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?

"I will agree that some LTCs need to increase staffing, but where do you propose the $$ will come from to pay for it?"

How about sharing some of the PROFITS that these greedy nursing home owners make and some of these administrative personnel who make 3 x's what nurses make and 10 times what the aides make???

YOU are part of the problem, CapeCodMermaid, because you are in a position to do something about these atrocities but you sit back and judge everyone else!!!! Shame on you!!!

Specializes in Gerontology, Med surg, Home Health.
"I will agree that some LTCs need to increase staffing, but where do you propose the $$ will come from to pay for it?"

How about sharing some of the PROFITS that these greedy nursing home owners make and some of these administrative personnel who make 3 x's what nurses make and 10 times what the aides make???

YOU are part of the problem, CapeCodMermaid, because you are in a position to do something about these atrocities but you sit back and judge everyone else!!!! Shame on you!!!

WOW...HUH?? I'm not judging anyone. I'm just saying that some facilities have great staffing. And to further clear things up, I am NOT an administrator OR an owner. I have NO say in how much the staff is paid or how much staff we have. My administrator has very little say in the staffing. It's people above us making the decisions.

So, Vonique, before you start insulting me and spewing venom, I suggest you know what you're talking about.

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...
LeeLee, you are misinformed. LTC is the most federally regulated industry in the US. We have more regulations than the nuclear power and waste industries, even.

I am a DNS and I gotta tell you, I have worked every nursing position on every unit in my building on every shift before I took the position I am in now. Part of the problem here is we get a picture on pur head of how nursing should be, and this is not reality. Its not reality in the hospital either. First of all, we don' just decide willy nilly how much staff should be scheduled. There is a formula that we and the DOH use to figure out staffing vs. number of residents. Second, we do not get the same reimbursement as the hospitals! My advice for everyone is to learn about your specialty. If you. Worked in an ICU, you would educate yourself about the specialty of critical care nursing. LTC nursing is a specialty as well. It would be refreshing to see us learn and make an impact in our specialty by making ourselves as knowledgable as possible instead of dwelling on things that will never change.

Well when I see the administration wearing clothes from target and driving cars that don't come from BMW or lexus, I'll buy into the whole "budget constraint" crap. I must say, my administrator and I both shop at Target, and she drives a Hundyai. This thread kind of goes on and on about the evils of management and of LTC, but no one has come up with an actual solution to what they believe the problem is.
Specializes in BSc, ASN- RN, MBA.

As a new nurse, my first job was in LTC. I was given a charge assignment on an 18-bed locked Alzheimer unit as well as being supervisor of the whole 140-bed (3-story building) facility. I was given 3 nights of orientation and the person orienting me was fired for drug diversion. Fortunately, the LPNs on the other units were wonderful and often it was 30:1 ratio on other units. It was trail by fire and the worst nights were those when it snowed overnight. I had to call in replacements for people who were stuck in traffic or couldn't get out of their driveway, on top of census paperwork, passing meds, and making sure the facility looked good and patients ok before dayshift arrived.

All this time, I was working on my MBA. After getting my MBA I was promoted to nurse admin. at a smaller facility but, I am in a dual role of ADON / DCE. I have been here 5 months now and quite frankly work harder than ever. I am in meetings from 8:30 to 11. These meetings are meant for the team to discuss and care plan resident care based on nursing reports/charting, with social services, dietary, therapy depts. input where needed. Often, we are rushed thru these leaving me feeling like we are often missing something. Then we have an all department meeting where often, the nursing dept. gets more and more piled on them. We do follow-up assignments for nursing and take them to each floor where the nurses have up to 36 residents. Every week there is a lengthy report that needs to be sent to corporate. Every month we have multiple reports that need to be sent to both corp. and the state. In my dual role, I am also the nurse educator and the person who interviews and hires new nursing and CNA staff. So, I get multiple phone calls from people who leave their applications who want to know the status of their application. BTW, Please don't do that. I don't even look at applications till I am ready to hire. I can't, I am too busy.

If a nurse calls out and we cannot find a replacement, guess who ends up on the floor giving meds - me! I had never done a 9 am med pass for 36 residents during the dayshift. the 9 am meds took me all day because I wasn't familiar with the cart, the patients, or where stuff was kept if it wasn't on the cart. It was not fun, but I tried to be a team player and went with it. All of my regular work however,was left for me the next day.

