CNAs or no CNAs? Primary or Team? What do you think?

Published

Just a debate we were having last night - thoght I would get some of your opinions on it. Would you rather have a larger group of pts with some CNAs to help, or a smaller group of pts and no CNAs?

CNAs/PCAs/Techs, etc - please don't be offended! I love you!!!!! We were just discussing what would be the best setup. You see, we have some WONDERFUL techs, and then we have the ones we never see. You know what I mean. So the question is, would you rather have a smaller group of pts where you are responsible for everything, or would you rather have someone to delegate to?

I would like to try doing a primary approach (with my own tech). Right now we are modified primary - the nurse has 5-8 pts but the tech has 10-16 (depends on the shift). The tech may be split between 3 or 4 nurses. I don't like that - too hard to find them when they have that many pts. I don't think I would like the team approach either - too confusing. Just looking for your input - not like anything is going to change, lol!

Up Vote Up Vote ×
Specializes in Med Surg.

As a CNA i have wondered the same thing. CNA's usually have 15-20 patients (noc shift) and are under 3-4 nurses. I have gotten asked on more than one occasion where I was when I was helping another nurse because that nurse needed help too. Don't get me wrong, I am not one who disappears off the unit, I am about to take my RN boards and I love to see everything that is going on. It's just hard for us to be two places at once and sometimes nurses forget we have 3 or 4 people to report to not just one. However, one night we had two nurses and two aides and commom sense would have suggested that one nurse and one aide are matched up, but we were split between the two nurses. When I questioned this, no one seemed to have an answer. It's a tough question to answer. Good pros and cons to both situations.

Up Vote Up Vote ×
Specializes in Behavioral Health, Show Biz.

I prefer working with a team

and I want CNAs

on my team.

We get the work done quicker

and I can focus on the big picture

and trouble-shoot

and problem-solve better

when I'm NOT

running around

collecting specs, ansering pharmacy and management calls and assisting with ADLs

ALL AT THE SAME TIME.

:cool:

Anyway,

I get tired of slipping in urine.

I NEED HELP!

:D

Up Vote Up Vote ×
Specializes in Acute Care, Rehab, Palliative.

I work in a setting with no CNAs and I do primary care. I wouldn't have it any other way. I like doing their care so I can do my assessments at the same time. I know I won't miss anything and I am charting what I saw instead of what someone else said they saw.

Up Vote Up Vote ×
Specializes in Neuro, Cardiology, ICU, Med/Surg.

I've been working as a PCA in a major teaching hospital and in August, I start as an RN on another unit that doesn't have PCA's (the only all-RN floor in the hospital). Our ratios will be better... like 3 patients to the nurse, and the RN's have to help each other out more. I can't judge what it's really like until I've worked in both situations as an RN though.

However, my initial reaction is what loriangel said. Though I am glad that all floors are not like that or else I wouldn't have gotten my foot in the door to get the experience as a PCA!

Up Vote Up Vote ×
Specializes in Ortho, Case Management, blabla.

Where I work there are times when there aren't enough CNAs to go around. So once in a while we work alone. I've found it doesn't really make a difference to me either way.

On one hand, with a CNA, I get 5-6 patients.

Without a CNA, I get 4.

Sometimes it is nice to get a break from having to double check everything, or worry about if the CNA got the I+O's charted or not, etc. Sometimes it is certainly easier to just be prepared to do everything yourself from the outset.

After a few times of realizing 10 minutes before the shift got out that your patient that had been stable all day suddenly had a blood pressure of 80/30 two hours before, and the CNA never bothered to mention it after they got distracted answering a string a call lights (gah).

I find it can depend on who I am working with as well. Oftentimes I enjoy providing the patient care myself. Time with the patient spent collecting vitals, doing the more basic stuff like a bedbath, or helping a patient up to the bathroom are excellent opportunities to get education done and assess things for yourself that unskilled personnel may otherwise miss or fail to report. I may be a bit more in a rush when receiving phone calls or doing my documentation, but it doesn't really bother me.

Up Vote Up Vote ×
Specializes in Ortho, Neuro, Detox, Tele.

If you can ensure me that I would NEVER have more than 4-5 patients...go for the primary...

otherwise, I need to think, and keep the big-picture overlook going...so please give me a CNA to help me do some hands-on care once in a while....

Up Vote Up Vote ×

Patient weighing in here:

I do not mind CNA's at all.

Team nursing would be ok

However I like primary nursing. I like knowing who is going to respond if I need something, or call for my nurse, I know who is going to come. You also form a relationship with that nurse, that you feel more comfortable if something happens to talk to them.

For an example though it is a little different:

In January I had surgery went through pre-op, surgery, everything went home.

February, I needed surgery again. I was waiting in the waiting room lo and behold I recieve a surprise visit from my aunt flow (I assume you all know what I mean :D)

I am thinking oh boy what am I going to do now. I get called back to pre-op SAME NURSE as the month before. I was SO relieved because I felt comfortable asking her for needed supplies due to my situation.

It was also nice because I think they did the nurse thing o purpose. I had the same pre-op and post-op nurse.

The post op nurse part was also nice becasuse recently my body has been reacting oddly to anesthisia as i wake up. I FREAK OUT!!!!! This nurse having cared for me previously knew what to do and what calmed me down, she knew it was the meds not me, and as soon as she got another med in me I would relax. (I have found out Demeral calms me down in that freak out mode, found this out when I was given it for pain.)

Up Vote Up Vote ×
I work in a setting with no CNAs and I do primary care. I wouldn't have it any other way. I like doing their care so I can do my assessments at the same time. I know I won't miss anything and I am charting what I saw instead of what someone else said they saw.

How many pts per RN (for each different shift)? What kind of unit? Thanks!

Up Vote Up Vote ×

Does anyone in an acute inpatient setting use team nursing? As in - one nurse for assessments, one nurse for meds, etc? I personally think that would be awful, but I'm sure it's got it's positive sides too.

What I wouldn't give to have my own PCA (sometimes PCA pump.....:chuckle). But then I guess you run into the same problem that some PCAs are absolutely fantastic and others are...uh, let's say lackluster, either way!

Up Vote Up Vote ×

I'm a crappy CNA, so I greatly appreciate the fabulous ones we have!!

Up Vote Up Vote ×
Specializes in Cardiac Telemetry, ED.

Our facility uses the patient centered care model.

I don't mind having CNAs. I like having the help, and I like the team approach. However, some nights when I never see the CNA at all, I feel that if I'm going to be doing primary care, then I need to have fewer patients.

Up Vote Up Vote ×
+ Join the Discussion