Working in MedSurg with ONLY RNs...

[newgradnurse2018]

Hi! i'm a new grad Canadian nurse working on a medsurg floor in a main hospital downtown Toronto. The entire floor is RN only, so we don't have any techs, RPNs (LVNs) or anything of the sort.. Which boggles my mind because I have to balance giving meds, cleaning up bowel movements, brief changes, and even feeding between 4-6 patients depending on whether I work a day or night shift. Day shifts I usually have 4 patients while on nights I take care of 6.. My friend who lives in the US (Texas) says most floors in the hospitals there have techs and LVNs who take care of the cleaning, feeding, taking vitals, etc. Are RN only units common in Canada or something? Is there a funding issue? Because the burnout is ridiculous....

[Horseshoe, BSN, RN]

Getting admitted to a university programme has become increasingly hard. My local uni requires an 90% in the required Grade 12 subjects. They admit 120 pupils a year. They usually have over 1200 applicants for those seats.

The union that bargains for RNs is different from the union that bargains for LPNs.

Remember that Canadian healthcare is funded by the taxpayer. The trend is to reduce the number of RNs in acute care because, frankly, they are getting too expensive to employ. I'm an LPN at the top of my pay scale. I make $35/hour. An RN with the same time served is making $50/hour. Units such as mine don't need a high concentration of RNs. Basically two per shift and the other six nurses are LPNs. The RN union doesn't like it but they negotiated hard, got the money and have in some areas priced themselves out of jobs. ORs have one RN and one LPN in the theatre. Our NICU's are hiring LPNs. Our Cancer Clinics (think specialized hospitals) are increasing their LPN staff. Really the only units that remain solely RN are ICU and PICU.

So what you have are high school students who don't make it into uni for nursing becoming LPNs. Career changers without degrees become LPNs (my intake had two teachers and a marine biologist). Many plan to try and find a bridge to move on. Many don't because the cost is high, numbers are limited in the bridges. In my province if you make it through the bridge, your final placement can be anywhere in the province, not necessarily near where you live. I have a friend who had to do her final placement nine hours from where she owned her home, she hasn't found an RN line yet and is still working as an LPN. Remember just because there are jobs posted doesn't mean our employer is going to fill them.

Okay, that makes sense to me now. Thanks for the clarification.

Because the RNs will have additional responsibilities that the RPNs do.not. Like being in charge, being a resource for new staff, taking over care of a patient if they become unstable, etc.

I have had RPNs say they don't want to become RNs because of the increased responsibility.

The difference in pay is over $31,000 per year (approx). That's pretty significant for the difference in roles described above.

But money is obviously not always the driving factor. I got very lucky. The guy I married with not a dollar to his name but full of intelligence and ambition turned out to be very successful in business. I bring this up from time to time not to brag, because these are not my achievements. I just benefit from them in that because of his professional success, I don't have to be driven by financial motives when making my job choices. I work PRN and have taken jobs that pay less just because they provide me with so much flexibility.

I realize I'm very lucky in that regard, but I know that most people have to consider $$ when making choices regarding job and education. $31 K in additional salary for so few extra responsibilities seems like a no brainer to me, but clearly my own situation is evidence that money is not the sole consideration in many of our life choices.

Thank you both for explaining how the thing works in Canada. I've always wondered.

[caregiverology]

The unit I work on typically has nurses caring for 4-5 patients on dayshift and 6 on nightshift. However, we do have 2 CNAs with 9 patients each on days and nights. Even with this workload, things can get overwhelming quick. There was another unit in the hospital that tried to do away with CNAs and just have RNs, but it didn't work out in their favor and they ended up hiring the CNAs back.

[ffooxx]

I also work in a major Canadian city, my unit is considered acute/RN only - we have one patient care assistant for our entire unit, so naturally most times you end up doing everything yourself.

We live in a country that provides free healthcare, of course we are on a tight budget.

[Fiona59]

I also work in a major Canadian city, my unit is considered acute/RN only - we have one patient care assistant for our entire unit, so naturally most times you end up doing everything yourself.

We live in a country that provides free healthcare, of course we are on a tight budget.

Now, now, healthcare isn't free. We're taxed up the ying yang.

[ffooxx]

Now, now, healthcare isn't free. We're taxed up the ying yang.

You know what I mean, yes technically we pay for it with our taxes - however, we definitely do not have the financial resources available to the US hospitals.

[Joyce37]

In the province of Quebec, I saw a medsurg floor with:

- 1 RN

- 1 RPN

- 1 orderly

for 11 patients

[Tenebrae, BSN, RN]

For those of us not in the know, what is an RPN

[NurseCard, ADN]

For those of us not in the know, what is an RPN

I would guess it's the same as an LPN, or LVN.

I work on a unit with all nurses. We usually have 3-4 apiece. Our census

keeps going up and staying up and our patients are getting more complex

so we are supposed to be getting aides soon. I'll believe it when I see

it.

[theRPN2b]

For those of us not in the know, what is an RPN

In Ontario,Canada. RPN stands for Registered Pratical Nurse, this is known as an LPN in other provinces (stands for liscenced practical nurse).

[Lindaholt]

I can believe the burnout. The RN is most efficient and effective if she/he can focus attention on meds, procedures, and critical care. It also is especially helpful to have other extra eyes and ears to report problems that require RN attention. I always enjoyed the times I could assist with moving, walking, and other activities that work best with two people.

[turtlesRcool]

Wow I couldn't imagine not having a CNA in North Carolina we work as a team and no one's beneath personal care for a Patient

I don't think the issue is about being "beneath" or "above" personal care. I think the issue is how to allocate your resources. Nurses are paid significantly more than aides. The more a hospital can utilize unlicensed staff members to safely attend to personal needs, the fewer nurses they will need because those nurses can be more efficient in doing the tasks only a nurse can do. If an aide can do personal care, that frees me up to give meds, call doctors, look up labs, return family phone calls, perform dressing changes, etc.

There are days when the floor is just heavy, and I get interrupted a lot for patient care, family requests, running to bed alarms before someone ends up on the floor, etc.

Those are the days I get to shift report and realize I have not trended the patient's labs. I have not looked up any of the provider's notes. I have not read the H&P or test results to verify what the off going nurse told me at the start of the shift. I have not pulled the PRN miralax I meant to get two hours ago.

Very often, the quality of my aides can make or break my shift.

[Leader25, ASN, BSN, RN]

USA here -- Some hi risk areas and ICUs might have all RN units,only one cleaning person for trash and equipment cleaning,everything else is done by RNs.There is good and bad about it....with overwhelming ratios..poor staffing...you can waste time on nonesense instead of starting that critical blood transfusion.Then there is the PHONE,DOORBELLS,lab calls,pharmacy calls,