[Town & Country]

Does your state have staffing requirements?

The only concrete requirement, spelled out in black and white, I've been able to find is that there must be an RN there 8 hours out of 24.

The rest is your generic "nurses must be able to fulfill patients needs in a safe manner", blah..blah...blah.....conveniently VAGUE.

I reported the nursing home to the Ombudsman, or whatever it is. No, it was JHACO.

I hope and pray they come a bustin' in there and interrogate the (censored!) out of them!

[graysonret]

Too dangerous a place to work. All it would take is one serious injury/death, and your license is cooked. A lawyer would have a field day with you, in court. And, I would guarantee the facility would find some way to throw you 'to the wolves". It's a reality of life these days. Around here, lots of places are begging for nurses. I'd be long gone from your facility. My license comes first...facility last. I wonder how the patients are doing? Got to be tough. Level of care can't be good, no matter how fast you move.

[FROGGYLEGS]

My last LTC job was at a small nursing home. We had about 50 residents. Being left alone was one of the many reasons why I don't work there anymore. One of the last nights I worked I was there from 10p-6a with absolutely NOBODY in the entire building because the one CNA that hadn't already quit was a no call no show that night. I was expected to provide total care to all of these residents with a good number of them being skilled and most of them incontinent. Not to mention all of the charting I was expected to do to indicate what a great quality of care I was providing all by my lonesome.

I worked that same building another night with one CNA. It was much better than the night by myself, but the CNA wasn't CPR certified and had never been trained to do CPR. Of course we ended up having a full code that night. Its sort of funny how much stuff they want you to have done BEFORE the ambulance even gets there, but you only get one person qualified to perform CPR and that is the same person who is supposed to be doing everything on the little list as well.

As mad as I get where I work now, I try to remind myself that it can get worse. Isn't it great to be appreciated by management?

[Hellllllo Nurse]

And I thought I had it rough at the last (ever) LTC I worked at because I was the only nurse (w/ 3 CNAs) for 65 residents for two years (nocs, nine tube feeders and two trachs w/ MRSA plus numerous brittle diabetics, demetia, etc).

Of course Bush won't spend any $$ to help provide care for America's "greatest generation". These are the people who made it through The Depression, and who fought and won WWII.

Bush needs all that money to buy weapons and to line the pockets of his cronies.




I hope that there is a special place in hell for administrators/companies/politicians who get rich off of the suffering and neglect of our elderly.


God help us all.

[Speculating]

Originally posted by Shezam!
OMG. Last night at work was the worst night I've had there since I started...From twelve midnight until five am, I was THE ONLY NURSE IN THE PLACE...Not even a MED TECH...It isn't safe...There are at LEAST sixty residents...I am going to start looking around elsewhere if they are going to try to make me work alone; I won't do it. It isn't safe ~ not to mention fair...I mean, putting "fairness" aside; it isn't safe for the residents...They need at least an RN and an LPN there, around the clock, and hopefully a med tech.

Shezam do you realize the amount of trouble you can get into if a situation does occur on your watch? First of all you will get in trouble and most likely lose your license and a lot more because you accepted the assignment as it was. If something happens and it could be very minor the world is sue crazy, and you employer will watch you sink. Administration will simple say “there was a problem? She was shorthanded? She never called us otherwise we would have taken care of the situation immediately”. Now let’s address your personal safety. What if one of your pt’s. whacks out? What if a couple of people on the street find out your all alone in there with all of those drugs. One good code or one of you pt’s. begins to sink your sunk! I’d be very hush hush if I were you at least until you were gone from that facility. If I were you the next time I went into work and found out I was alone again for the shift, without taking report on a single pt. (key point), I would stand up put my coat back on say goodbye to my co-workers and hit the door. I'm almost positive as long as you don’t take report they can’t charge your license with any kind of abandonment, so I would double check. And, for those talking about JCAHO I lost faith in them the day I found out each facility has to pay JCAHO to come in and certify them – does anyone besides me sense a huge conflict of interest.

[jornac]

I have an idea!!!
I work in a 75 bed facility in Wyoming. Our State has a minimum staffing requirement of 1 nurse (RN or LPN) for every 50 residents. Therefore, we are required to have 2 nurses in house at all times. at all times.
It is my understanding that there us also a facility minimum requirement for staffing that is related to the number of employees it would require to safely see that an evacuation of the residents could occur in an emergency (i.e. Fire).
Does anyone remember a recent news report about a nursing home having a fire at night and residents that didn't live due to not being able to evacuate them?
Ever think of the risk that the facility is taking in this situation? Do the powers that be care about risk and safety issues. Risk and safety could also include an injury producing fall and need for CPR on another resident at the same time.
I would look for another place to work rather than put myself through the stress and concern about the safety of everyone that is depending on the facility (me as their representative) to meet their needs and keep them safe.
Has anyone from administration been in the facility during the night shift? Do they realize that these people that we care for do not all sleep at the same time?
The big question that I would ask myself is "Does this facility CARE about the residents, or am I the only one who does?"
You are in a horrible situation! The best thing that could happen for the people you CARE FOR is that the entire facility would CARE ABOUT them. If it is not possible for you to make them understand the risks they are taking, they will never understand the risks you are taking.
Take care of yourself as well as the residents. As nurses, we often forget to take care of ourselves, and no one else will do it for us. I commend you for taking the stand you have taken and wish you the best of outcomes.
jornac

[Julielpn]

Does anyone know where I can find the "laws" for nursing homes in Indiana ? There's a few things I'd like to look up and use in my defense whenever one of these situations rears it's ugly head again (and I'm sure it will).

[zuchRN]

I know that if you ask your DON for a copy of the regs and tell her that you just wanted a copy so you can make sure you are following the rules...or you want to brush up for survey to be sure that you are doing things correctly...some bs like that, she should give you a copy of the regs no problem. There are federal regulations, which is what you are surveyed on so it is best to get the feds regs. The IN regs are just a little different with things more specific like you have to have telephone orders signed in so many days, 2 step mantoux's......stuff like that. what you are tagged on is actually the f-tags or the federal tags. You can get a state tag, but usually don't. As far as IN with staffing, if a complaint is called to the state with regards to staffing, the surveyor will come in and eval the last 3 months of schedules and then look at pressure , weight loss and ADL issues to determine if the facility should be tagged. In IN you are only tagged for staffing if the short staffing resulted in negative patient outcomes...example is pressure areas.....fallls etc. It is actually very difficult to prove inadequate staffing related to megative patient outcomes. If your DON does not give you a copy of the regs....email me and I will get you a copy of federal and state...I have multiple copies....

[Sarah Kat]

Originally posted by Rapheal
Interestingly I just read a quote from President Bush in an associated press article where he states he will not require mandatory nurse-patient ratios in LTC because it will increase medicare and medicaid spending. It is too bad our society places so little concern on the sick and the elderly. Another reason nursing is tough- and no remedy in sight.

Of course. Why would rich folks (who will never see the inside of a LTC) want to spend a few pennies more into medicare to take better care of others?

[Town & Country]

Yeah, well I think this place gave me a bad reference. In other words, they didn't give a bad ref but probably said I was "unavailable for rehire" because I've applied for a couple jobs and not gotten them, even with excellent refs.

I tried to get into agency nursing but they want refs from your EMPLOYERS, which are the ones I've had problems with because I buck unsafe staffing.