Let's talk about LTC

  1. Is there anyone else out there that thinks LTC staffing ratios are outdated? We don't have any vents , we have one RN and one LPN on most days for 54 residents, some days we have another 8-1 LPN who should be a 7-3:30. On weekends, they have eliminated the RN on my unit, put 2 LPNs and made the RN on the other unit the house RN. Problem is, on weekends they put me, an RN into capacity of the facility LPN- med pass etc, but I cannot function as an LPN only, I would have to take MD orders, call families, do admissions, take care of change of status, etc. My med pass alone is 3 hours and there is no way I can cut down on that. Most days I don't get breaks and take a 15 minute lunch as I get hypoglycemic and must eat.
    Our population is getting older, more fragile and less stable, and with more dementia (almost all of them!) We are an old fashioned nursing home with no dementia unit.
    My administrator reamed me a new one when I suggested the 8-1 p LPN be changed to 7-3 because of rising census. I suggested that we were unable to deliver good resident care and she stated that we were not an acute care facility and that I don't understand staffing procedures.
    Our census is 54. Just wading through the slowly dying residents some days takes up alot of my time, comfort measures, talking to the families, doctors, etc. Most days treatments don't get done, and we are staffed at least half by agency. On any given day we will be working with one RN and an LPN, because an agency called off (they get sick too, or go to a higher paying facility). IF we staff the way they want on weekends, and the RN from the other unit has a calloff, she must pass meds on her side and I become charge on my unit. I say it just doesn't work.

    The state ultimately sets staffing and it is outdated. These people deserve care, not "fly by the seat of your pants" nursing.
    Anyone else drowning in LTC?

    Blessings,
    Last edit by cargal on Nov 7, '02
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  2. 10 Comments

  3. by   emily_mom
    When I worked LTC, each CNA had 10 or 11 pt to get up and we only had one nurse for 35-40 people on that wing. About half were dementia. I agree that it is outdated. There is no way to provide safe care to pt when you're so overworked. That nursing home had to close b/c of not making a profit in 6 years d/t Medicare and Medicaid. A friend of mine works in a home that only takes private insurance or private pay, and their ratios are much smaller. They also get paid a lot more. She has 15 pt for meds and no dementia.

    I would say that until the govt. starts to pay more on every billing dollar, the prob will not get solved. However, that opens a whole other can of worms, so I will just shut up now.
  4. by   blondie
    Ditto to everything said by cargal. I am the one RN for 40-45 residents, no LPN to assist. On top of this, our aides are so used to seeing only one nurse on the unit, I think some of them see it as normal. I recently had one say to me, "Maybe if you didn't take your lunch, you wouldn't be so behind in your paperwork." Yeah, like that one 15-minute break I took all day is the reason I had to work an hour-and-a-half over. I was so behind the eight ball, there wasn't even any time to educate this young woman. Also, the facility is under pressure from the State to reduce the amount of psych meds. So now we have an increase in aggressive behavior, anxious behavior, behavior that is dangerous to self. We have people who really need to be closely monitored and no staff to do so. My state does not have staffing ratios, does yours?
  5. by   VivaLasViejas
    The staffing ratios in my state (1:10 on dayshift, 1:15 on eves, 1:25 on nocs) were established in the 1970's & 80's, when many nursing home residents were still ambulatory and needed some help with ADLs---not the total care patients we have today. Obviously, the vast majority of owners/operators of nursing facilities don't have their own family members in one, or they would INSIST on staffing by acuity rather than just the numbers!!
    Last edit by VivaLasViejas on Nov 8, '02
  6. by   cargal
    Originally posted by blondie
    Ditto to everything said by cargal. I am the one RN for 40-45 residents, no LPN to assist. On top of this, our aides are so used to seeing only one nurse on the unit, I think some of them see it as normal. I recently had one say to me, "Maybe if you didn't take your lunch, you wouldn't be so behind in your paperwork." Yeah, like that one 15-minute break I took all day is the reason I had to work an hour-and-a-half over. I was so behind the eight ball, there wasn't even any time to educate this young woman. Also, the facility is under pressure from the State to reduce the amount of psych meds. So now we have an increase in aggressive behavior, anxious behavior, behavior that is dangerous to self. We have people who really need to be closely monitored and no staff to do so. My state does not have staffing ratios, does yours?
    Blondie,
    You give meds to 40-45 residents? I only give to 25-30 and the LPN has the other half of the unit with as many. My beef is this is not only NOT SAFE, but they have no quality of life. They are lonely, bored , sick and I am passing meds or doing paperwork. There is forced incontinence-that is my big complaint. If grandma came in continent and with some dementia, that will not last long, we'll have her incontinent in no time!
    But we will have the paperwork to cover it. No appetite, well stick in a g-tube.

    This population is much to fragile and has issues that cannot be dealt with on paper or during the med pass.
    It really sucks.


