Skilled Nursing Facility Trends (Current CNA's please reply)

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I just landed a job as a CNA at a Skilled Nursing Facility. After being interviewd by the Director of Nursing, I was shocked to learn that the CNA to resident ration is 1 for every 13 residents. My concert here is; Is this a safe staffing level? In my opinion, there is no way a CNA can safely provide nursing related services to 13 residents at a time.

Reply, and tell me if you believe this to be a safe staffing level. Also, let me know of other SNF trends that I should be made aware of.

Thanks!!

Specializes in Med-Surg/urology.
I am a CNA at a long term care facility. I generally have a ratio to about 13 but have had as many as 23 to my care. The 23 was a little insane and due to staffing issues. 13 is completely manageable. At times someone may have to wait a little bit for help into bed but a few minutes is not going to hurt anyone. I do NOT cut corners I brush teeth, do peri care, wash faces, and everything I am supposed to do. I do work efficently and have no problems. And yes I do even stop and talk to the residents!

It is not that bad... don't be afraid of hard work.

Dont get me wrong, I wasnt trying to imply that all CNA's with 13 residents cut corners..just the ones @ my facility do! And yes, they admitted it to me out of their own mouths, so I'm not just jumping to conclusions:uhoh3:

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I am a CNA at a long term care facility. I generally have a ratio to about 13 but have had as many as 23 to my care. The 23 was a little insane and due to staffing issues. 13 is completely manageable. At times someone may have to wait a little bit for help into bed but a few minutes is not going to hurt anyone. I do NOT cut corners I brush teeth, do peri care, wash faces, and everything I am supposed to do. I do work efficently and have no problems. And yes I do even stop and talk to the residents!

It is not that bad... don't be afraid of hard work.

Wow 23 residents! You're really putting some muscle into it. Well, now that I see a 13 residents to 1 CNA ratio from a different stand point, I think I will be able to manage things. Especially since prioritizing and managing time effeciently is key to doing this job successfully. And since I'm not afraid of hard work, then I'm even more confident now!:)

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Specializes in LTC, Home Health.

I used to work in an LTC. 13 residents in the AM is a lot. No matter how quick you are, someone will be lying in their own excrement until you come clean them...that could be an hour or more! I used to go home feeling very bad about the patients. It was not uncommon for us to have 14-18 residents at a time. You can not properly care for more than 8 persons at a time...unless they care for themselves. Something will be left out.

I am not knocking the person who said she never cuts corners with 13 residents. I know from years of experience that 13 is a bit much but it is possible. However, things will be skipped if you have that many residents. Just think of all those who are waiting. It can only work if you have a few independent patients. I used to have 13 dependent patients and it would take me all day to finish AM care!

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Specializes in LTC.

I generally had 10 when I worked 3-11 and sometimes it was awful. After I had the same assignment several times I could swing it without cutting corners but it was still pretty rushed.

I always thought it was easier if you had all very dependent residents, or all rehab. The dependent hall was still hard work but you could stick to a routine or cut corners at certain times and then catch up on them later (like brushing teeth or whatever). Throw some rehab or middle-of-the-road residents in with total cares and they would ring constantly and keep you in their rooms as long as possible and then no one would get changed or taken care of. It's like that on days too but less so, because no one is in a big hurry to get out of bed like they are to get into bed.

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what are the normal caseload for CNA working in a skilled nursing facility??

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Specializes in None yet..
It's for the PM shift (3pm-11pm). I'm going to care for demented, mentally illed(locked down), and rehab residents. Im going to be doing what's called "float pool" work, where I'm bounced from station to station. Now I'm debating whether to accept the job, or keep my current job as an home health aide (which pays the same amount of money) as keep doing one on one care.

OMG, OMG, OMG! I hear bells going off! You're describing my current and first CNA job! I thought float pool for evening shift on every unit of my large, combined long-term and transitional care unit facility would be a great opportunity to maximize experience and learning.

Well, maybe. Fact is, every CNA is required to do more than is humanely possible. Even the most amazing CNAs with 20 years experience cannot do every ADL and meet every need of every patient; it is always about triage. (And dealing with those "fluff my pillow, change my channel, "I'm lonely" bell ringers. Not that these needs aren't valid, too...) Being a regular on a team means you can learn the basics about your patients and relegate them to the automatic part of your mind. Being in float is like learning to drive a stick over and over and over - relearning the basics each time you get into a car.

