Primary Care Nursing


The hospital I work at has been on “team” nursing for many many years.  A unit has 30 beds, during the day there are 3 RNs, 3 LPNs, and 3 Techs (CNAs), and each group has 10 patients.  Of course there is a support nurse, and a charge, and the unit manager on the floor.  At night, ideally, there would be 3 RNs, 2 LPNs, and 2 Techs, but at times there might only be 2 RNs.  The RN’s primary duty is to assess, teach, intervene, etc.  LPN is meds and dressing changes, and the tech would be vital signs, feeding, and bed, toileting,  and bath care.

Recently, they’ve tried to go to primary nursing on one floor, with hopes to move the entire hospital to this (and get Magnet status).  During the day, there would be 6 nurses (5 RNs and an LPN).  According to state law, the patient needs to be assessed by an RN at least once in a 24 hour period.  So the charge nurse would assess the LPNs patients, then the LPN could take over and chart from there.  Everyone else would assess and chart, and do their meds, etc.  At night, there would be the charge nurse, and 4 RNs and 1 LPN, and the same concept would follow.

I’ve had no problem when I’ve gone to this floor to work, it’s been great, no problems.  Last week they changed the staffing grid.  So last night, I had 8 patients primary care.  Me.  Me to do meds, assessment, interventions, Dr calling, and so on.  It’s crazy.  How do they except us to give good patient care?  My license, my livelihood is on the line.  If this is what is expected, I will move to the ER, or even another institution.  I really do enjoy my job, but this is not a safe practice IMO.

I understand the nursing shortage, I understand the need for money cuts, but didn’t all take a pledge to do no harm (beneficence) when we entered the field of nursing?

I do plan to make my thoughts known to my supervisor, hopefully my voice will be heard!


2 responses »

  1. Frustrating that there is a nursing shortage when there is no shortage of applicants that have the pre reqs and cant get into a program. 600 applicants who have met the qualifications to get into the program which has 30-40 slots for a lottery draw one time per year where I am. This is just an A.S. 2 yr program. The other 2-4 yr RN programs in the area are impacted as well. The only way to get in automatically is paying for a private school where you would also need pay more to do pre reqs and the program. We can finish our pre reqs that have to all be B or higher and still wait three years just to get into the RN classes and then do that for 2 years. FRUSTRATING!

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