    Blessings,
  7. by   KaroSnowQueen
    I quit LTC a year and a half ago. When I started at the facility I left, I was charge on a 39 bed unit. On day shift I had a QMA to help pass half the meds, and four to five CNAs. On second shift, I still had the QMA (qualified medication aide) and two CNAs.:smile:
    When I quit six years later, they had done away with my QMA on both shifts, day shift had three aides and second had one. The number of patients, and the amount of care they needed did not decrease, indeed it had increased if anything.
    I was a screaming, bawling nervous wreck. I quit and went to work for an agency and work in a hospital PCU three days a week, same unit, same coworkers most days, with four to six patients twelve hours a day. This is better, but not great.
    I went today and put an application to work at the local Ford plant. If they hire me, I take a pay cut for nine months. AFter that it just goes up until I hit 35 dollars an hour, plus REAL benefits, not to mention Ford employee discounts on cars! Plus two weeks off at Christmas and Fourth of July, paid. And no one whining about whether I take my vacation or not. And time and a half on Saturdays, and triple time on Sundays. :smile:
    WHY would I want to stay in nursing and go crazy, when I can go there and get some respect, real money, real benefits, and retire in twenty years with most of my brain still intact. I think if I had stayed in LTC, I would be on Prozac. Or Thorazine. Or Ativan. Or all of the above!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! !!!!!!!!!!!!
    The level of staffing in LTC is not safe for the physical health of the patients or the mental health of the staff. Until someone somewhere, whether in the form of government, OSHA, patient rights organizations, or striking nurses gets something done, the old, the ill, the mentally ill and their professional caregivers will al continue to suffer and the big bucks will keep going into the corporate pockets. As long as they have their big bucks and can drive their Beamers to work, they will laugh off our concerns and do nothing.
    Last edit by KaroSnowQueen on Nov 8, '02
  8. by   jevans
    Cargal

    Do you have assessment tools for work load?
    And are they being used?


    Another way of addressing Mgt suggestion that you do not understand is to do a project

    1- Look at patient dependency, use a recognised tool

    2- Obtain your clinical incidents, look at times of the day and nature of the incidents

    3- Benchmark with other facilities in your area using this type of data

    4- Look at work load assessment tools

    Unfortunately the only way to success is to provide Mgt with written evidence. I hope this has been some help
    j
  9. by   cargal
    Originally posted by jevans
    Cargal

    Do you have assessment tools for work load?
    And are they being used?

    I am not in a position to know what they are, and unfortunately, the administrator staffs at whim- somewhat like Karosnowqueen stated. I'm sure she is in compliance with the state, but the state regs are outdated. I know you are from England, and I think that if you saw this type of old fashioned nursing home you would be quite disturbed.



    Another way of addressing Mgt suggestion that you do not understand is to do a project

    1- Look at patient dependency, use a recognised tool
    I am not aware of any tool that I could use, am open to suggestions!

    2- Obtain your clinical incidents, look at times of the day and nature of the incidents- I am not privy to this information, that type of documentation goes to the DON or ADON, and they lost their nurses cap a long time ago to put on the cap of a suit.



    3- Benchmark with other facilities in your area using this type of data This is a good suggestion, but how do I get this type of information. What if the whole system sucks and most are understaffed according to nurses, but not according to the state.

    4- Look at work load assessment tools
    Where can I get them for LTC? What if they don't back me up?
    Unfortunately the only way to success is to provide Mgt with written evidence. I hope this has been some help
    j
    You are always helpful, jevans. If you ever want to visit me I will give you a guided tour of our private hell. There are a lot of new facilities that are quite nice popping up, I think I will try one in the future, unfortunately, they are private pay, so the poor cannot afford them. Until I find the facility that is right for me, I am trying Hospice and agency nursing.

    Thanks again j
  10. by   cargal
    Jevans,
    Could you describe what kind of staffing patterns you have at your facility? I think that I have read in other posts that you love your job. Are you happy with delivery of care for the very old in your country?



    Blessings,
  11. by   jevans
    Cargal

    I actually work in rehab not LTC although average length of stay is 40 days

    We have 24 patients - only stroke and they vary from totally dependent to minimal assistance

    Our staffing ratio is

    Early= 2 Qualified and 5 Unqualified weekends it is 2 and 4

    Late- 2 Qualified and 3 Unqualified weekend it is 2 and 2

    Night= 2 Qualified and 1 Unqualified


    Inthe Uk we recognise Bartel it is a dependency tool that looks at hygiene, mobility, feeding and continence[ if you would like a copy I can PM it to you] It does however have its flaws but it is quick and easy to use
    Another one that I particularly like is Katz score cos it also addresses cognitive problems I found it by doing a search on

    www.bmj.com

    Clinical incidents- it was the same here until I started to keep a register before they were submitted to senior mgt

    Benchmarking- I sent out letters addressing them to ward managers stating that I was interested in finding out what staffing levels and patient dependency was like in other areas. Suggesting that in an attempt to improve services. Also by stating that I would provide them with data that I had collated. It works cos they want to know too

    Workload assessment tools can be obtained online - one that was used here is GRASP I recently looked but you have to pay for that one but I am sure there are others

    Finally NO I am not very happy with care for our elders in this country _ It stinks!!!!!!!!! Second class citizens it is a collective societal crime which needs and indeed is being addressed.
    Our dept of health has recognised that with the ever increasing older person there is a demand for healthcare. There have been several papers in recent years attempting to address the inequalities, and diversities of care provided. The latest one does look at all aspects of wellbeing - so I am trying to be optamistic

    Sorry I do tend to get on my soap box but I feel so strongly about it

    j
  12. by   GPatty
    Yes. I think staffing ratios are outdated.
    I am a brand new LPN who has been working 7p to 7a in a LTCF of about 60 residents, by myself most nights, only with 1 or 2 CNA's. A bit rediculous, I think.

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