How many residents is too many for one nurse?

Specialties Geriatric

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How many residents is too many residents for one nurse to safely and adequately take care of? Where I work, the nurse has anywhere from 15-25 or 30 residents, depending on what floor/hall they are on. There is two nurses per floor (each floor has the potential to house 55 residents total) on days and afternoons, however on midnights (which is what my regular shift is supposed to be starting tuesday) there is one nurse per floor and 2-3 CNAs. Now, on midnights there isnt as many meds to pass until the 6am med pass, there aren't that many sugars to check, and there aren't a huge number of medicare patients to specifically chart on (the facility's protocol is chart by exception except for medicare patients, patients on antibiotics, patients who have fallen or new admits, and any other condition that requires frequent documentation... which should be all patients in my opinion as there's a reason they are there!). So, I will have, depending on the census, up to 55 patients to myself along with 2-3 CNAs... How on earth can that be safe??? What if one patients begins to decline and I am tied up with them and another one starts to decline... there isn't two of me, and the other nurses in the building wont be able to leave their floor because they are the only ones on their floor too... Granted 911 is a call away and literally 2 minutes up the road, and the hospital is 5 minutes the other direction, but STILL - that's too many patients for one nurse to safely take care of in my opinion. Is it like this is most LTC/SNF facilities? am I being unreasonable?

Specializes in Med nurse in med-surg., float, HH, and PDN.

EGAD, people! It's worse out there than I thought it was! Don't you feel, sometimes, like Lucy Ricardo at the candy-packing conveyer belt?!!!!? And the supervisor comes to check and says, "You're doing great!" Then she yells to the person sending the candy through, "SPEED IT UP!"

Specializes in Gerontology, Med surg, Home Health.

EMTs/Paramedics are NOT obligated to perform CPR or anything else if the resident has a valid DNR. They can transport to the hospital and not do CPR or insert an airway...at least in Massachusetts.

We can not dictate code status to the residents. It is their right to decide how much they want done and it is up to us to uphold their wishes. Personally, I think it's beyond outrageous to have to do CPR on a 93 year old guy with metastatic CA but it's not my choice.

That said, one day we will be staffing according to acuity and not simply numbers. One day, Medicaid will wake up and realize that they have to pay us more to take care of these people who are sicker and sicker.

I have actually had a crazy number of residents on nights, you dont even want to know but it was more than 55....If you work nights and have a ridiculous number some nights, depending on staffing/if they are able to get anyone else in you have to write everything systematically in priority on a piece of paper and god help you if you don't have angels as CNAs, but try your best and do what you can. Dont kill yourself and make sure you have those moments where you take a deep breath. Also if you cant get non-essential tasks done you must leave notes for the next shift and ignore their rolling eyes, they don't get it that there is more staff on days and it is actually possible to do things whereas running all over on nights for critical situations is a wee bit more difficult when you dont have as many CNAs.

Specializes in Geriatrics, Ambulatory Care.

That said, one day we will be staffing according to acuity and not simply numbers. One day, Medicaid will wake up and realize that they have to pay us more to take care of these people who are sicker and sicker.

I am in Texas which has the second lowest Medicaid rate in the US AND just had a 3% cut BUT we are taking higher acuity residents.

BTW I had a 105 y/o full code. When we explained what would happen if we performed CPR, the daughter stated "she is strong she can handle it."

Specializes in Med nurse in med-surg., float, HH, and PDN.
I have actually had a crazy number of residents on nights, you dont even want to know but it was more than 55....If you work nights and have a ridiculous number some nights, depending on staffing/if they are able to get anyone else in you have to write everything systematically in priority on a piece of paper and god help you if you don't have angels as CNAs, but try your best and do what you can. Dont kill yourself and make sure you have those moments where you take a deep breath. Also if you cant get non-essential tasks done you must leave notes for the next shift and ignore their rolling eyes, they don't get it that there is more staff on days and it is actually possible to do things whereas running all over on nights for critical situations is a wee bit more difficult when you dont have as many CNAs.

:eek: OMG-OMG-OMG! Bless you heart, your legs and your very busy brain! (I know about the rolling eyes, for I am a note-leaver, too. YA HAFTA! Otherwise you don't feel like you've got everything covered!) I was wondering how long you have been a nurse? Just curious, 'cause I'm an oldie-but-goodie.......nevertheless, I have a very hard time accomodating the avalanche of duties crammed into one lil' ol' shift. Well, maybe because in yon days of yore, we had sufficient staff, a smaller ns./pt. ratio, and fewer acute cases, so your assignment was more reasonable and you had TIME for patients as people. And the charting wasn't so...so....so....AAARRRGGGGGHHHH! (...and we walked barefoot in the snow 5 miles to get to work:lol2:!!!)

