RN looking for advice on new floor routine

[karen50]

Been a RN for 28 years on a medical surgical floor--small hospital--town--17,000. The powers that be have decided to mix up how we run the floor with our assignments--for years we had one "charge nurse"--for 34 patients--hard --but you knew that was "your job a couple times a month". Then we switched to 2 charge nurses to make it easier--split the floor in half. Now they have decided to break up the floor in 5 different RNs --but you have to do all the meds(had a med nurse before)--all the charting(took away charting from our LPNS) and of course all the orders and calling the doctors. Our hospital is trying to get magnet status --so they are getting rid of our LPNS --which has everyone upset and crying. My question to handle is- with one charge nurse everyone respected you to leave you alone if you were busy thinking or waiting for a call back from doctors--or charting--or looking up labs and comparing them whether you should call that difficult doctor or not. Now everyone is so angry with each other "look at her--I'm busy and she is just sitting there typing". "she should get up and answer more lights" --you feel like your constantly torn apart--noone is happy--everyone is judging everyone-If I didn't have these years here--and live 1 hour away from the next hospital, I would leave in a second. what does anyone think would improve the situation--head nurse is having meetings every month--but nothing gets resolved. Karen.

[Kdog]

It's called PRIMARY NURSING and 1 nurse is completly responsible for the entire pt. care. It is not easy. I've been doing it for years and it's stressful and you actually spend less time with the patient because you're on the phone with MD, LAB, Case managers, families and on and on. You will be constantly interrupted and pulled out of the pt.s room to answer calls. TEAM NURSING is so much better for the pt. and staff. BUT now ACCOUNTABILITY belongs to 1 nurse and not 3. Some hot shot masters or doctorate nurse came up with Primary nursing, go read about it.
Ancillary staff will get mad because you are charting etc and NOW you don't have time to answer lights. So, during a staff meeting have this explained. Change is not easy and neither is primary nursing.

[cougarnurse]

I would suggest reading Echo Heron's book Condition: Critical. There is another book prior to that, and from what she writes, primary nursing was the 'norm' waaay back.

I hear you on the meetings where nothing gets done. Why mess with a good thing, right?

[karen50]

Thank you for taking the time to respond to my question--that book looks interesting---may I ask how will it help our floor adjust to primary care --without killing each other? Karen.

[cougarnurse]

The book is pretty much an autobiography, and shows what happened AFTER switch from primary care.

Maybe you and co-workers need to hold a conference to hash things out?

[Kdog]

The change you are going through is very very difficult. Hopefully, you have a good nurse manager to help guide the staff to ease the turmoil.
Also, try to get the staff to support each other, they are feeling overwhelmed too and the frustration spills over to create a toxic work environment. That's all I can think to do now because I doubt administration is going to switch back to team nursing....
Take it easy.

[dbsrn]

Lots of luck to this hospital in achieving magnet status!! The Magnet status is suppose to indicate that the hospital has created an environment that supports nursing, focuses on professional autonomy, involves decision making at the bedside, nursing involvement in determining the nursing work environment, professional education, career development and nursing leadership.

See the following link for more info on what Magnet status is and isn't...and then hold the big cheeses accountable

ANCC Magnet Recognition Program® - American Nurses Credentialing Center - ANCC