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The Underestimated Benefit of Ancillary Staff

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Specializes in Pediatric & Adult Oncology. Has 10 years experience.

How are your units run? Do you have helpful tips to share?

Recognizing the major advantage of having ancillary staff as part of the team in any healthcare setting. The assistance they provide to both patients and nursing staff can improve patient satisfaction, decrease rate of nursing burnout and increase overall unit efficiency.

The Underestimated Benefit of Ancillary Staff

Having worked in multiple healthcare settings, many of us have seen how differently each unit can function. While no two units will be the same naturally, differences can be attributed to many factors, including patient acuity, management style, staffing plan/ratios, and much more. While several issues noted are frequently discussed and improved to better the performance of the unit, there is one topic that is somewhat avoided - the massive benefit of employing ancillary staff.

Years ago, I worked on a high acuity, high volume, outpatient Oncology unit. While we frequently treated around 100 patient per day (with limited nursing staff), we certainly didn't do it alone. Yes, it was busy - but always eventually manageable, mainly due to the assistance the nursing staff received from other members of the team. For example, we had a unit assistant to help answer the eternally ringing phone and direct calls to nursing staff only when necessary. They were available to help make phone calls on our behalf to track down patient transport, security, etc. The unit assistant cleaned the patient area after each patient, freeing up valuable time for us to prepare for the next patient. We also were fortunate enough to have a patient care assistant to help with vitals and comfort measures. (While nurses are always happy to get apple juice, magazines and warm blankets, we don't always have the time. Having a patient care assistant was not only a major benefit to nurses, but also to the patient's overall experience and comfort level - crucial.) Having a team of phlebotomists also made the patient volume possible. Without them being the first to lay eyes on the patient (calling nursing when something seems off), drawing labs, taking baseline vitals and weight - we never could have treated that many patients in a day.

After leaving that position, I experienced a very different setting on multiple occasions. One where there is very limited, to no staff - other than nursing. This leaves the nurse with so many non-nursing tasks on top of her regular duties that the patient is ultimately the one who pays the price, time for bedside care is extremely limited. Aside from the expected nursing duties (monitoring, medication admin, charting, etc, etc, etc, etc - so many tasks!), without ancillary staff, he/she is now additionally required now to allot time for answering the phone, making charts/copies, sending faxes, cleaning beds, restocking, running to the blood bank and pharmacy, and more.

Nurses are expensive. Is their time best spent performing non-nursing tasks? Certainly not when it is taking away from patient care, making it difficult to attend to patient needs and spend much needed time at the bedside. It can take up so much time on a busy unit that it in fact prevents nurses from taking more patients, limiting the unit capacity. This becomes a slippery slope in terms of hospital revenue, as well. When all of the budget is spent on employing only nursing and no ancillary staff - the hospital is not maximizing their return on investment. Units who do not employ any assisting staff members typically will not be able to treat and discharge patients as quickly and efficiently as one with a fully diverse staff could. When beds aren't filled or turned over as quickly, money is ultimately being lost. Nurses are burnt out faster, being asked to perform multiple roles with limited resources and time.

Is it possible to have a busy outpatient unit run only by nursing staff and management? Yes, but does it really make the most sense? I don't believe so. The benefits to having a robust and diverse staff are many. This can most certainly improve efficiency but more importantly, it can allow us all, as a team to provide the best possible care to our patients - while still holding on to our own sanity.

What are your experiences? What positions have I left out that have been most helpful to you as a nurse? How are your units run? Do you have helpful tips to share?

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19 Comment(s)

Sour Lemon

Has 9 years experience.

My hospital has a few CNAs, but many nights we're staffed with RNs, only. They also give us 2-3 med/surg patients each whenever possible (which is almost all of the time). I have to say, it's not a bad set-up. Although the CNAs we do have are wonderful, I don't really miss them. Four or more patients without support staff can get rough depending on the patients, though.

I do agree that it's not a cost effective way to do things ...my place even staffs 1:1 patients with RNs routinely.

mmc51264, ADN, BSN, MSN, RN

Specializes in orthopedic; Informatics, diabetes. Has 8 years experience.

