So our hospital has hired a consultant group to come in and make us more efficient, reduce readmissions, get more for less, blah, blah, blah. Been down this road before and it seldom has a good outcome.
But I am just not sure about this new "patient care delivery model" they are suggesting for our unit and wanted to see what others are doing out the in allnurseland:nurse:.
So, we are a 29 bed cardiovascular unit in a community hospital. Our patient mix includes r/o and acute MIs, post PCIs and pacemakers, CHFers, OHS 1 day post op, thoracotomies, rapid afib, along with overflow med tele. We do not pull sheaths. The only drips we tirate are heparin and cardizem, and insulin on OHS patients only. We take up to 5 patients each if we are sharing an CNA, 4 without, 3 if a patient is on an insulin gtt. There are usually 2 CNAs on the floor, 3 if our census is >24.
The consultant group is recommending we adopt a primary nursing model where each nurse takes 3 or 4 patients, without a CNA. There would be 1 CNA for the whole unit, but they "would work at the direction of the charge nurse." The consultants claim that this is the national trend. Is this true?
To some nurses this is a dream come true:yeah:. Me, I'm not so sure. I fail to see how paying someone $30-40/hr to empty the trash & linen, take grandma to the bathroom for the umpteenth time, leave the floor to fetch food, blood, wheelchairs, linens, is cost-effective, or delivers better patient care:rolleyes:.
So what do y'all think? Is anyone on a cardiac/tele floor doing primary nursing?
if you presently take 5 patients, maybe four, which always goes down to three if you have an insulin gtt, i think a permanent 1:3 nurse: patient ratio sounds great. i have worked on floors like yours and having a great unit clerk and one (or maybe you can nudge for two) aides would make things pretty darn good, especially if you can make sure your patients are all in a pretty close grouping to decrease wasted time running up and down halls all the time. sounds like you have an all-rn staff, too, which is nice, so you don't have to cover meds or assessments for an lpn. i'd say go for it.
I am not sure what you are trying to imply though by your comment.
My implication is the type of care you are typically giving looks different. Total care on a infant is very different than total care on a 60 year old man.... You also typically have parents involved in care as well in my experience. In that situation im not sure a lot of cna would really be necessary so you would best be served by the matrix your mentioning. I must live in the california of the midwest though because nobody has the pt loads like you guys mention. on a med surg floor you have 3 to 4 pts on the day... around that on pms and 5 to 6 on nights. the peds floor even at night only has 3 to 4 patients
On the inpatient hospice where i work i can have up to 8 at night but i have a cna that is dedicated to my patient load. we do all our turns and cares together...most nights we only have 6 patients and we still keep busy. I just don't think it is feasable that i could give quality care without support in doing turns and cares.
RNs will being doing their own VS which I don't mind as long as I don't have to fight for a pulse ox.
Mostly the staff is concerned that hygiene will go by the wayside because it will be low on the priority list. Bathing is important of course, but not necessarily a safety issue.
Yep, we have a high patient turnover, 50-75% turnover in 24 hours is not unusual. No swing/resource RN unless we want to take more patients each.
Another monkeywrench thrown in is that we will only staff for the census we have, instead of trying to stay 3 beds ahead (2 on nocs). When I was relief charge last week I came out of report to 5 bed requests and phonecalls demanding I take them all ASAP.
We use that same system and frankly it stinks. Who ever came up with our staffing numbers needs to come in and work with us! They say should drop by one nurse on night shift...hello, our kids pretty much get the same care around the clock. We have learned how to play the system.
I hesitate to ask because I don't want to violate AN Terms of Service.
But,
yes it is. I take it you have experience with this group?
I hadn't realized it was potentially against the TOS, so if it is we'll just refer to it as the company formerly known as Arthur Andersen (TCFKAA). Enron's downfall wasn't due as much to the Execs at Enron as much as the illegal and incompetent actions of their accounting firm; Arthur Andersen. When the government took away their right to do business as an accounting firm, they (those not in jail) formed Huron Consulting. They most definitely still have an accounting, not patient care, knowledge base and focus.
I haven't had experience with them but I know Nurses who work at facilities that have used (TCFKAA) and their method seems to be get rid of all support/ancillary services to Nursing without actually reducing Nursing staff ratios. I'm guessing this is because Nurse to patient ratios is a common measuring stick, while how much support those Nurses have is not. A 5:1 ratio or even a 4:1 ratio sounds great but there's a big difference between a 5:1 ratio with support and a 5:1 ratio with no CNA, Fewer support Nurses (such as IV teams, admit nurses, "Crisis Nurses/Rapid Response" Nures) No UC at night, etc.
I think the best way to make sure that these types of changes are appropriate is with a Time Study. These used to be fairly common, although nobody seems to do them much anymore since it would only reveal what we already know which is that we expect Nurses to to 10 hours of work in 8 hours. A time study would give you some real numbers to work with to estimate the impact.
Specializes in Emergency Dept. Trauma. Pediatrics.
My implication is the type of care you are typically giving looks different. Total care on a infant is very different than total care on a 60 year old man.... You also typically have parents involved in care as well in my experience. In that situation im not sure a lot of cna would really be necessary so you would best be served by the matrix your mentioning. I must live in the california of the midwest though because nobody has the pt loads like you guys mention. on a med surg floor you have 3 to 4 pts on the day... around that on pms and 5 to 6 on nights. the peds floor even at night only has 3 to 4 patients
On the inpatient hospice where i work i can have up to 8 at night but i have a cna that is dedicated to my patient load. we do all our turns and cares together...most nights we only have 6 patients and we still keep busy. I just don't think it is feasable that i could give quality care without support in doing turns and cares.
I rarely have had infants, mostly older kids and a few toddlers. But as far as parents mostly being involved, yea I wish. I mostly have had parents that are hardly at the hospital, parents that I have to take the kiddo out in the hall to play for 2 hours so the parents can sleep because they refuse to take care of their kid because they are tired and frankly I was worried for the kid because if how agitated the parents were getting. Or there is the kiddo that came in on the flight for life and no sign of their patients for 4 hrs. I certainly can't take patients in with me to other patients room while providing care Mao it leaves me in a bit of a dilemma when I have stuff like this happen. Add to that, kids tend to get a lot of visitors. Everyone and their momma and cousins and friends show up at 8 at night to hang out which leads to a whole other set of problems.
Been down this road before and it seldom has a good outcome. 
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nurseprnRN, BSN, RN
1 Article; 5,116 Posts
if you presently take 5 patients, maybe four, which always goes down to three if you have an insulin gtt, i think a permanent 1:3 nurse: patient ratio sounds great. i have worked on floors like yours and having a great unit clerk and one (or maybe you can nudge for two) aides would make things pretty darn good, especially if you can make sure your patients are all in a pretty close grouping to decrease wasted time running up and down halls all the time. sounds like you have an all-rn staff, too, which is nice, so you don't have to cover meds or assessments for an lpn. i'd say go for it.