do YOU understand Medicare regs?

[ecb]

I am an RN supervisor in a LTC facility

I am the regular floor nurse on the medicare floor with 27 beds on it, and the other end of the unit, which has 33 beds, is staffed by an EXCEPTIONAL LPN, I have another very efficient LPN working for 59 beds downstairs. On night shift we are given anywhere from 3-5 CNAs to do the floor care, when it is only 3 the lic. nurses do the VS, empty the Foleys, the irrigation set replacements, and TAPs. When we have 4 we just do the TAPs, and with 5 they do all of that as well as put away personal laundry as well as take out their own trash bags of diapers.

Recently I was the RN on call (they did me a FAVOR of making it my weekend ON) and since I was oncall I was supposed to come in if we were short. The only shift that was short was MINE, I took on all 60 beds 2 of the 3 nights. The DON told me this is legal, the agency nurse I worked with told me it is NOT, and that there HAS to be a second nurse on the floor if there are medicare people on it (even if it is only 18 of the 27).

The floor is oretty light med/accu check wise, but is moderatly heavy treatment and TF wise, and the day I DID have the additional (not EXTRA mind you) nurse I ended up 911ing out 2 residents for very accute situations, and needed her to do my am med/accu check pass FOR me. I thank any powers that be (that are not payed for by my corporation) that this did not happen on one of the other 2 nights.

I am scared, that situation is only doable when NOTHING goes wrong, no elopement attempts, no chest pains, no violent residents up and stalking the halls, no patients ODing on meds ther family/friends bring them, and of course no one dying (weather they are a full code or not). but I admit I am becoming very uncomfortable with the increasing advantage I see being taken of my staff, and shift.

When I voice my concerns I get told that they are not unreasonable requests and I need to look at the whole picture, but we are working nights, many of my staff are doing double shifts to make extra money, we are not allowed to take naps on our lunch breaks, and we DO work with 3 or 4 more often than not.

sorry to sound like I am just griping, but I am very uncomfortable with this. and am coming to you for your experience and assistance in seeing if I am being unreasonable or not. This is not a hospital but a nursing home, but still....

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*** May we all have the serenity to accept what we cannot change, and the determination to change what we cannot accept. ***

[ecb]

Now there are more changes, I am being required to stop the float position, and send

any odd CNAs to the lower floor, (where there is only 1 LPN for 59 residents) which

will be ok, as long as nothing goes wrong, they are also asking ME the only RN on most nights to rotate OFF the medicare floor down to her floor to do half of her chart checks, and one side of her med pass.

I do not mind, too much, as long as NOTHIG else is going on, but it seems we are getting dumped on more and more, and I still cannnot find a comprehensive explanation for staffing regs in relation to my medicare floor

Help!

someone PLEASE

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*** May we all have the serenity to accept what we cannot change, and the determination to change what we cannot accept. ***

[dianee]

You need to remeber it's your license. You are the only one who can decide what is too much. Your judgment seems very rational and grounded and you sound like you are making decision withn true professionalism. good luck standing up for yourself, and more importantly, your patients. Di-