We have a unit secretary that is invaluable! They know how to order stuff we need, order transportation for us (we can do it, but most like to track the admissions and discharges for bookkeeping purposes), they answer the call lights and tell us-the good ones "triage" for us to find out whether it is serious (go now) or not so much (I dropped me remote).

We have great aides. We have great phlebo. We also have some of the best EVS (housekeeping). They sometimes build a rapport with the patients and report back to the nurses. I work ortho, so we have a very close relationship with OT/PT/SLP as well. I think I can say that I work with an amazing interdisciplinary team. The only ones I don't have rave reviews for is our dietary staff. Some are great, many don't care if some eats or doesn't. It is sad.

brillohead, ADN, RN

Specializes in Cardio-Pulmonary; Med-Surg; Private Duty. Has 5 years experience.

I've been trying to pound into management's head that we need MORE aides to increase patient satisfaction and employee satisfaction and reduce turnover and burnout.

I'd rather have six patients with an aide than five patients with no aide ... that extra set of hands is invaluable, especially with the number of patients needing Q2H turns, brief changes, etc. (Less than 10% of our unit's patients are walkie-talkies.)

ICUman

Specializes in Cardiac Cath Lab. Has 5 years experience.

Sour Lemon said:
...my place even staffs 1:1 patients with RNs routinely.

Are you suggesting the hospital shouldn't do that? This is a common practice.

Sour Lemon

Has 9 years experience.

ICUman said:
Are you suggesting the hospital shouldn't do that? This is a common practice.

I think it's great, I've just never seen it before in med/surg for something as simple as a confused patient. I've always seen CNAs utilized.

missmollie, ADN, BSN, RN

Specializes in Neuroscience. Has 4 years experience.

If that is your real picture, you need to change it. Things are easily searchable or googled, even images. Be anonymous!

Ashley Hay, BSN, RN, BSN, RN

Specializes in Pediatric & Adult Oncology. Has 10 years experience.

missmollie said:
If that is your real picture, you need to change it. Things are easily searchable or googled, even images. Be anonymous!

Hi Missmollie,

Thanks for your concern but I have to politely disagree. I've worked in several healthcare settings over the years and this article was based on a collection of different experiences, not just one. I think it's important to openly (and constructively) discuss pressing issues that affect the nursing profession - as that is the only way things can move forward toward change. For example, in recent years more and more media attention has been devoted to sensitive topics in nursing like burnout, safe staffing ratios, etc. I don't feel a need to post this anonymously as the focus of the article speaks to the invaluable benefit ancillary staff brings to any unit. I'm believe that issues in nursing, not matter how delicate the topic, should be tackled with respectful, factual, open & honest dialogue. When all parties come to the table with an open mind, more can be accomplished and changes can be made effectively. Thanks for taking the time to reading this article - and for attempting to protecting a fellow RN 🙂

CardiacDork, BSN, RN

Specializes in Critical Care. Has 6 years experience.

A confused patient should get a 1:1 sitter not a 1:1 RN.

1:1 RN needs to be reserved for the sickest patients. ECMOs are 2 Nurses to 1 patient. The ECMO Nurse and the ICU Nurse. CABGs should be 1:1. Fresh POD 0 most cardiothoracic patients should be 1:1. So much to keep up with and you have to really be watching those lines and strains minute by minute. Fresh VADs too.

MikeyT-c-IV

Specializes in Vascular Access. Has 13 years experience.

I miss volunteers. My first hospital had volunteers on the floor to help pass ice, drinks, food, etc. They were incredibly helpful.

My current hospital uses volunteers to help direct people around the facility. With reductions in staff they would be such an asset on the floors.

Regarding RN vs CNA sitters, we usually use CNA's for our confused patients. Naturally this pulls a CNA off the floor leaving the unit short. In years past we also trained non-clinical staff to act as sitters. I don't think this is common practice in our facility, anymore.

Ashley Hay, BSN, RN, BSN, RN

Specializes in Pediatric & Adult Oncology. Has 10 years experience.

MikeyT-c-IV said:
I miss volunteers. My first hospital had volunteers on the floor to help pass ice, drinks, food, etc. They were incredibly helpful.

