So I am a relatively new RN.....maybe 15 shifts or so being on my own......I get in to work yesterday and see thy have made me "primary" for 4 very sick patients. All 4 strict contact iso, extensive IV therapy, diuretics, laxatives, to the second pain management...the whole nine yards......vents, trachs, dead weight unable to help with their care at all....
I found that during the shift I was basically a half-a__ed CNA and a half-a__d nurse.
Anyone else have experience being a "primary" nurse?
What are your thoughts?
Personally I told them that I won't do it again until I have more experience and that when I do I think 3 pts would be much more doable......
The good news is that I probably lost 5 pounds worth of sweat
Where I am, primary nursing means that there is no CNA......there is only me......so if I go in to hang a piggy pack and the pt is covered in poop then I have to priotitize, hang the IV first or clean poop lol
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
RN In FL said:
To me.....Primary nursing IS NURSING! Some may call it "being a half a** CNA", but if you are organized, with a CNA, then it can be done. If you are scatter-brained and are unable to prioritize....then HANG IT UP!, you will dislike primary nursing. I feel the key is to get your patients in order at the beginning of the shift and things will flow...especially on a med/surg unit. J/S
The OP is employed in an LTAC...long term acute care....... and most likely has 4 medically complex patients 2 of them trached, vented on a cardiac monitor having weaning trials and the others could be totals as well with complex designs, chest tubes and a halo traction with tube feedings total care and medically complicated hospital courses.
These patients are challenging to even the most seasoned of nurses. I have seen patients on the general floor in a LTAC that were higher acuity than the ICU down the road. Every hospital dumps/places these medically complex patients to these facilities. They are licensed acute care but care for patients long term. All of these medically complex patients, from multiple facilities, are under one roof one one floor.
There are better tasks that can be accomplished by the aides so that the RN can accomplish the tasks that require a license.
The OP is a new grad and I Think it is a little precipitous to "Hang it up" which reminds me...mindlor I don't know if I have shared my brains sheets before......
I made some for nursing students and some other an members have made these for others.....adapt them way you want. I hope they help
My nurse educator told me that a good nurse knows that each shift they will have 100 tasks to do but they will only be able to do 70, Therefore they must choose which 70 are not going to get done.
Cool.
The only problem is that with our charting system all 100 must be checked off, therefore if I follw the advice of this person.....I will have to lie 30 percent of the time......
I have the full support of my Nurse Manager...many are scared of her but I communicate with her honestly and I think she really appreciates it. She really is awesome. She is new to the favility and also hates the computer system that we use lol......
What scares me is that at any given time I am juggling so many balls, if I drop one that happens to cause great harm then my license will evaporate.......its pretty scary....
LOL thank you GrnTea. It is getting better My specialty is managing family and I have gotten and given many hugs......I just widh I had more time to really provide the care that I want to provide.....
Specializes in Managed Care, Onc/Neph, Home Health.
Esme12 said:
The OP is employed in an LTAC...long term acute care....... and most likely has 4 medically complex patients 2 of them trached, vented on a cardiac monitor having weaning trials and the others could be totals as well with complex designs, chest tubes and a halo traction with tube feedings total care and medically complicated hospital courses.
These patients are challenging to even the most seasoned of nurses. I have seen patients on the general floor in a LTAC that were higher acuity than the ICU down the road. Every hospital dumps/places these medically complex patients to these facilities. They are licensed acute care but care for patients long term. All of these medically complex patients, from multiple facilities, are under one roof one one floor.
There are better tasks that can be accomplished by the aides so that the RN can accomplish the tasks that require a license.
The OP is a new grad and I Think it is a little precipitous to "Hang it up" which reminds me...mindlor I don't know if I have shared my brains sheets before......
I made some for nursing students and some other an members have made these for others.....adapt them way you want. I hope they help
Oh my, I totally stand corrected. I BEG YOUR PARDON.
I have found that when I'm forced to wear two hats, CNA and RN, I don't wear either adequately. I go home feeling like a loser because I'm not proud of the way I performed either job.
It doesn't happen often, but I hate it. I don't mind "helping" the CNA, but I don't want that job on top of my own.
Since when did doing CNA duties become "not your job" as a nurse? CNA duties ARE nursing duties, just delegated. Whether primary nursing or team nursing, you're still responsible to make sure they get done.
I love primary nursing. I have the clearest picture of my patients because they're mine, shared only with a CNA. I know everything that happens with them because I'm either there or talking about things with my tech. I am responsible for everything and the overlap and potential for error between caregivers is minimized.
I was floated to a floor a few weeks back where team nursing was the standard. It was so disorganized. My CNA and LPN didn't do their jobs even though we discussed and agreed on delegated duties at the beginning of the shift. If all hell breaks loose and the shift goes down while I'm the primary nurse, I have 4 patients that I am totally responsible. Yes, it sucks sometimes, but it's manageable. If all hell breaks loose in team nursing, I'm totally responsible for 8 patients. The advantage is undeniable, at least in my situation.
In my neck of the woods, "primary nursing" means no techs...so the nurse does all with no real assistance. ALL of the ADLs, code browns, feeding, blood draws, I & O's etc. on top of nursing duties. No backup when you have multiple patients on bowel preps or an entire team of fall risk patients. And since every nurse is doing everything for their patient without any UAP assistance, it means that everyone is running their butt off and just can't help each other out much.
It makes no sense to me...puts the patients at higher risk as well as causing a more rapid burnout.
It really is tough being on the floors. Eventually it will get slightly better with more experience, but it will always be very tough work. No one said it was easy, they just said it would be worth it. I hope it is worth it for you.
Primary nursing on a med surg floor would be wonderful... if it were practically or economically feasible. It works on an ICU floor because the ratios are 1:1 or 1:2. And even most ICUs I've seen use techs. On a med surg floor the only way for a RN to provide total (no aide and no LPN) care would be if said RN had 3-4 relatively independent patients. In what parallel universe is *that* going to happen?
Team nursing means more hands on the floor. True, it also means fewer of those hands are RNs, but more staff equals more care. And if the tasks are delegated appropriately, the level of care is 100% as safe as any primary care model. I will be the first to say that a LPN is not equipped to fully assess and manage care for an acutely ill pt. But a LPN IS as fully equipped as any RN to administer meds, monitor vital signs, dress a wound, insert a catheter, down a NG, maintain a IV, etc. And thus the RN is freed to take a larger pt load and focus on managing overall care and keeping in close contact with the doctor. And the CNA is freed to actually bathe and ambulate and feed and toilet and all the other things that fall to the wayside at the hospital. Team nursing just makes sense to me. Maybe I'd feel different as a RN, but I doubt it.
My specialty is managing family and I have gotten and given many hugs......I just widh I had more time to really provide the care that I want to provide.....
TheCommuter, BSN, RN
102 Articles; 27,612 Posts
OP is a new nurse. Perhaps it is way too early in the game to tell him to hang it up. It takes some new grads a year or two to find their groove. ?