializes in Medsurg/ICU, Mental Health, Home Health.
It worked in the ICU, but it was a little different there - two patients max and it wasn't like all of the ADL stuff was piled on one shift vs. another. Also, at least two or three RNs were floating at any given time.
It worked in L&D because those patients usually were the walkie-talkie type, and again...max two moms. During pushing to two hours post delivery, it was 1:1.
As for MedSurg, what worked on the Oncology floor in my hospital was that ten patients were divided up among three RNs...that seemed to work. Usually one of the RNs had a lighter assignment and they all helped each other.
I think it works in closed units if the ratios are based on acuity and if the staff work well together. I'd give it a try - if it was promised that I'd have four patients TOPS.
The success or failure of this model of care will be attributed to nurse/pt ratios and acuity of said patients as well as the team work of all staff involved. Some days it will be great, some days not so much. You are right to have some concerns, especially as they are admitting up front that they expect higher than the goal of 3 patients per nurse.
FurBabyMom, MSN, RN
1 Article; 814 Posts
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!