[redtintedpaperdoll]

Hello! This is my first post despite having lurked around for a few weeks. Needless to say, I have found a lot of topics to be a great help. I'm a foreign graduate RN newly hired here in the US, currently working with a 400+ bed nursing home. Needless to say, I did a LOT of adjusting (and still am). It has been almost two months since I entered this job and I have a question regarding patient-staff-duties ratio. It’s a long post so please bear with me:

The nursing home has several floor units with approximately 86+- residents on each floor at any given time. On each floor there are 3 nurses (LPNs or RNs), one for each wing, 7-8 CNAs, and one charge nurse. As a medication AND treatment nurse you get approximately 28 patients under you. Medication and treatment would involve PO, via GT, IV, dressings, bolus feeding etc. To give a scenario, one wing (with 26 residents) I recently worked in had 6 residents with a GT (so meds and feedings go through the tube). PO meds were ok to give but sometimes, the residents wander/go around the unit or nursing home so you have to find/chase them. Then I had to keep track of those who have scheduled insulin shots. For the treatment, wound dressings in that same wing I had 6 to do. 5 residents had trachs so I had to do trach care too (did I mention GT care already?). No matter how hard I try to do and finish everything on time, I cannot. I even skip lunch in order to do all my work but still… I have observed the other nurses who have been in the facility for a while and have the same shift as I do but I don’t know whether they deliberately skipped some patients or had major speed superpowers since they seem to finish. On this mentioned unit floor, I said there were 3 nurses for medication and treatment for each wing but on some floors, there are only 2 nurses for 43+- residents. Is this right? Sometimes I wonder if I’m that slow/inefficient or is this how it is in nursing homes? If anyone can give me the normal ratios/set-ups in nursing homes, I’d be very glad to know since I have been kicking myself for not doing my work well enough. Thank you!

[fultzymom]

Our facility is a 150 bed facility. Two units have 25 each et two have 50 each. Our big units have 2 nurses (25 pts per nurse) and 6 STNAs. One unit (dementia) has 25 patients for one nurse and 3 STNAs. Then our skilled/rehab unit has 25 patients with 3 nurses and 3 STNAs and a shower aide. At night, each unit (even the 50 bed ones) go down to only one nurse per unit. But that is only from 10p-6a. Hope this helps some.

Leslie

[fultzymom]

Just another thought for you: don't think badly of yourself. You are making a huge adjustment coming to another country, trying to start a new job. It takes a while to get things down pat in the nursing home setting. The patient ratio is huge and there is a lot to learn and it takes a while to get down the routine. I remember thinking that I would never feel comfortable with knowing that I knew my job well. Then I remember the day that I was sitting there feeling like I had been there forever and it was comfortable. Such a good feeling!! Keep your chin up and keep going forward.

[CheyRN]

Originally Posted by fultzymom

Our facility is a 150 bed facility. Two units have 25 each et two have 50 each. Our big units have 2 nurses (25 pts per nurse) and 6 STNAs. One unit (dementia) has 25 patients for one nurse and 3 STNAs. Then our skilled/rehab unit has 25 patients with 3 nurses and 3 STNAs and a shower aide. At night, each unit (even the 50 bed ones) go down to only one nurse per unit. But that is only from 10p-6a. Hope this helps some.

Leslie

Not trying to be demeaning, but that staffing sounds like heaven. The last LTC facility I worked at as an LPN, my patient load was 53 residents and if I was lucky I had 2 CNA's. Usually I only had 2 until 2am and then it was just the one CNA and I to do the am FSBS and insulin (12 at last count), get a minimum of 10 residents up, and do all the medical records updating (computer input, medication ordering and inventory management, monthly MAR printing, checking and filing) and "other duties as assigned" in addition my meds, treatments and labs. And heaven forbid if I didn't have the day shifts carts cleaned and stocked, their coffee made. That BS about that "but that is only from 10p-6a" has got to come to an end. If that were a pediatric unit, if there was greater than a 4 or 5 to 1 ratio, the government would be called in and everyone would be up in arms. Why do nursing home residents deserve less nursing care than kids?

[fultzymom]

Originally Posted by CheyRN

That BS about that "but that is only from 10p-6a" has got to come to an end.

WOW!! Did not mean to start a war here. I was just telling her what my ratios were at my home. And it is not BS. That is the raito. I am not saying that it is right or wrong that is just the way that it is. And I may be management now but I used to work night shift as the LPN and I did the same thing and had the same ratios and had to deal with them. And no, I did not always like them but it was what I had to do. And I did it to the best of my ability to make sure that my patients were taken care of. GEESH! I was simply stating the facts. I was saying that only our night shift has ratios were that low, not necessarily that I agree with it. Sorry to offend.

[kstec]

I think 30-40 residents is the norm everywhere. I think that because you have so many tube feeders and trach patients that maybe your numbers should be a little lower. Trach care is so time consuming and because they depend on that to breath, I would think they would want the nurse to have time to check on them frequently. But what do I know. At my LTC facility I have 30 residents, no g-tubes, no-trachs, 5- dressing changes and 4-5 diabetics. My acuity is not as bad and the original poster. Good luck and do your best and if you feel that you just can't get it, move on to a facility that has lower ratio for the acute residents, or good numbers for stable residents.

[jjjoy]

Originally Posted by fultzymom

WOW!! Did not mean to start a war here. I was just telling her what my ratios were at my home. And it is not BS. That is the raito. I am not saying that it is right or wrong that is just the way that it is. And I may be management now but I used to work night shift as the LPN and I did the same thing and had the same ratios and had to deal with them. And no, I did not always like them but it was what I had to do. And I did it to the best of my ability to make sure that my patients were taken care of. GEESH! I was simply stating the facts. I was saying that only our night shift has ratios were that low, not necessarily that I agree with it. Sorry to offend.

I don't think the poster was saying YOU were spouting BS, I think the poster was saying that it's BS that The Power That Be allow such conditions. I think she was saying that just because TPTB justify a situation like just one nurse for 50 patients by saying it's "just from 10p to 6a" doesn't mean we should accept that it's truly safe. Her point was that if these same patients were children with similar care needs that the same staffing would not be acceptable.

[mary78910]

i'm working part time in a nursing home full time in a hospital, i feel like my nursing license is on the line every time i step into the nursing home, scares me to death. i have 25 patients and one aide. i do all the treatments acu checks etc. they have meds all day long cant take a break to save your life. they do 78910 meds all together then 11-12-1-2 , then 3-4-5-6 ok i have a question my patient has a 4 heart med then a 10 heart med, they get given within an hour of each other. because when i leave the night shift comes on an passes all her meds. and they wonder why some of these people have bp of 90/50 and they only take bp once a week. i take them before any bp med pass, maybe thats why i'm slow. also i never got to all my treatments and god for bid if you try to take the time to stick a stethoscope to someones heart or lungs, are you serious, i was shocked these people dont get assessed. i also walked into a room and smelled infection i took this guys dressings off and about had a fit, his legs were bbbbbaaaadddd. i called the wound doc he said no one has called me in over a week his appointment isn't for a month i had no idea then i got in trouble for calling him, are you serious, this man is about to lose his legs and i get in trouble. well anyway, i'm putting my two weeks notice in tomorrow i like my license too much for this i love med/surg and just recently went to ob hope i learn to like it as much. but nursing home, i love the residents but not the worry about my license. plus i don't feel like i'm giving them the care they deserve i just can't work that way.