[Sharon]

Now that you have reviewed the PCNA Utilization Toolkit, can you identify one benefit and one difficulty with the PCNA Utilization Toolkit? If your organization has used this tool, did you participate and did it change practice?

[Nely]

We have recently used the PCNA toolkit to help us review a few of our inpatient units.
It was well received.
Many staff wondered how a modified, simple version can be used for making the daily patient assignment to ensue one nurse does not have all of the higher scored patients and vise versa.

[Jeanette]

Hi Nely,
I agree with you, a modified model would be well received by staff for daily assignments.

[Jeanette]

The PCNA Utilization tool sounds amazing. I think would be great to use but in real life where do you get the time and extra staff to have these meetings. This procedure sounds very complex for a busy inpatient unit. Also you can’t pick your staff if the floor required 4 RN due to the tool results and you only have 3 on shift, the tool is not a good resource. I can also see a problem with try to even out work loads.
On the floor, when doing the staffing assignment we would look at the complexity of the pt, the staff that was coming on shift and who had the most experience in both RN’s and RPN’s. Sometimes I would have a pt that was more complex that would require a RN but because of my experience I would get the pt and for certain thing ask the RN to assist .

[Johanna]

I like how the PCNA tool sets out objective physical criteria, such as with the Vital Signs and the level of consciousness for determining acuity. I also like how it uses examples of conditions and interventions that indicate more complex care. I can see where it would be helpful in a Medical/Surgical unit setting.
Some criticisms include: how often is the tool to be completed? It would be very challenging to get all staff together to complete these meetings. Is it meant to take on the function somewhat of a “care conference” on a weekly basis?
When I did my practicum on a Surgical Unit (I was doing some academic upgrading), on my first day, I was assigned to an older gentleman who had just had surgery on several leg fractures. He had numerous co-morbidities, and on my first morning of practicum, he began to deteriorate. As an experienced nurse (but not an experienced Surgical nurse), I tried my best to keep up with his fluctuating Vital Signs, level of consciousness, and Blood sugar levels. Finally an RN stepped in and I took over one of her more stable patients.
On later reflection with my Clinical Teacher, it was revealed that she had chosen this patient for me herself, and she stated, “on paper, he looked better that he really was”. On subsequent weeks, that patient was always assigned to an RN, and later on in the term, I learned that he had died from his injuries.
If the Surgical Care Team had this tool at their disposal, my first day might have been quite a different story!

[Katie]

I like how you highlight that the clinical teacher pointed out how patients are not always how they seem on paper. Such a true statement in all settings of practice. It would definitely be interesting to see how the PCNA tool would be able to catch some of the nuances of an initial referral in order to best highlight the needs of the patient assignments.

[Katie]

This is not a tool we have utilized in our organization. I do appreciate how it may benefit to balance out the caseload distribution, and if it was effective in highlighting the clt needs from the initial referral better than current state where many times the information is not accurate and nurses walk in to home not prepared for the care at hand, this would be a welcome addition for managers and field staff. I do wonder if it is the best tool to reflect the varying differences in the knowledge, skill and judgment of the nursing staff. Time is not the best predictor of experience, getting to know your nurses and meeting them where they are at in order to raise the bar on ‘full scope of practice’ is key to developing a clinically advanced team. This is not something that is easily translated into a ‘toolkit’ format.

[Maame]

I agree with you Katie it is beneficial in the sense of distrubtion of nursing caseload but as you said is it the best tool to reflect the differences in knowledgeable skill and judgement of the nursing staff.

[Maame]

One benefit of the PCNA utilization toolkit is that it get’s an overview of the nursing case load of a inpatient unit. It also assess the stability, complexity and predictable of the patient’s condition. One difficulty is that this tool cannot be implemented in every setting. I work in a long term care setting and the RPN is responsible for 32 residents per shift, this toolkit can only be used when a care conference comes up. Even so the nurses isn’t providing care it’s the PSWs’. From the inital admission date the resident’s condition is assessed to determine if the resident requires one person or two person assist with their ADL’s (activities of daily living).

[Author]

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