RBC/Primary Nursing.. Oye!

[Nurs0706]

Hi Everyone!

I am a RN on a med-surg (primarily surgical) floor at a large teaching hospital. Our floor is one of four floors designated to be the first "wave" into the relationship-based care (RBC) implementation. We had our kick-off date with our recent changes on May 12th, and are currently utilizing the changes we created during the preparation process.

My questions and concerns are if anyone has had a negative impact with RBC? To be honest, I find myself very cynical about the entire deal. Not that the idea behind it is bad, but instead the process that it entails and the influnce from the administrators. The first meeting I attended the administrators and individuals from RBC said that it was "Exactly what we (as nurses) wanted." That sentence still fascinates me, especially because we as nurses had no say in who the hospital hired as consultants to change the care model. In addition, we were never really asked if this RBC thing was what we wanted it all. They basically said it was our choice to what we wanted to do, however if we say anything negative or want to make any changes that we really think would be good for the floor, they say that we aren't "postive" enough and basically get our ideas shot down. I am on the RBC board and although some employees seem to be enthusiastic I find myself boiling inside from my frustrations with the process. The changes that are being implemented often include more paperwork and tasks which are taking away the idea that primary nursing is supposed to ensue - and by that I mean a relationship with the patient and the care and attention provided to them. Plus I hate going to meetings where people read me "motivational" poems (which I feel are a lack of time and make me feel like a child) and tell us that we need to take care of ourselves, yet at the same time say everything must be patient-focused. This is not a bad thing, but when it starts to influence the schedule, employee's lives at home, health, and overall well-being, then you will start to lose staff due to unhappiness. I think staff needs to be kept happy too because if the staff begins to leave and there is limited to no staff to take care of the patient, then RBC wouldn't even be possible.

I honestly can say that I feel like this is all being forced upon us by administrators that do not even work on the floor, and is a huge driving force for them because it will probably help to get the hospital magnet status, which means that the hospital will "look good" most likely at the nurse's expense. The concept is a good one. That the patient will be well-cared for. However, I think RBC nursing also avoids so much in what is really important. Nurses are skilled in so many aspects, not just "care" in the sense of sitting with the patient or providing comforts. Nurses are knowledgeable, address life-threatening conditions and necessary treatments, administer sometimes dangerous medications and monitor their effects, utililze technological competence, and participate with so much more in the holistic few of the patient. I believe in order for nurses to gain social acceptance and increased respect that these skills should be showcased and made aware of to the public. I feel that RBC sometimes makes the profession of nursing look like fluff.

Does anyone else feel this way about RBC nursing or am I just nuts?

Thanks!!! :)

[Cindy-san]

I'm still on the fence about it. It sounds like a good idea, but good ideas don't always end up being good things.

For my unit, a Primary Nurse is supposed to build a rapport w/ the family and be their "go-to" person for troubles and concerns. We talk to the pt's current nurse, get an update on what's been going on w/ the pt while we've been off, see what issues need to be tended to (PT eval, get nutritional support started), see if the family has any concerns, and so on. We can also request to be assigned to our Primary pt (we're only supposed to be Primary Nurse for one pt at a time).

Some of it is kind of pointless, I mean, if they're still 'tubed & going to stay that way, they're getting nutrition by day 2. Almost all of them get PT evals. Most of the stuff on our little "checklists" that we monitor for the patient aren't really much of an issue to get done. And that's really it for the paperwork, check-off and date when stuff is done, and add in a needed goal or concern when it comes up.

It's nice in other ways, b/c with the long term pts, someone is familiar w/ the various events that have been going down w/ these pts, and you can ask them about it (like: have they been having issues with...?)

It sort of goes back to what I was doing at my old job, I am a nosy person & I like to know what's going on (particularly when I see someone I cared for still around, I start wondering why they're still here). The families of ex-pts always liked to talk to me, so I tended to end up involved one-way or another.

We've only had it for a short period of time, but I haven't seen any issues with it, aside from people not wanting to do it.