primary care? staffing ratio?

[deedah72]

Hi, was just wondering if anyone does primary care at their hospitals with no nurse aides or techs. Our hospital has been leaning towards this idea. One RN will have 4-5 patients doing primary care with no techs or aides on the floor. I talked with a nurse one time from California and she said that the staffing ratio was an issue at one time, so the hospitals dropped the patient/nurse ratio for the RNs but then got rid of all the techs and aides for financial costs because of having to staff more RNs. She said that it was just as bad as having more patients and a tech to answer call lights, toilet etc.... Any thoughts? I'm currently an LPN and transitioning to RN so I'm closely watching the RNs and what they go through. By the way I did send my email to my congressman from the ANA website to pass the patient/ratio act.

[CABG patch kid, BSN, RN]

We do primary nursing at the hospital I work on, at least at nights (I think that they have a few aides on day shift but they are few and far between). I'm happy with it for the most part, but there are some nights that I wish I had an aide there to help with all the bathroom trips my patients need sometimes! But in the grand scheme of things, I would rather do all the aide stuff myself and only have 4 patients to do med pass, charting, reviewing orders on, etc etc. Also, this is my first job as an RN so I have nothing else to compare to, but overall I like my ratio and do just fine without the aides. All of the nurses on my crew depend on one another to get things done!

[loriangel14, RN]

I am an RPN in Ontario and where I work we do primary care with no aides. I prefer this because then I see everything first hand and do not need to rely on someone else's assessment of the pt. Usually pt assignment is 4 pts on days and 6 on evenings. It is the same for RNs and RPNs. We do work as a team though to get everyone done, especially on evenings.

[deedah72]

I guess that is were the difference lies, the teamwork, I don't see very many RNs on our floor helping each other out, it's basically your patients, my patient kinda thing. If someone is really drowning, there are a few that will give an iv pain med for them or start blood sometimes but for the most part your on your own. On occasion when I'm afforded the opportunity to take a patient load (I'm an LPN), I enjoy the primary care because you know everything first hand about the patient.

[MNmom3boys]

It totally depends on the shift for me - I have done shifts w/ NAs and shifts w/o. The "difficulty" of a given shift for me is more dependant on the acuity of the patients rather than the presence or absence of NAs. The NAs on my floor tend to be worth their weight in gold when they are staffed, but I have also had really rough shifts when they were working and really rough shifts when they were not.

We have to staff by a grid that takes number, but not accuity (fresh post-op pts!) into account. We have between 3-5 patients, and on days when the patients are a day or two out of surgery it is doable w/out a NA, but it only take one fresh post-op w/ poorly controlled pain or nausea to make me wish mightily for a good NA to help carry the load! (Although the other RNs on my unit are fabulous about teamwork also!)

[Becster]

I work on a Med-Renal unit. We take 3-4 patients during the day, 4 eves, and 5 at night. On days and eves, the charge nurse does not take patients but at night, the charge takes 4. I am one of the few that works 12 hour shifts, so I typically have 4 patients. I am running most of the day. I feel like it was a good day if I get a full lunch and one 15 minute break without OT. I feel like our acuity is relatively high for a medical unit because of the renal aspect. These patients tend to have a lot of comorbidities. We also do peritoneal dialysis for the entire hospital so there are times that the charge is off the floor doing this. We have remote telemetry capabilities in several rooms, but do not hang cardiac gtts. We do titrate insulin and heparin and are part of a pilot program that screens for MRSA on admit so we often end up with a large number of patients on isolation precautions. We try to work together, but there are times where you cannot find anyone to help you with a turn or to get someone up to a commode. It's been very stressful lately.

My question is, what are other facilities doing to make total care work? How do you assign your patients so that the workload is distributed fairly? How are supplies set up? Is your unit set up in the standard rectangle with the nurse's station in the middle like ours or do you have a set up that puts your rooms in better view? Are you computerized or still on paper? What is the acuity on your units? Are your patient mostly independent or do you have more patients who need assistance with all ADLs?

We are meeting with management later this week to discuss staffing issues and would like to have ideas to make things more managable. Any tips would be much appreciated.