My all-nursing unit is considering hiring PCTs, looking for advice.

[sam95UAB]

Hi everyone!

I am a new nurse (8 months) currently work on an all-nursing medical-surgical unit with 30 beds. Our current nurse/patient ratio is 1:3 when fully staffed. Our ration would change to 1:4-5 with 2 PCTs

Currently, there are no PCTs/CNAs on our floor and we do not have a float nurse.

We are voting on getting PCTs and I am not sure how to vote. This is the only floor I have worked on, so I don't have much to compare my experience to.

My patients are adults, 1-2 of my patients are bed bound and require bathing and turning during my shift. Sometimes, our patients need feeding as well. Many of the patients I care for would be in step-down units in smaller hospitals.. My unit is also known for having difficult to handle patients, we take patients that every other hospital in my state refuses to care for..

How do you feel PCTs impact the care of your patients? I feel that whenever I am handling a MET call, passing medications, or hanging blood, often times it is hard to balance other priorities like feeding and bathing as well.

Thank you for the advice :)

[Sour Lemon]

1:3 in med/surg with no CNAs is pretty ideal, assuming that the nurses you work with are team players. The thing about CNAs is that they can be really good, or really bad. So, are you a gambler?

[brownbook]

What is a MET?

I can think of just as many CNA's who do the least possible, as RN's. Fortunately have not had to work with many of either.

[NurseCard, ADN]

1:3 with no PCT's sounds fine. I work on a similar but smaller unit. We do not

use PCT's and can at times have 4-5 patients to ourselves. That's tough of

course, but 1:3 works well. I like that I'm the one doing the vital signs and

looking at my patients' skin.

I would rather not have to deal with PCT's, having to supervise them.

I would vote no. That's just me though.

[brownbook]

I didn't really answer the question. Being a COB, CNA's were the norm in my 20 years of acute care bedside nursing. They all knew their job and did it well. It never entered my mind that I had, to or was supposed to, be supervising them.

And I still don't know what a MET is?

[adventure_rn, MSN, NP]

Not really answering your question, but it seems as though the transition from no PCTs to using PCTs would be challenging. There's so much collaboration, delegation, and teamwork that goes into ensuring that everything gets done in an organized, timely matter. In school, I remember my instructors talking about how learning to delegate effectively (and knowing when not to delegate) was one of the hardest skills for new grads to learn, along with time management. Since the workflow change would be totally new for the current nurses and the new hire PCTs, I'm guessing the interim period would be very hectic. It may be worth it in the long run, but if you do make the switch I'd prepare for some challenges during the adjustment period. Do you have nurses on your unit who have worked on other units which utilize PCTs? I'd look to them for guidance and insight if your unit does decide to make the switch.

[bblondon]

I didn't really answer the question. Being a COB, CNA's were the norm in my 20 years of acute care bedside nursing. They all knew their job and did it well. It never entered my mind that I had, to or was supposed to, be supervising them.

And I still don't know what a MET is?

A MET call means there is a patient emergency or change in vitals etc. It stands for medical emergency team.

[zoidberg, BSN, RN]

Side note, you would probably want 4 techs for 30 patients. With 15 patients per tech, just getting vitals Q4 would keep them busy. Even getting close to 10 patients makes it to where the tech is not going to be able to do as much for you. And, with that patient load, your tech turnover is going to be crazy.

[bugya90, ASN, BSN, LVN, RN]

We use PCTs and I love them! We have a 28 bed unit and on days we have 3 PCTs (assuming all bed are full and don't have to float anyone). One PCTs is the unit clerk and takes 4 patients in the rooms closest to the Nurse's station and the other 2 PCTs split the rest so it's fair (Ad Lib, total cares, etc). PCTs are responsible for all baths, passing meal trays, and the afternoon vitals (nurses get the morning vitals as part of the assessment). PCTs do most of the toiletting but nurses are also responsible for this so whoever is available should be he one helping the patient to the restroom. PCTs are also great to have for the patients that require x2 for lifts. On the other hand if you have a lazy PCT that tries to hide out all day, your day will be a nightmare.

[Snatchedwig, BSN, CNA, LPN, RN]

On my floor I cant possibly handle my assignment without CNAs. On a good day I have 5 patients, on a normal day I have 7. Majority of my patients are vented with complex comorbilities. With the help of the CNAs(which are all amazing at my hospital. I worked with some pretty bad ones at previous facilities) I am actually able to spend more quality time with my patients. Without the CNAs, there is no way i can juggle a patient with a potassium of 7(+ ischemic bowel) on a ventilator with 6 other equally complicated patients. I LOVE the CNAs.

[AJJKRN]

I think it's all in how they will be expected to perform (I say this as I myself was a CNA for years going through nursing school).

If the CNAs work together with the nurses AND with each other then it may be worth it. Right now I can have anywhere from 3-4 stepdown patients or 5-6 floor patients but I still feel like I'm doing all the work because I still help the CNA to turn all of my patients or give baths, my vitals and blood sugars if I need them early, etc or I end up doing it alone...

I would much rather just work with other nurses that are held accountable to team work with 3 floor patients than spend all the time I do either babysitting or working just as physically hard as I do with the CNAs.

For perspective, I'm also a float nurse and on not one floor in my hospital do the CNAs work together but instead just get the patient's nurse or another nurse to help them. Now if they were trained differently and expectations were to work together between CNAs then I might feel a lot differently about the subject.

Oh I just thought of this...so where exactly are the "extra" nurses going to go if CNAs are added to the matrix?

[MilliePieRN]

I'd choose 1:3 with no pct's over 1:4-5 with minimal pct's any day. Vote no... sounds like you're trading nurses for techs and that's not a good trade.