While the tool (PCNA) does provide a through review of pt care needs , I do agree with a previous comment that the process of implementation could be a bit of a barrier. It has been a long time since I worked in an acute care setting, but with high levels of Pt turnover (admissions/discharges) on say for example a Med/Sug unit, pts needs could be very different even within a shift, so consideration of changing care assignments would need to be done. The tool does appear to be less applicable in LTC where the staffing model is more consistent due to the client population.

In my previous roles in Acute Care, case load distribution can be unfair. Although the PCNA toolkit is available, not all employers follow it.

I found that depending on where you’re working, the acuity of the patients and the staffing the case load distribution would always be in more of the favour of the RN compared to the RPN, even though the PCNA toolkit was available the charge nurses were not always in favour of equal distribution.