Admin Cuts PCTs in ICU

  1. Dear Nurse Beth,

    I work in a
    20 bed MICU that decided to lay off our PCT and only have one unit secretary. This means the RNs have to transfer patients, wash down the monitor leads, restock our nurse supply chart, remove the linen and garbage. We have a tight RN staff according to the number of patients. That means more responsibility for the RN that the PCT did for patient care, blood draws, blood sugars, help with turns, wound dressing changes, Of course we can do this, but it gave us time to spend more time with the patient and their family. Is this the future of nursing? What can we as the RN staff do to make the administration understand this is not working and need our valuable PCTs back?

    Dear No PCTs,

    Every RN knows the value of PCTs and CNAs. We love them. They keep our patients clean and cared for. They assist RNs so we can work at the top of our licensure. No good can come of getting rid of PCTs. It's a shame when admin sees them as disposable and an extra cost.

    Admin looks at the bottom line and is concerned about quality measures to the extent that they affect reimbursement. Often decisions are made that are short-sighted and costly in the long run but money is "saved" in the short term. It flies in the face of logic to enlist the highest-paid employees (RNs) to empty trash and stock supplies.

    As my Dad would say, it's stepping over a dollar to pick up a dime.

    Cutting support staff can result in higher RN turnover and lower patient satisfaction scores. Pressure injuries can develop from lack of turning-all to save the cost of paying a PCT's salary. One complex pressure injury can cost the equivalent of a year's salary.

    Nursing leaders have a responsibility to advocate for their staff and for patients, but this can fall on deaf ears, and some leaders are afraid to speak up. The structure and politics of a hospital can mean that the PCE's vote is not equal to the CFO or CEO's vote. Eager CFOs rush to show that they can save the organization money, and nursing concerns are trumped.

    Historically, poor decisions like this are reversed when poor outcomes start to happen, and the pendulum swings. Again, it is driven by the bottom line.

    Let your manager know your concerns. If you have a unit based council or shared governance, express your concerns through that structure. Be specific about tasks that are not getting done, such as regular turning or mobility.

    Use any change in metrics to show that care has suffered, such as pressure injury prevalence or falls. Best wishes.

    Nurse Beth
    Author, "Your Last Nursing Class: How to Land Your First Nursing Job"...and your next!

    Last edit by tnbutterfly on Nov 13
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    About Nurse Beth, MSN, RN

    Joined: Mar '07; Posts: 1,534; Likes: 4,543
    Nursing Professional Development Specialist; from CA , US
    Specialty: Med Surg, Tele, ICU, Ortho


  3. by   sepulveda
    I'd say that it's unfortunate that PCTs have been cut. I also work in an ICU and though we have PCTs, I would say that they are rarely used. This is probably due to us recently getting them only 6 months or so ago. We are so accustomed to providing full patient care that we often forget that they are available. I mostly give them stuff to do, such as EKGs, because they are bored and begging to do something.

    I guess what I am trying to get at is that you will get accustomed to not having them. I compare it to dishwashers. If you've never had a dish washer and move into a place that has one, you might ignore it and continue to wash dishes by hand. However, if you've always used a dishwasher, you may find the transition to washing dishes by hand a little unconvenient.

    The transition is more difficult when going from having to not having than the other way around. I'm not saying that it doesn't suck that you lost the support you're accustomed to having; I'm saying you work with what you have and it'll get easier.