RN total patient care... - page 3

I'm just curious how many of you work in hospitals that has gotten rid of all LPNs and CNAs. My hospital is moving in this direction and a few floors have went to RN total patient care. I don't mind... Read More

  1. by   hopefulwhoop
    My hospital is getting rid of LPNs, but there are no plans to get rid of CNAs. They are moving in the direction of having CNAs only on the private halls. Nurses on the semi-private halls will be doing total care with a proposed 4:1 ratio. I have a feeling that ratio won't stick...
  2. by   brithoover
    Quote from weemsp

    I'm wondering where in Canada this is the norm??? I've worked in hospital settings for more than 21 years...in ALL that time I've NEVER seen any unit without LPNs and CNAs.
    I'm in Ontario. I've been in 3 different hospitals and never seen CNAs. We do have LPNs but they take their own assignments. So RNs and LPNs are both doing total cares.
  3. by   jrsmrs
    Yep, same here. Also in Ontario, and each nurse here (whether RN or RPN) has their own load of pts, no help. If you're one of the 4-5 (days) or 6-8 (evenings/nights) pts assigned to me on my shift, I do it all. Vitals, glucs, physical assessments, meds, baths, toileting, attends changes, linen changes, feeding, communicating with docs or others, arranging for services, discharge planning/discharges, admissions, managing crises, etc, etc, it's all on one person. It's a lot, but we get it done. In fact, I kinda wonder if I might actually like this job if I worked somewhere that I didn't always feel pulled in 100 different directions.
  4. by   Caffeine_IV
    I don't like that idea especially on med surg with 5+ patients per nurse.

    I prefer having a nursing assistant to fall back on if I put someone on the bedpan and they ring to get off, if someone is a 2 person assist etc.

    I have worked without an assistant before when they fired 2 at the same time and it was horrendous. Bed alarms going on, constant running. We had to take our own patients to xray, ct, etc. We barely had time to chart. We didn't bathe anyone. There was no time.
  5. by   HouTx
    Very interesting discussion. In response to the "Canadian model" of having LPNs & RNs both doing total patient care... Most American nurse practice acts would not support this because there are clinical responsibilities that are RN-only. So the poor RN would end up having to perform these activities for the LPN's patients as well as his own. Not a good situation at all. It would be preferable for them to combine the load and divide responsibilities accordingly.

    The current trend in American nursing is to explore staffing models that support differentiated practice. Utilizing RNs to perform RN-only and higher level activities as well as assume responsibility for overall patient care management & supervising unlicensed or LPNs to perform tasks within their scopes of practice. This is a much wiser use of increasingly scarce labor dollars - more staff at the bedside for far less $ than an all-RN staff. All-RN staff will be limited to those areas in which patients are unstable &/or have unpredictable courses of treatment. It just does not make economic sense to pay RN wages for tasks that can be accomplished just as well by lower paid staff.
  6. by   brithoover
    LPNs in Canada (RPNs) have a VERY wide scope of practice here. In fact, I could probably count on one hand the things an RPN wouldn't be allowed to do on a med-surg unit. They are becoming more popular, and are much cheaper, thus utilizing the scarce dollars.
  7. by   loriangel14
    Up here RNs don't supervise PNs or assume responsibility for overall patient care. PNs are responsible for their own practice.
  8. by   BrandonLPN
    It should be pointed out, however, that the PN program in Canada is a two year associate's degree. Thus the Canadian LPN is equivalent to the American ADN. That explains their wide scope of practice, relative to most American LPNs.

    Perhaps we (in the US) should somehow combine the LPN and ADN into some sort of two-year degreed "technical nurse".

    Of course, this would be a huge slap in the face to currently practicing ADN RNs. I'm not sure how you could merge the two roles without causing a lot of hard feelings.
  9. by   VANurse2010
    I can tell you I'm not being slapped with a "technical" nurse label when I passed the same boards and already have a four year degree (albeit not in nursing) and only missing a few fluff courses in community health and "leadership"
  10. by   classicdame
    in our facility the floors have CNA's, but not 24 hours. If census and acuity demands, the CNA may be subbed for another RN. We do not hire LVN's. Pedi and ICU and PACU have never had CNA's (in our facility)
  11. by   Fiona59
    Quote from VANurse2010
    I can tell you I'm not being slapped with a "technical" nurse label when I passed the same boards and already have a four year degree (albeit not in nursing) and only missing a few fluff courses in community health and "leadership"

    I am a "mere" LPN but I also have a four year degree in another discipline.

    I work with LPNs who have Masters in their homelands.

    I also work with RNs who graduated from hospital based programmes and our old two year RN diploma. Their educations are in no way comparable to mine or many of my coworkers but they have the magic letters "RN" behind their name. They have held onto their status due to the granfather clauses and attending the same in house educational classes for new skills.
  12. by   classicdame
    I guess the point is licensure, not education.
  13. by   Fiona59
    Quote from weemsp
    Honestly, it's not a matter of the other nurses not " helping each other out".
    I think the point is..if 1 nurse is busy with an iso pt, total care...they can't just leave that pt to go answer a bell...( we agree on this point) But the real issue is...if 1 nurse is busy then it stands to reason that ALL nurses will have this problem. It's not a crazy notion to assume that ALL nurses can be occupied with one of their pts at the same time....THIS is what leads to call bells not being answered.
    And I've worked on many units where I've had more than 5 pts in one assignment.
    I would be careful with making the statement ".....American nursing"....
    We face the same challenges in Canada!!!!
    From some of your earlier posts, I thought you were working overseas with a humanitarian organization. How long has it been since you worked in Canada?

    I've worked on units with fresh discharges from ICU in addition to fresh post ops. Five patients or more are the norm in the evenings and nights.

    I can make the statement "American Nursing" because I've worked with more than a few American nurses when our health authority imported them several years back. They had absolutely no concept of team work for the first little while. Their patients were taken care of? Life was good. We cover each others breaks, we take unassigned patients to the toilet. We give pain meds to patients who aren't ours.h

    These nurses also loved our patient ratios and when we sat down and explained that they didn't have to take vacation days to be sick, they thought they'd died and gone to heaven. One woman who came from Texas was so anti-union that we asked her why she came north. When she realized she got sick days, vacation days, double time OT rates, family emergency leave days, education days all as perks of being in a union suddenly she wasn't so bad.