- Email: [email protected]
Being Proactive About Assistive Personnel
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I Being Proactive About Assistive Personnel I I
I
I
I
n February, Lifelines asked if the use of unlicensed, assistive personnel was endangering nursing practice. Here's what 784 people who responded to the survey, either by FAX or by taking the survey on our World Wide Web site, had to say:
Are RNs being replaced by unlicensed, assistive personnel in your clinical setting?
Yes: 54 %
No: 46 %
f o r those responding "yes, " 65 percent said 10 percent or fewer RNs were being replaced. "The biggest problem is that the RNs on the floor today do not know how to work with unlicensed personnel."-Nurse Manager; Hospital; Virginia
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-
"The term 'skill mix' is being used to have fewer RNs delegating to LPNs. Looks like we're going back to team nursing."-RNC, MSN; Hospital; Denver, CO "So far the changes have been positive. Techs are joining the care team with RNs as partners in practice. This has increased the satisfaction for both RNs and techs, as well as the accountability on the part of the techs."-Assistant Head of Nursing; Hospital; Cleveland, OH
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"A change occurring in the midwest is 'role redesign.' RNs are now referred to as clinical coordinators and techs are taking on more RN responsibilities. Also, the number of NPs in the area has outgrown d e m a nd ."- Nurse Practitioner; Hospital; Kansas Is your job, or a colleague's job, now threatened by this practice?
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No: 68%
Yes: 32 %
"We need to differentiate our practice and not give up any nursing functions."-RNC; Hospital; Tallahassee, FL 3 "RNs provide economic benefit-We need to show that."-Nurse Manager; OWGYN Clinic; West Virginia "We staff based on professional guidelines and suggest others do the same."-CNS; Hospital; Boston, M A
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Is this practice impacting patient care in your setting? Yes: 53 %
No: 47 %
Respondents were divided between the impact of that being "manageable" ways and Sometimes dangerous" ways. -w "This brings about more work for the doctors because the assistants can't triage phone calls or
April 1997
a nswe r m ed i c a I q u e st io ns ."- RN; Private office; Gaithersburg, M D
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"This adds another person(s) the RN has to be res p o n s ib Ie for. "RNC; Hospital; Florida "The level of care provided by aides in the home care setting has increased the value of home care services tremendously. Patients are kept out of nursing homes because of the assistive care provided."-Vice President of Managed Care; Home Health Services; Knoxville, TN
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"There has been a decrease in the consistency of data collection, reduction in accuracy, and completeness of data collection. We have also seen a decrease in patient education, satisfaction, and overall quality."-Manager Outcomes Analysis; Home Health Services; Santa Anna, CA
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"Subtle changes are not being identified. Interventions are being made when a change in patient condition is blatently obvious because techs lack training in critical thinking processes."-RN, BSN; Hospital; Lansing, MI How can nurses be proactive about the use of UAPs in their clinical settings? "Nurses need to be more vocal about their capabilities in comparison with unlicensed workers."-NP; Women3 Center; N e w York % "Nurses need to speak up and get information about changes in their profession into their local newspapers. We need to engage the lay public and take every opportunity to speak to our legislators."-Professor o f Nursing; OB/GYN Clinic; Chapel Hill, NC
"RNs can be freed up t o do the management of the unit, the coordination of care and family, patient and staff education."-Nurse Manager; Hospital; Hawaii
-
"We need to increase consumer education about the dangers of this practice."-Charge Nurse; Hospital; Laramie, WY
-
"We use these employees to assist the RN thus giving her more time to be with her patients."-CNS; Hospital; Dayton, OH "Be happy to delegate clerical and non-nursing tasks. Nurture and mentor UAPs that are interested in nursing. Act as a role model and encourage them to go to nursing school, if appropriate. Be proactive about job descriptions, education, training, and know the facts."CNS; Hospital; St. Louis, M U
Lifelines
21
N U R S E S
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Are Nurses Giving Patients All the Care They Really Need? The Challenges of Providing Excellent Patient Care
S
ome of the most important aspects of providing quality, satisfying patient care aren't found in textbooks or procedure or policy manuals. The technical aspects of providing care are of utmost importance, but there are other aspects of care that nurses provide daily. But because of the structural changes now under way in the health care industry, patients may be in jeopardy of losing out on excellent-sometimes even adequate-care from their nurses. Studies have demonstrated that patients want their nurses t o demonstrate technical expertise, provide them relevant and helpful information in their work toward wellness, and help them regain their independence as
Have changing nurse to patient ratios affected the quality of care in your setting? No -Yes, ratios have changed from (please fill in thenumbers) -(#) nurses for-#)patients to -(#I nurses to -(#I patients. This is affecting patient care by:
quickly as possible. Additionally, patients want their nurses to "be there" for them, and t o do the "little extras" that provide physical and emotional "comfort" during their recovery. They want to be able to say at the end of their care cycle that their nurse "really went beyond what was just necessary to help me." Are nurses now spending more time away from the bedside, and as a consequence, are patients not receiving that extra care they perceive is so important in promoting their recovery and wellness? In this issue, AWHONN Lifelines looks at the challenge of providing quality patient care in a radically changing environment. Watch for the results in our June issue.