:eek: OMG-OMG-OMG! Bless you heart, your legs and your very busy brain! (I know about the rolling eyes, for I am a note-leaver, too. YA HAFTA! Otherwise you don't feel like you've got everything covered!) I was wondering how long you have been a nurse? Just curious, 'cause I'm an oldie-but-goodie.......nevertheless, I have a very hard time accomodating the avalanche of duties crammed into one lil' ol' shift. Well, maybe because in yon days of yore, we had sufficient staff, a smaller ns./pt. ratio, and fewer acute cases, so your assignment was more reasonable and you had TIME for patients as people. And the charting wasn't so...so....so....AAARRRGGGGGHHHH! (...and we walked barefoot in the snow 5 miles to get to work:lol2:!!!)

I'm a young girl, but I was orientated to nights mostly by an "old nurse" in a facility I no longer work in, but the note leaving although it incurs rolling eyes, and people who are usually not paying attention to your rambling (so you leave the note so if they dont want to listen they can read! lol) I have a very hard time on nights, because I am trying to be resident-centered, so if I wanted to get everything done I would be hauling everybody out of their beds at 3 and 4am, which I dont believe in.

I also wouldnt mind walking barefoot in the snow to work if we could "go back to" your days when you had time for the residents, honestly after some night shifts, depending what happens I feel like I am literally going crazy...especially when I have to leave work late and driving home with the sun blaring in my eyes and I just want to sleep!

Specializes in med-surg.

well today was my very first day on the floor as an LPN at a long-term-care facility. I worked 7-3, and since it was a holiday I was the only nurse on my floor, putting me in charge of 40 patients with 4 CNAs. Normally during the day there are two nurses, one at the desk and one passing meds. BTW I am a new grad and was only given 3 days of training. I had only trained on that particular unit only once and the med pass was terrible. Needless to say, 40 patients is a lot, especially during the day where they are all on several medications and many of them get accu-checks and insulin. I am definitely not ready to be in charge of that many people, but my job already told me they could not offer me any more training, so I feel like my only choice may be to leave, even though I've tried so hard to get a job over the past several months :( If this place doesn't think it is worth it to invest in training me, I certainly shouldn't be risking my license for them.

Specializes in Hospice / Psych / RNAC.

SPICEGRL most of the LTC places only give 3 days orientation. My first LTC job I only had 2 days due to someone calling in sick. You will get better with time I know it almost seems like that's not going to happen but it does. The experience will do you good. Other then that why sit at home waiting for something else.

Just keep on doing interviews; something will come along ... be patient.

Specializes in Peds Medical Floor.

Everyone gets 10 days of orientation at my LTC. 3 days and then sticking you by yourself is awful!

Spicegrl, 40 can be a lot depending on their acuity and it sounds like you have a lot of diabetics, make lists to organize yourself. I find it is easiest for peace of mind if you check/medicate all the diabetics first once you figure out who they are, unless of course you have people who are more urgent than the diabetics, such as your demented patients who could become ornery and even perhaps violent if they are not medicated, again I do not know what kind of floor you have but usually try to prioritize and not go according to the order it is on the MAR, which again is not as easy as it sounds like it should be I know.

However it IS possible....and you will be ripping your hair out possibly but try to do your best, go home and have a margarita!

I think it is crazy that animal shelters have more regulations that LTC.

In Wisconsin the statutes say "facility must provide "adequate" staffing to meet the safety needs of the residents. What exactly is adequate? One licensed nurse to 50 residents is not adequate in my opinion. LTC has a bad reputation over the years in many areas...

I find it interesting that a DON and the facility don't understand the pressure and the stress, that is put on Nurses in LTC, and everyday you feel that you may be putting your license on the line. Does the facility care? or the DON care? Probably not, everybody pretty much is too busy covering their own ass's!!! If DON knows what nurses are up against, then do something about it!!! What I know is I love LTC and I went into nursing to care for people, not spend a whole five minutes with each resident, to pass the meds, and try to assess I feel their is no patient nurse relationship (professional), it is really like hurding cattle!!! I had 8 hrs of training, told them I needed more, but each day the facility I worked for had a excuse why they couldn't get more training, basically NO STAFF, so here I am 8 hrs of training, with thirty patients, I have the station closest to the nurses station, so basically everybody is a fall risk, oh and by the way, I had to basically learn the paperwork all by myself through trial and error!!!

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