Division of Labor in Nursing

RNperdiem, RN · Apr 17, 2011

Hmmm... Might be a mixed blessing.

If there are people to help with the "tasks" then why not assign a nurse many more patients?

Of course the nurse will be fully responsible for what happens to all these patients, and it is difficult to really know what is happening with the patients when a lot of work is contracted out to others.

A system like that will only work if the quality of the unlicensed personnel is high and they communicate with the nurse so everyone works like a real team.

Katie5 · Apr 17, 2011

Hmmm... Might be a mixed blessing.
If there are people to help with the "tasks" then why not assign a nurse many more patients?
Of course the nurse will be fully responsible for what happens to all these patients, and it is difficult to really know what is happening with the patients when a lot of work is contracted out to others.
A system like that will only work if the quality of the unlicensed personnel is high and they communicate with the nurse so everyone works like a real team.

I see where you're coming from,but of course it would be a team, otherwise it wouldn't work. And like you mentioned, the nurse has the responsibility of overloooking the whole team. Just because the work is "contracted out" does not take away the burden of responsibilty from the nurse. This method seeks to lighen the load, not completely take away the responsibilty.

FancypantsRN · Apr 17, 2011

i have worked both sides of the fence. a floor with pct's to do vitals, i & o, help with lab draws, 12 lead ekg's, accuchecks and bathing pt's. the floor had 20 beds and there were 3 pct's on nights, 5 RN's plus a free charge nurse. sounds like a dream right? it was awful.... depending on who your tech was, the tasks may or may not have been done and you spent more time chasing after them to figure it all out then it was worth - i am not kidding. it seemed like a dream in theory.

next floor i worked there were no pct's. we did it all and had 5 (usually open heart) pt's. it was more challenging without the help, but at least i knew everything going on with my pt's and felt more in control of their care.

like the previous poster says, it all depends on the quality of pct's a facility hires. they really do make or break the nurse's job.

CharmedJ7 · Apr 17, 2011

I'm gonna mostly agree with the mixed blessing argument - it's nice to have phlebotomists for example when they come and do their job in a timely manner, but when you start having to chase them down to get labs drawn, when they come by then leave because "oh, pt refused lab draws for stat pro heart" but 'forgot' to tell the nurse that, well, then they are really more trouble than they're worth and I'd rather have just done it myself. Same deal for PCTs. I think sometimes admin forgets that being the coordinator of care and holding all other depts accountable takes a lot of time, just because we have a couple less tasks doesn't mean we're not busy and are able to pass meds to a couple more pts. The mantra of "everything is ultimately the nurses responsibility" irks me because at least in my facility, it often leads to a lack of accountability for some of the other departments, esp the PCTs.

One thing that works really well where I am that I absolutely love though is IV therapists. They are very good at coming when called and prioritizing for pts with PCAs, etc. Personally phlebotomy-wise I'll take the extra work of drawing off a central line (or frankly, butterflying it) because at least I can guarantee it was done, when it was done, and know about when to look for results. I like having RTs, even though sometimes they're really hard to get ahold of. Techs are hit or miss, a good tech is a blessing, a bad one makes my life far harder than none at all.

DogWmn · Apr 17, 2011

Well, back when I worked in a hospital it was ALL nurses...RN's and LPN's, the division of labor was based on our scope of practice and a team nursing model that worked, I thought quite well. All the patients got excellent care, we were never so overwhelmed like it appears to be now.

CompleteUnknown · Apr 17, 2011

I don't know... like some of the posters, I think I'd rather do most things myself. The more we give away, the more patients we are expected to manage and this is really hard when you're trying to keep an eye on what everyone else is doing (or not doing, and therefore needing to be chased up). Every time you turn around someone is telling you about a problem with a patient or a test or a treatment until you almost go crazy trying to address it all. Then management smiles sweetly at you and wants to know why you're complaining, after all, you have all these extra people and teams and departments to lighten your load!

BluegrassRN · Apr 17, 2011

If I have an aide, it means I am responsible for more patients with less time to care for them, get to know them, etc. While a good aide is worth her weight in gold, honestly there simply aren't that many out there, or at least not at my hospital. I wish we would get rid of aides at my hospital and just have RN care.

If I get my pts's vitals, help with hygiene and ADLs, I know so much more about their skin, their activity level, their ability to perform these activities, their cognitive level, their neuro level, in short, I simply am much more familiar with their health. It's better for the patients if I perform total care for three patients instead of "overseeing" care for 5-6. It's my license either way, I'm responsible for all the knowledge in both scenarios, but I simply know more if I'm the one providing care.