1.
4.
2.
5.
Which factor is most affecting your ability to provide excellent patient care in your clinical setting? -Fewer nurses are attending to more patients -Patients are spending less time in a care setting -Patients are much sicker in a care setting -Nurses are asked to focus more on management functions -Nurses are asked to delegate "softer" care and comfort activities to others -Other (please explain)
3.
Proponents say nurses can use the structural changes under way in the health care industry to move from task-based nursing to outcome-based nursing. Is this happening in your care setting? -No -Yes How is this affecting patient care? Please explain:-
May we have a litfie inibnnntion ebouf you? Your title City State
22
Lifelines
Do you have reasonable security that if it is your choice that within one to two years you will still be in your same job with relatively the same degree of work and patient oversight that you now have? -No -Yes How is this affecting patient care?:
Would you feel satisfied as a patient in your current care setting? Would you allow your family members to receive care in your current care setting? -No -Yes Why or why not?
How are nurses being proactive about providing
. quality patient care in your clinical setting?
WE \!ant
1
your Opinion!
Photocopy this survey and distribute it to your colleagues. Fax your responses STAT to 202-737-0575, or log onto AWHONNs home page at ttp'l/www.awhonn.org and take the survey online.
Care setting Namehelephone number (not for publication)
April 7997
I Being Proactive About Assistive Personnel I I
I
I
I
n February, Lifelines asked if the use of unlicensed, assistive personnel was endangering nursing practice. Here's what 784 people who responded to the survey, either by FAX or by taking the survey on our World Wide Web site, had to say:
Are RNs being replaced by unlicensed, assistive personnel in your clinical setting?
Yes: 54 %
No: 46 %
f o r those responding "yes, " 65 percent said 10 percent or fewer RNs were being replaced. "The biggest problem is that the RNs on the floor today do not know how to work with unlicensed personnel."-Nurse Manager; Hospital; Virginia
-
-
"The term 'skill mix' is being used to have fewer RNs delegating to LPNs. Looks like we're going back to team nursing."-RNC, MSN; Hospital; Denver, CO "So far the changes have been positive. Techs are joining the care team with RNs as partners in practice. This has increased the satisfaction for both RNs and techs, as well as the accountability on the part of the techs."-Assistant Head of Nursing; Hospital; Cleveland, OH
-
"A change occurring in the midwest is 'role redesign.' RNs are now referred to as clinical coordinators and techs are taking on more RN responsibilities. Also, the number of NPs in the area has outgrown d e m a nd ."- Nurse Practitioner; Hospital; Kansas Is your job, or a colleague's job, now threatened by this practice?