Since the CNAs with regular assignments are good people have more to do than they can ever get done, they don't have time to do the things that could make the job easier for their floats. (Like identify the patients I'll be assigned before the end of report, or give detailed reports on basic care plans. After all, the regulars know how everyone transfers. Reports instead are targeted to those who know the basics already and just need to know if someone had a BM or is showing increased confusion... changes only, the tip of the knowledge iceberg.) I've found that being a float means having to show up early (and off the time clock) so I can review care plans for 23-24 people in a unit, not just the 6-8 assigned to me individually.

Plus, many people who have failed to cut it as care providers or team players get booted to float pool. (I'd assumed it would be the reverse and that superstars would be needed to handle float.)

Thirteen residents of the condition you describe assigned to you individually is too much for day or evening. Plus, you are going to be responsible for all or a percentage of the other CNAs residents when they are on breaks. Thirteen is low for night but I don't recommend night for a first job. You are pretty much alone with an equally huge work load that can be complicated by having most of your residents waking up and wandering the halls (or worse, falling out of bed) when the moon is full. NOT for beginners, IMO.

The great advantage of facility work over home health is that you will get breadth of experience and learn time management and tips 'n' tricks from other CNAs.

I'd say pass on this job and stay in home health for now but keep looking for a job with better ratios.

Good luck!

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Specializes in None yet..
Wow 23 residents! You're really putting some muscle into it. Well, now that I see a 13 residents to 1 CNA ratio from a different stand point, I think I will be able to manage things. Especially since prioritizing and managing time effeciently is key to doing this job successfully. And since I'm not afraid of hard work, then I'm even more confident now!:)

Good luck. It really does depend on your case load. No matter how hard you work, you can be given more than you can do... and sometimes more than you can do to meet minimum care standards. One unit where I work has a 300-pound woman with advanced MS and an highly demanding routine. We are lucky if we can get the individual part of her evening care done in 45 minutes before the second person comes in to do the two-person assist part. When you have 8 residents and you've used at least an hour and a half on getting one to bed, well... you can do the math.

What fuzzywuzzy said about all dependent care is true in my limited experience. The ones whose bodies are totally dependent but whose minds are still sharp are huge time demands. It's understandable. An active mind needs hands and feet to execute its thoughts and it will want to use yours. All the time.

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Specializes in None yet..
I am a CNA at a long term care facility. I generally have a ratio to about 13 but have had as many as 23 to my care. The 23 was a little insane and due to staffing issues. 13 is completely manageable. At times someone may have to wait a little bit for help into bed but a few minutes is not going to hurt anyone. I do NOT cut corners I brush teeth, do peri care, wash faces, and everything I am supposed to do. I do work efficently and have no problems. And yes I do even stop and talk to the residents!

It is not that bad... don't be afraid of hard work.

I'm impressed at your hard work and efficiency!

I'm also curious about the status of your 13 residents. How many two-person assists? Mechanical lifts required? Total dependents? Dependent eaters?

Do you have any tips for us about how you organize your work to make it more efficient? As a new CNA, I'd really appreciate learning any you care to share and I bet I'm not alone. Thanks!

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Taking care of 13 out of 23 in a day would really far stretch out my day, can you still have time to eat or smoke - simple leisure or 2 wont hurt a lot right? might as well take some pills to keep me awake while thinking there are still several patients down the line before my shift ends.

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Specializes in None yet..

Checking in again. I had my first shift with responsibility for 13 patients in the TCU. However, a few were independent and many were standby or stand-pivot transfers; most were relatively independent on ADLs and only one was a two-person lift transfer. No one was wanting to hop in and out of bed via (one or two person) mechanical lift. (Yes, I've had a person who required a two-person mechanical lift who got out and into bed three times during evening shift.

And I had only one patient who thought she was the center of the universe and made detailed demands every 10 minutes. (Things like "Bring me ice." "Large glass?" "Yes." Then hysterics because she wants a small glass. Return from kitchen with small glass. Then hysterics because ice is not in a Dixie Cup. "Get the Dixie Cup that's on the sink!" Then, on receipt of said Dixie cup, "That's the wrong size!" because the Dixie cups on her sink didn't match were about 10 mL bigger than the ones she had lined up on her bedside table. Interactions like this every ten minutes for an hour after she was in bed.

I still think a 1:13 ratio is impossible in the situation you describe. Did you take the job?

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I am in the same exact situation. I work as a Caregiver right now and am starting my CNA class on Sept 2nd. I am also wanting to work in a SNF so I can gain experience and when I become an LVN I can stay at the same place and work for them as an LVN. I hate going from job to job to job. I want to stay at the best place possible and retire from there. I'm an older student. (35) I would take the job at the SNF too. Good luck!! :)

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