How many residents is too many for one nurse?

Specialties Geriatric

Published

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 Gerontology, Med surg, Home Health.

So not to get personal, but most of my clothes come from Target or Marshalls. My car has 117,000 miles on it. I am sometimes at the facility for more than 12 hours. A ten hour day is normal for me. Who should we take if we don't take medicare or medicaid? Very few private pay patients out there these days.

I think y'all should have a quiet sit down talk with your management. No yelling or finger pointing allowed on either side. Keep a list of what you're expected to do in your day. I was just at a meeting where an administrator had NO CLUE what the nurse managers or staff nurses do. I told her she should spend more time on the units. I got a cold stare and she no longer speaks to me.

And, yes, I carry my work cell phone with me. We do not allow overhead paging unless it's a code blue. I don't sit at my desk so if anyone needs me for anything, they call my cell phone. It's the same one I have with me 24 hours a day 7 days a week and am expected to answer it ANY time it rings.

Well our management has no clue and it's a "not for profit" facility, which is weird cause all the administrators make much high salaries than any of the nurses do. If we complain, they just eliminate you because in this area, competition for jobs is tight. Our managers are not concerned with quality of care, patients, or employees, it's only about money to them. Even the aides complain that there are not enough nurses! They have to be getting stuck pretty hard to actually notice that. I'm not saying all management is bad, but ours is.

Also, they're not on call after regular work hours, they never work holidays, they leave at 5 and good luck trying to get ahold of anyone after business hours. They don't work weekends either. They just expect us to deal with everything with no help. And forget the pharmacy, that's a joke too!

Plus if you work nights, at least 3 times a month you come in during the middle of your sleep time to a meeting where management just complains about nursing and puts you down, tells you they need more, and you need to do more with less. It's getting very demoralizing. The pharmacy doesn't bring meds... but don't borrow! If your patient doesn't get their meds, you're written up! Well, I can't pull supplies out of my ying-yang, people. Maybe they should solve problems instead of just blaming nursing for EVERYTHING. Bed's broke, call the nurse. Dietary messed up, call the nurse. Security problem, call the nurse. TV's broke, call the nurse. Patient wants anything that anyone else could do when you're busy as heck, no worry, the nurse can do everything and anything all the time and get 24 hours of work done in 12. We're superheroes you know. By the way, you're written up for not following a protocol when you asked to be oriented on it and they said more "more than 6 shifts of orientation (for a brand new grad) wasn't in the budget" and you've never done it before so you have to guess (non-patient care issues but pointless paperwork issues)

It makes me hate nursing to be in this environment. Nothing to do with the patients but all management and staffing and budget nonsense. I became a nurse to help people and with all this garbage and politics and everything being only about money, I see why so many nurses are leaving the field. Not to mention the way older nurses treat younger nurses. No wonder in a few years nursing shortages will be gripping the country.

I'm sorry to be so negative. but I am venting. I still go to work with a smile on my face and do the best for my patients, but I can feel the burn out. Not with the patients, but with the system.

Specializes in Gerontology, Med surg, Home Health.

I was also burned out until I found a wonderful place to work. I don't call the night nurses in to meetings in the middle of the day. I do a 3-11 AND an 11-7 shift once a month so I can speak to all the employees. Do I like it? No...it takes me 4 days to recover, but it's important to me (and my administrator who also does these shifts) that the staff feel supported. We are not perfect, but our staffing is better than any other place I've ever worked and I've been in the business for years and years. Find a good place to use your skills. They do exist.

I am looking all over, but I haven't found one yet. 2 separate places have been this craziness now. I just want a job that values that I give a crap. I just keep trying.

Specializes in MDS.

I know for being on the floor for the first night alone and being a new nurse, last night's 23 pts really was too much for me! Not to mention, it's considered a "hard" wing by other nurses anyway. I guess this was my hazing! :eek:

Specializes in MDS.
And I'd like to see our managers and DONS deal with the crap scheduling, excessive unpaid meetings, and overwork we deal with. I know they have a lot of things to do, but they never blink an eye or think twice about setting unrealistic goals, adding extra time-consuming tasks and coming down on the nurses for every little thing. I'd like to see them deal with the situation with no orientation and constant put-downs like the newer nurses at my facility have to. All they seem to do is sit at the desk or walk around with their cell phones which is against the rules except for "business" for them (yeah right) and when we have a call off, they make US, the busy nurses try to find a replacement in the middle of med pass and if there's no one who is willing to come in or who isn't on overtime, we just get stuck working short after we waste time making the calls, and I never see them coming to the floor to help with med pass. They are the first to judge and lay blame yet they refuse to offer any assistance or help.

You know, I see this where I work and have only been employed since this month! I already hate the atmosphere and time constraints, but don't want to job hop so soon. I hope I can stick it out for a year and get my "acute care exp", and go on to another field of nursing. Idk though. After last night's fiasco of being on a hard unit and first time alone, I am irritated and depressed. How can I pass meds, do accuchecks, give insulin, assist with dinner in the dining room, change drsgs, fill out meal consumption charts, do 24 hour report in book, AND document in hot charting?!? Maybe it'll get easier once I become used to being a nurse anyway, but I feel so frustrated right now. :(

It does get easier with some time and adjustment, you learn what needs to take priority. I feel a little better now, but, it still is too much work and too many patients. And God forbid a fall (like my night last night) or something else happens, your night becomes a nightmare. I hope it gets easier for you soon. I know how scary and upsetting it is :( You're not alone.

It is common to have residents with greater than 20 medications. We are struggling with a nearly impossible task. The doctors are receiving perks for prescribing many drugs and we are left trying to figure out how to shovel spoonfuls of pudding, laced with chunks of nasty pills into demented frail elderly. The doctors write and we try to comply. We don't question it because the doctor calls the shots.

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

Why are facilities not responsible for putting nurses and their licenses in jeopardy every day and night they are operating?

Nursing Ethics seem to be totally ignored. The NURSE has to keep trying harder. The NURSE has to learn how to set priorities.

The NURSE is the one "at fault" because they have a hard time working an impossible situation. The NURSE is not "good" if they take time for the patients needs that are not meds. It is just disgusting.

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