Hi everyone, I am a new grad wanting to eventually get into hospice. I was told that LTC would be a great place to start....chronically ill, geriatrics, experience with the technical skills. I had an interview today, went very well....two hours long, they took a urine for tox, so I am thinking I may be offered the position. The facility has four wings: two are skilled nursing, one Alzheimer's, and one rehab. I was told there is one RN and one CNA per wing with up to 24 residents per wing....they are not at capacity right now. The DON said ideally, if the census goes up, she would like two CNA's per wing. I am terrified!!! 24 residents to do meds on, chart on, do treatments....and God forbid if there is a crisis! I know that once I get my feet wet, get organized, and get some type of routine, I will manage. Any advice for the baby nurse from my more experienced friends?

ONE Cna for 24 residents!?

Really 24 residents for one CNA? That's too much to ask for from a CNA.

Are you sure you didn't hear wrong about the one CNA. One RN/LPN per 24 reidents is fine. One CNA per 24 residents is impossible! Unless their census is really really low? I'd frankly be nervous working in a facility with that severe of a census drop....

I believe there is only one CNA because the nurse is supposed to help.

Hi everyone, I am a new grad wanting to eventually get into hospice. I was told that LTC would be a great place to start....chronically ill, geriatrics, experience with the technical skills. I had an interview today, went very well....two hours long, they took a urine for tox, so I am thinking I may be offered the position. The facility has four wings: two are skilled nursing, one Alzheimer's, and one rehab. I was told there is one RN and one CNA per wing with up to 24 residents per wing....they are not at capacity right now. The DON said ideally, if the census goes up, she would like two CNA's per wing. I am terrified!!! 24 residents to do meds on, chart on, do treatments....and God forbid if there is a crisis! I know that once I get my feet wet, get organized, and get some type of routine, I will manage. Any advice for the baby nurse from my more experienced friends?

Yes, I heard right, but I don't know their total census at this point. It is a rural area. I checked on Ucomparehealthcare.com and they had a 4/5 on state inspection status, which was much better than other facilities in this area....some were ones or twos.

Who will help the CNA with all the 2 person assists when you are passing all those meds?

i have worked in ltc care for many years,first as a nurse aide, then charge nurse, weekend manager, department head, andnow as a national consultant. atcapacity that would be too heavy of a load, period. if your census right now is around 15, it couldbe manageable. anything more than 15 istoo much for just two staff persons. remember you are providing all of the nursing care for those residentsas you outlined above.

secondly, go to www.nursinghomecompare.gov thatis the cms (centers for medicare and medicaid services) website. look in depth at the staffing score. it ranges from 1-5 stars. you can be a 4 star facility with 1 starstaffing. the annual state survey setsthe benchmark for the 5 star rating system, which is what you saw on thewebsite you mentioned earlier. the othertwo parts to the five star system are staffing, specifically rn staffing, and qualitymeasures/quality outcomes. staffing andqi/qm’s can raise or lower your score.

thirdly, what shift will you be working? days? evenings? nights? each shift has inherent issues of itsown. if you will be on the night shift,two staff persons would be appropriate. however, think about this, most of the medications and treatments fallto the day shift nurse and the majority of new admissions come on evening shift………thatspells busy! i would ask to interviewsome of the current nurses and see how they enjoy working there. this is your career, your license, yourlife. be proactive and in control.

lastly, don’t be so anxious to work as anurse that you take the first offer that comes your way. i have found that in waiting a few weekslonger a better work environment was waiting just for me.

please re-post and let us know if you takethe position or not.

m. gale, rn, msn, rac-ct:nurse:

Thanks Mdgale!! You have given me much to think about!! I checked out the website you provided and they have two stars (below average) for both RN staffing and staff rating! I really appreciate your help and will re-post as I make a decision. I sure don't want to do anything to jeopardize my license!! I worked too hard for it!!

Good luck in your new career, Dianne. Lastly, I'm sorry for the missed spaces in my reply. I typed it in WORD and then copied it into the text box. Apparently, that gets rid of some of my space bar entries. Who knew? LOL

Are you sure you didn't hear wrong about the one CNA. One RN/LPN per 24 reidents is fine. One CNA per 24 residents is impossible! Unless their census is really really low? I'd frankly be nervous working in a facility with that severe of a census drop....

Lol one RN or LPN for 24 residents is not fine. It's less than most places, but still unacceptable and dangerous, period. It's amazing what people will tolerate wow.

Really? I've never seen a nurse have only 24 pts in LTC. At my facility, on the skilled/rehab/whatever unit (trachs, woundvacs, IV ABX) the 3-11 nurse has 25-28 pts. On the strictly LTC unit (where I work) I have 40-49 pts on 3-11.