-
No: 68%
Yes: 32 %
"We need to differentiate our practice and not give up any nursing functions."-RNC; Hospital; Tallahassee, FL 3 "RNs provide economic benefit-We need to show that."-Nurse Manager; OWGYN Clinic; West Virginia "We staff based on professional guidelines and suggest others do the same."-CNS; Hospital; Boston, M A
-
Is this practice impacting patient care in your setting? Yes: 53 %
No: 47 %
Respondents were divided between the impact of that being "manageable" ways and Sometimes dangerous" ways. -w "This brings about more work for the doctors because the assistants can't triage phone calls or
April 1997
a nswe r m ed i c a I q u e st io ns ."- RN; Private office; Gaithersburg, M D
-
"This adds another person(s) the RN has to be res p o n s ib Ie for. "RNC; Hospital; Florida "The level of care provided by aides in the home care setting has increased the value of home care services tremendously. Patients are kept out of nursing homes because of the assistive care provided."-Vice President of Managed Care; Home Health Services; Knoxville, TN
-
"There has been a decrease in the consistency of data collection, reduction in accuracy, and completeness of data collection. We have also seen a decrease in patient education, satisfaction, and overall quality."-Manager Outcomes Analysis; Home Health Services; Santa Anna, CA
-
"Subtle changes are not being identified. Interventions are being made when a change in patient condition is blatently obvious because techs lack training in critical thinking processes."-RN, BSN; Hospital; Lansing, MI How can nurses be proactive about the use of UAPs in their clinical settings? "Nurses need to be more vocal about their capabilities in comparison with unlicensed workers."-NP; Women3 Center; N e w York % "Nurses need to speak up and get information about changes in their profession into their local newspapers. We need to engage the lay public and take every opportunity to speak to our legislators."-Professor o f Nursing; OB/GYN Clinic; Chapel Hill, NC
"RNs can be freed up t o do the management of the unit, the coordination of care and family, patient and staff education."-Nurse Manager; Hospital; Hawaii
-
"We need to increase consumer education about the dangers of this practice."-Charge Nurse; Hospital; Laramie, WY
-
"We use these employees to assist the RN thus giving her more time to be with her patients."-CNS; Hospital; Dayton, OH "Be happy to delegate clerical and non-nursing tasks. Nurture and mentor UAPs that are interested in nursing. Act as a role model and encourage them to go to nursing school, if appropriate. Be proactive about job descriptions, education, training, and know the facts."CNS; Hospital; St. Louis, M U
Lifelines
21
N U R S E S
...... ...... ..................... ...............
Are Nurses Giving Patients All the Care They Really Need? The Challenges of Providing Excellent Patient Care
S
ome of the most important aspects of providing quality, satisfying patient care aren't found in textbooks or procedure or policy manuals. The technical aspects of providing care are of utmost importance, but there are other aspects of care that nurses provide daily. But because of the structural changes now under way in the health care industry, patients may be in jeopardy of losing out on excellent-sometimes even adequate-care from their nurses. Studies have demonstrated that patients want their nurses t o demonstrate technical expertise, provide them relevant and helpful information in their work toward wellness, and help them regain their independence as
Have changing nurse to patient ratios affected the quality of care in your setting? No -Yes, ratios have changed from (please fill in thenumbers) -(#) nurses for-#)patients to -(#I nurses to -(#I patients. This is affecting patient care by:
quickly as possible. Additionally, patients want their nurses to "be there" for them, and t o do the "little extras" that provide physical and emotional "comfort" during their recovery. They want to be able to say at the end of their care cycle that their nurse "really went beyond what was just necessary to help me." Are nurses now spending more time away from the bedside, and as a consequence, are patients not receiving that extra care they perceive is so important in promoting their recovery and wellness? In this issue, AWHONN Lifelines looks at the challenge of providing quality patient care in a radically changing environment. Watch for the results in our June issue.
1.
4.
2.
5.
Which factor is most affecting your ability to provide excellent patient care in your clinical setting? -Fewer nurses are attending to more patients -Patients are spending less time in a care setting -Patients are much sicker in a care setting -Nurses are asked to focus more on management functions -Nurses are asked to delegate "softer" care and comfort activities to others -Other (please explain)
3.
Proponents say nurses can use the structural changes under way in the health care industry to move from task-based nursing to outcome-based nursing. Is this happening in your care setting? -No -Yes How is this affecting patient care? Please explain:-
May we have a litfie inibnnntion ebouf you? Your title City State
22
Lifelines
Do you have reasonable security that if it is your choice that within one to two years you will still be in your same job with relatively the same degree of work and patient oversight that you now have? -No -Yes How is this affecting patient care?:
Would you feel satisfied as a patient in your current care setting? Would you allow your family members to receive care in your current care setting? -No -Yes Why or why not?
How are nurses being proactive about providing
. quality patient care in your clinical setting?
WE \!ant
1
your Opinion!
Photocopy this survey and distribute it to your colleagues. Fax your responses STAT to 202-737-0575, or log onto AWHONNs home page at ttp'l/www.awhonn.org and take the survey online.
Care setting Namehelephone number (not for publication)
April 7997