The DON is often in meetings as well all day. 72-hour post admission meetings, quarterly resident meetings, meetings about residents with significant weight loss or falls, care conferences with families, etc. Lets add to this corporate conference calls every week that pile even more on our plate.

Please don't think that floor nursing staff are the only ones understaffed and overworked. We are all feeling the sting of the decreased medicare and managed care payouts. Truly, only the strong will survive this. I have been at my job 5 months and nearly was ready to walk out friday after working a full week of 12-hour days. Add to this a 1 hour commute each way and essentially having to be on-call all the time.

I am just venting here a bit, but I get tired of people blaming admin. for their issues. I have been on both ends. Charge nurses can go home and forget about their jobs until their next shift. I can't. I get paid ok but govt takes out more taxes resulting in only $400 more a month than I had made before. $400 does not go that far when you have an hour commute every day - it pretty much covers the gas.

Can someone please help me with this question? I am the only nurse at an ALF I get 24 hours per week and there are over 50 patients and no other nurse at all. I am not really the type to work a bunch of hours for free which is what they expect me to do since I get a salary. They are also constantly complaining because the census is too low. If most of these patients were appropriate for an ALF I think this would be okay but I believe that a least 50% should be in another type of facility, like a nursing home or mental health facility. I only worked with the previous nurse for about 4 hours then I was on my own. Because of this I missed one lady's skin breakdown the first week I was there (I can't look at all their butts every day) and we were reported to APS, there is an ongoing investigation over this and they want to know how I missed it. Any advice would help.

I'm so sorry CapeCodMermaid. I really didn't know what I was talking about and I apologize. I only read one post of yours and jumped to conclusions, which were wrong. But after my post I began reading more and I realize now you are definitely not part of the problem and I'm so glad that you have found a job where there seems to be some sanity. My gripe is with those administrators and DONs who will actually argue that 5 aides for 60 residents, and quite needy ones at that, is adequate staffing, and I know they don't even believe their own nonsense but are just saying it to appease us and keep their high-paying jobs.

But I know that is not you. I'm soooo sorry!!!

Vonique

Specializes in Geriatric/Sub Acute, Home Care.

I was primarily a 3-11 nurse with working some nights. Sometimes getting stuck with a double TOO often. It was a great shift if you are a night person and love to get your body clock all out of sorts. But it wasnt for me. However....I had 32 residents on my shift. and 5 Aides who were devied up amongst another 30 patients....so 5 aides total for 62 people and 2 nurses. I think its too many.....20 is enough and it depends on treatments, wound care, meds, fall potential, dementia cases, G tubes, and the one and only possible cardiac arrest you get. Then everything is focused around that one and only patient. If something else happens you better have some great aides on the floor or if your lucky to have another nurse give you a helping hand. However, I found out the hard way.....aides disappeared to the Ort Cloud, the other nurse was also somewhere else where I couldnt spend time looking for her. I tried to get myself into a stable strict routine, and had many evenings where I had to threaten my aides with writing them up because they just werent around near their patients......Its a very very tough job. Administration always thought you were some kind of machine that could just go on and on. I think if this was a men dominated job it wouldnt be like this. Women do far more multitasking than men any day.(sorry guys its true) between juggling family/friends/and a job it takes superhuman strength.

ROTFL!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! :lol2: COULDNT OF SAID IT BETTER!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!:bugeyes:

OMG! U MADE ME RETHINK TRYING TO DO THIS JOB!:eek: IM SO SORRY FOR YOUR SITUATION, MY HEART TRULY GOES OUT TO YOU. :redpinkhe THAT IS MY BIGGEST FEAR EVERYDAY I GO TO WORK. SCARY, IT COULD HAPPEN TO ANYONE OF US.

Really really!!!!!!!!!!! I educate myself everyday after work and on my days off! I spend hours on the computer researching. I spend even more time reading books, talking to more experienced nurses, going to inservices, taking ceu's, signing up for classes at the local college and browsing ltc nursing forums to soak up every once of extra knowledge that another nurse may have to offer!!!! I'm willing to bet my pay check most ltc nurses out there do just what i do.

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