Primary Care Nursing at the VA

military girl · Oct 12, 2004

Hi to all,

I would like some feedback from some of the VA nurses out there.

On my floor they(management) has instituted primary care. I work on a very busy rehab floor. Before we went to the primary care model, we had a team leader who passed meds on 10 -13 people and a treatment person who did the treatments and baths. Each team had 2 people.

Now they want us to do primary care, each person can have up to 7 patients. We have to do meds, treatments, baths, and ITP(interdisciplinary treatment plans) on these people, plus summaries. Some of these patients are total care, and most of them need assistance getting in and out of bed. You have to answer your own lights.

Since we went to this model, there has not been an increase in staff. Most of the staff is overworked, stressed and frustrated. On midnights, the nurses don't have to do so much of the paperwork, but midnights is staffed with less nurses, but still have to care for the same amount of patients(currently between 37-38).

Just wondering what anyone thinks of this?

RNPATL, DNP, RN · Oct 22, 2004

Hi to all,
I would like some feedback from some of the VA nurses out there.
On my floor they(management) has instituted primary care. I work on a very busy rehab floor. Before we went to the primary care model, we had a team leader who passed meds on 10 -13 people and a treatment person who did the treatments and baths. Each team had 2 people.
Now they want us to do primary care, each person can have up to 7 patients. We have to do meds, treatments, baths, and ITP(interdisciplinary treatment plans) on these people, plus summaries. Some of these patients are total care, and most of them need assistance getting in and out of bed. You have to answer your own lights.
Since we went to this model, there has not been an increase in staff. Most of the staff is overworked, stressed and frustrated. On midnights, the nurses don't have to do so much of the paperwork, but midnights is staffed with less nurses, but still have to care for the same amount of patients(currently between 37-38).
Just wondering what anyone thinks of this?

First of all, I am an advocate of primary care. I like to be in control of what is happening with my patients on a given shift. However, primary care and the VA should really not be used in the same sentence. Here are my thoughts on the subject:

1. The VA does not support enough ancillary help to make primary care work. By ancillary support, I mean nursing assistants, transporters and health unit secretaries. Primary care means that the nurse has to perform all of these functions as well as take care of patients .... an impossible task!

2. Information technology at the VA is wonderful. In fact, I would say that teh VAMC is probably years ahead of other hospitals. The implementation of BCMA and CPRS are marvels ... that is for nurses that love technology (which I am one of). However, with technology comes down time and the need to use paper systems. Over my time with the VA ... primary care was great with the use of computer systems, except when there was a problem. And, when there was a problem .... it would take the government far to long to fix it! Several times had to deal with down time on BCMA .... which was a nightmare!

3. Caring for too many patients can cause the nurses to burn out and leave and this is one of the reasons that VA has the turn-over with RN's that it has. In addition, there is generally very little in place to support primary care .... maybe one med cart or two that 5 or more nurses need to access and share .... no PXYIS narcotic system ... so the nurses have to count narcotics on and off each shift .... that is sooo 1980's ..... anyway, those are my thoughts.

If the VAMC was serious about primary care, they should listen to nurses that want to make it work and use their experience to be successful!

BadBird, BSN, RN · Dec 6, 2004

Just another reason I transferred to Critical Care where the staffing ratio is 2:1, you are facing impossible odds.