RN total patient care...

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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 doing everything myself, but I hate the fact that when I'm busy in a patient's room and I have other call lights going off, there is no one to answer them. The unit clerk will sometimes answer lights but they can't do patient care and usually page me to tell me someone needs to go to the bathroom. It's just very frustrating.

Specializes in Med/Surg, Academics.

Easily two-thirds or more of the patients on the floor I work the most are total care. For hospital floors to even think about RN total care, the ratios MUST go down and the redundant or just plain stupid charting must be eliminated. It's that simple.

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We have something like that, but there are 2 CNAs on the floor for 30 patients. They take vitals a d do I & Os, occasionally change or bed or two. They Help as needed but have no direct responsibility for any of the patients. Most of the time they only do vitals. It is not a good system.

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I'd happily do my own vitals and I&Os. I just wish we had CNAs to answer lights when we are busy with other patients. I felt so bad the other night when I was tied up in an isolation room and I could here one of my other pts call lights ringing forever. I finally was able to get to it and it was a lol who peed her bed because I wasn't able to get to her in time. She felt ashamed and I felt HORRIBLE! Like I said in my original post, I don't mind doing primary care, but I just hate in when my other patients get neglected while I'm busy with someone else.

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This is something I just don't understand about American nursing, don't you help each other out?

If the call bells are ringing in other rooms and I'm free, I answer them as does everybody on my unit. The unit clerk isn't allowed to answer them and heaven help you if the Unit Manager finds out you're ignoring the bells.

On surgical units it's 3 RNs, 3 LPNs, 2 NAs, and a Charge RN. Every nurse is responsible for their patient's care. The NA is there for two person care and if you are really lucky they'll shower your patients. Depending on the NA, they might empy your colostomies and foley's..

It's five patients, their care, their meds, their dressings for each nurse.

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Specializes in Pediatric Cardiology.

We don't have LPNs but we do have CNAs and I would be lost without them. I couldn't imagine doing everything I do now PLUS bathing, toileting, VS, feeding.. and so on. I could do it with 3 patients but not with the current 5 I have with admits and discharges.

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Specializes in ICU.

Fiona59, maybe American patients are just demanding. Half of the time all of the nurses and all of the CNAs on my floor are tied up in patient rooms. When there is no one at the nurses' station at all, there is no one to answer call lights, answer phone calls, call the MDs, etc. There is a reason I'm not working on my floor when I get my first RN job. We help each other when we can, but there is usually too much to do with too few staff. No one has free time to help anyone else. There have been lots of days as a CNA where I don't get a lunch at all on a 12 hour shift and I have held my bladder the entire 12 hours because there was just too much to do to "waste" time urinating. It sucks.

I would only be a fan of total care in an ICU setting, which is where I am doing my preceptorship. For one, most of the patients are unconscious so you can't get stuck in a room because the patient keeps asking for things, and secondly there are only a couple of patients per nurse. Any floor where the patients aren't sedated should not have total care, IMO.

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Total care is the norm in Canada.

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.

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This is something I just don't understand about American nursing, don't you help each other out?

If the call bells are ringing in other rooms and I'm free, I answer them as does everybody on my unit. The unit clerk isn't allowed to answer them and heaven help you if the Unit Manager finds out you're ignoring the bells.

On surgical units it's 3 RNs, 3 LPNs, 2 NAs, and a Charge RN. Every nurse is responsible for their patient's care. The NA is there for two person care and if you are really lucky they'll shower your patients. Depending on the NA, they might empy your colostomies and foley's..

It's five patients, their care, their meds, their dressings for each nurse.

Fiona...

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!!!!

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Specializes in Acute Care, Rehab, Palliative.
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.

But even if you have PNs on the floor, they have their own assignment. They aren't there to be handmaidens to the RNs.

Many hospitals in Canada don't have aides and the RNs and PNs do their own cares.

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Since RNs (deservedly so) make substantially more than CNAs and LPNs, any possible "all RN" staffing model will result in less nursing staff on the floor no matter how you look at it. That's just an economic reality.

Yes, maybe an ICU level acuity floor can get away with this due to the fact that their acuity level already demands a 1:2 RN ratio. So the ICU is irrelevant to the subject at hand. We're talking about med/surg floors here.

Less hands on the floor is never a good thing. A 30 bed unit would need at least ten RNs per shift for this to be safely doable. Maybe an ultra posh, metropolitan hospital that caters to rich and powerful clientele could afford such staffing. But most hospitals in America? No, not doable.

Now, take that 30 bed unit and add some LPNs/CNAs. For the same amount of money you could have 5 RNs, 5 LPNs and 3 CNAs. More hands on the floor is safer. And, for the record, I'm not saying these LPNs should take their own pt assignment. They should work in a team with the RN. In this model, each RN would get 6 pts. This is VERY doable when each of these RNs has their own LPN working next to them. The LPN could pass most meds, do the treatments and scads of tasky stuff. Think how much time that would free up for the RN. And, on top of all that, there'd STILL be 3 CNAs running around the floor to boot.

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Specializes in Oncology, Med-Surg.

It is so not doable! I worked on a busy Onc floor. RN assignment was 5 patients. Went in one day and without any warning, they announced that they did away with the CNA's and we were to do total care. It was a nightmare! I couldn't get most of my nursing tasks done because I was so busy toileting, etc. Had a patient code while I had another one on the toilet and couldn't get to her, so she tried to get up on her own and fell. I could go on and on about that shift. It was so unsafe! I quit after my shift and so did two other nurses.

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Last night wasn't doable! Got slammed with admits, was a full moon, and I didn't sit down once! No break whatsoever! Sorry...had to vent. "/

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Specializes in Med/Surg, Academics.
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.

I also want to add that even if all nurses aren't busy with patients, we are required to do charting. If I don't carve 10 minutes here, 5 minutes there, out of my day to go brain dead at the computer doing the required charting, I will NEVER get it done. Where I work, the phones we carry are constantly ringing...so much so that my patients have commented on it repeatedly.

The unit secretaries (especially one of them) are usually wonderful about answering from the desk, discerning needs, and fulfilling needs if a nurse isn't required to carry out the task. One unit secretary, however, is awful, and she "protects" the CNAs. A patient needs water? The nurse is called. A patient needs toileting? The nurse is called. She always starts out with, "All the CNAs are busy." RNs work 12s, CNAs work 8s. This particular unit secretary has actually called to tell us of these minor needs not requiring an RN DURING SHIFT CHANGE and stating "All the CNAs are busy."

Phlebotomy also has issues. They come to the floor, a pt is out for a quick diagnostic, and they will call to ask us to call them when the patient comes back. I have said no every single time, but I give them an ETA based on the diagnostic and the time of departure. Your workload, you manage it.

Sorry, this turned into a rant! :D

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