My current hospital uses volunteers to help direct people around the facility. With reductions in staff they would be such an asset on the floors.

Regarding RN vs CNA sitters, we usually use CNA's for our confused patients. Naturally this pulls a CNA off the floor leaving the unit short. In years past we also trained non-clinical staff to act as sitters. I don't think this is common practice in our facility, anymore.

Thanks for bringing this up! I completely forgot to mention volunteers - and I've worked with some pretty amazing ones. They are a huge asset to any unit.

JBMmom, MSN

Specializes in Long term care; med-surg; critical care. Has 6 years experience.

I loved my years as a volunteer. I think I had about 400 hours before I left for college. I played with kids on the pediatric floor, answered lights and brought things like water and tissues on the med surg floors- or passed the message that a patient needed help to the correct staff, I even got to participate in the community game time on the psychiatric unit. Sadly, the volunteers I see in the hospital now are limited to escorting patients out at discharge, they could be so much more involved, so everyone's benefit.

Ms.UndastoodRn

Has 9 years experience.

I worked in a very busy Neuro unit in Indiana with NO PCAs!! It was purgatory! The PCAs were unlicensed so they didn't do vitals, accuchecks, pass food trays or retrieve them, empty foleys, no I & O.....nothing. They could sit if you had a confused patient and maybe give a bath but mostly tell you everything YOU the nurse needed to do or hadn't done. It would've made a huge difference for that nursing unit who lost 6 nurses during my 6 week assignment. All were travel nurses and ratio was 5-7:1. Very dangerous conditions, license in jeopardy every shift. PCA, PCT, nurse tech, whichever your facility uses are GOLDEN!!! I respect anyone in their money making profession, but for nurses this part of the team is invaluable!! You need a village to take care of patients! Case managers, social workers, secretary's, phlebs, etc are all necessary to provide exceptional patient care.

sergel02, BSN

Has 3 years experience.

The staff makes it so much better! I was at a place that only had nurses and a secretary. No nursing assistants or phlebotomy. My new place has secretaries, nursing assistants, and a lab team who does our labs for us. It makes a world of difference.

Ashley Hay, BSN, RN, BSN, RN

Specializes in Pediatric & Adult Oncology. Has 10 years experience.

Ms.UndastoodRn said:
PCA, PCT, nurse tech, whichever your facility uses are GOLDEN!!! I respect anyone in their money making profession, but for nurses this part of the team is invaluable!! You need a village to take care of patients! Case managers, social workers, secretary's, phlebs, etc are all necessary to provide exceptional patient care.

Couldn't agree more. Thanks for your comment!

FranEMTnurse, CNA, LPN, EMT-I

Specializes in LTC, CPR instructor, First aid instructor.. Has 23 years experience.

Very well written article. Being a nurse myself, I have seen the necessities of all of the afore mentioned staff members, and as a patient who has needed most every type of support staff members including the healthcare team including the first responders who helped sustain my life. As currently being a home care client, I am experiencing a shortage of health care workers. I had a very efficient home care worker who was with me a long while, but due to a family necessity, she was forced to leave her job as my wonderful home care worker, and work at her first job full time in the hospital. She was the member of a fantastic home care agency that provides quality staff. I MISS HER SO MUCH!

vintagemother

Specializes in Med-Surg, Psych, Geri, LTC,.

Sour Lemon said:
My hospital has a few CNAs, but many nights we're staffed with RNs, only. They also give us 2-3 med/surg patients each whenever possible (which is almost all of the time). I have to say, it's not a bad set-up. Although the CNAs we do have are wonderful, I don't really miss them. Four or more patients without support staff can get rough depending on the patients, though.

I do agree that it's not a cost effective way to do things ...my place even staffs 1:1 patients with RNs routinely.

Nights...med-surg, no other pt care staff. 5:1 ratio. Plus 1 extra nurse per 10 pts. It's not working well some of the times.

We are facing a choice of losing a nurse and gaining 2 pt care staff members....

Tough choice. Because sometimes 1 nurse has 1+ pts in isolation rooms plus 2 pts at high risk for falls, with zero other staff members located anywhere within eye or ear shot.