All nursing floor - with no nursing assistants???

blssdrn12 · Oct 31, 2009

OMG-What you describe was back-in-day called primary nursing. It was the nursing model of care that I was taught-back in the 80s-that was the best for the patients and the best use of our nursing skills.

I didn't think anyone did it anymore!!

KJ

JSBoston · Oct 31, 2009

I do like the idea of it somewhat. Right now, let's just say I do NOT work with high quality nursing assistants, so I basically do everything myself anyway. I just worry about having a high number of patients without help if something goes wrong. It's a very large hospital, so I'd hope they wouldn't throw all of the bed bound heavy patients with multiple wounds on that floor when there are so many others.

Music in My Heart · Oct 31, 2009

The local academic medical center does this... RNs only. I don't work there but the nurses that I've spoken with seem to favor it.

yetanotheramanda · Oct 31, 2009

I would hope that in this environment you would have a reduced patient load, since you don't hav any NA's to help you out.

JSBoston · Oct 31, 2009

I would think and hope the pt load would be reduced, and I'm sure I'll hear that in my interview, but you know how things are sometimes you're told one thing but then there is reality :) I'm sure it's great, I just wanted to hear opinions on it.

**All Heart RN** · Oct 31, 2009

I can definitely see the benefits to having an all nursing floor...however, I wonder what the patient load is like on those units?

On our ICU, the average age of a patient is 75 y/o and the majority of them are incontinent and require hourly accuchecks. I absolutely could not imagine having to titrate drips (& monitor reactions, especially to powerful pressors such as Levophed), monitor labs, measure CVPs and monitor arterial waveforms, document hourly vitals and I/Os, q4 assessments, give meds,answer/make calls to docs/RTs/STs/dieticians, pacify families...

On top of cleaning incontinent pts, giving baths, stocking linen closets, transferring pts...Wow!

springfieldrn · Oct 31, 2009

When I did primary nursing we had 3 patients. I really liked it, I felt I had more control over my day and knew my patients better. More than 3 patients? I wouldn't do it.

jtmonique · Oct 31, 2009

This is what the hospitals in my area are working towards this model they have already quit hiring LPN's and have only 1 or 2 aids in an area and they are working on moving away from that. They say they want us to be able to provide total care....I think team work is best.

CASTLEGATES · Oct 31, 2009

I've mainly worked for only RN places and steer clear of mixed one's. It's proven to reduce errors and conflict (less chain of command, more accountability). Many places here do that still and I believe it's the way to go; always has been. I found the patient loads to be less because they justify your CNA by throwing more at you and guess who's doing the charting? CNA places the RN does more work in my opinion.

Sure have a cna to help a unit as a runner doing stuff and learning stuff but never assign a patient to one (an RN student preferably).

tothepointeLVN, LVN · Oct 31, 2009

The hospital that I did my final clinicals at had adopted a hybrid team nursing/primary approach. Each nurse had 5 patients and 2 of those usually the less intensive ones were primary care. I made friends with the nurses by always offering to take the primary care patients as my 2 patient assignment.

solneeshka, BSN, RN · Oct 31, 2009

I actually work on a primary nursing floor and the lot of us who started there did so because we liked the idea *in* *theory*. In theory, it's the best way to provide care because there is so much assessment data that you glean from doing complete care for a patient. Unfortunately, I don't think we are staffed properly and our ratios are way too high to do it right. As a result, it's like working a regular floor where the tech has permanently called in. Sometimes it's great, but that's only when we get a low ratio by a fluke (and by "low," I mean 4 patients, sometimes 5 if they're all pretty stable and ambulatory). Many times, we have 6 patients, and the acuity of patients on our unit can run pretty high (we generally have 1-2 "complete cares" each on a shift). It just doesn't feel safe and we have no time to do the "nursey" nursing things, it's all cleaning up poop, answering call lights, and passing meds. To sum, primary nursing = great, but only if the ratio is low.