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 don't understand why there aren't hard and fast rules that limit the number of patients one nurse is responsible for.

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

Aem1215---I really appreciated hearing the difficult job sups and adms have; you ALSO are overloaded, assignment-wise.

With all due respect, I would submit that the 'formula' used to figure out nurse-patient ratios is no longer effective, for whatever reason.

LTC med-passes, in particular, are impossible. I would love to shadow those who claim to have become so proficient at passing dayshift meds for 30 patients that they are through in time to socialize for an hour or more, or take multiple breaks.

Yeah, I would like to check their waste baskets, or maybe the waste baskets in patients rooms. Also, ever wonder why some cards should be empty and they still have 1/2 the meds left?

Aem1215---I really appreciated hearing the difficult job sups and adms have; you ALSO are overloaded, assignment-wise.

With all due respect, I would submit that the 'formula' used to figure out nurse-patient ratios is no longer effective, for whatever reason.

LTC med-passes, in particular, are impossible. I would love to shadow those who claim to have become so proficient at passing dayshift meds for 30 patients that they are through in time to socialize for an hour or more, or take multiple breaks.

Specializes in LTC, Med-Surg.

How about this? My snf has about 120 beds. We have an accountant, a secretary, a social worker, a dietician, an activities director. Then we have the DON. We have three RNACS and I'm not sure what it is they do that someone else can't. Each shift has an RN supervisor. Then theres a floor RN (me) with 65 patients and three or four aides. The RNACS are 9-5 and do not do patient care. We have so many cooks in the kitchen that no one knows what's going on! Can anyone explain why the DON can't delegate directly to the shift RN supervisor (who also does not see patients unless we code someone) instead of going thru the RNACS? As far as I can tell, the only thing they do is orient new staff via paper and video and do paperwork of some sort. I bet their wage would be adequate funding for six more RNs

Specializes in LTC, Med-Surg.

Oh, I didn't mention. I work nights, 7-7. Our patients are the normal/ ridiculous mixture of inappropriate for this snf/high acuity- should be in a hospital types. I have worked there for a month. The other night, three of my pts managed to be "found on the floor" (they never fell, dontcha know!) and in the midst of all that mess, I had to send a pt out cuz they were...not ok. Four hours and ten reams of paperwork later I finally punched out at ten am. And guess who just got her first write up for clocking unauthorized hours!!

Specializes in Assisted Living nursing, LTC/SNF nursing.
Oh, I didn't mention. I work nights, 7-7. Our patients are the normal/ ridiculous mixture of inappropriate for this snf/high acuity- should be in a hospital types. I have worked there for a month. The other night, three of my pts managed to be "found on the floor" (they never fell, dontcha know!) and in the midst of all that mess, I had to send a pt out cuz they were...not ok. Four hours and ten reams of paperwork later I finally punched out at ten am. And guess who just got her first write up for clocking unauthorized hours!!

Sounds familiar, especially the getting written up for not clocking out on time. The last place I worked was notorious for that, never mind what happened during the shift and the 'you should have done this, you should have done that'. Excuse me, you come and work a night in my shoes and tell me you could have done things the way you thought I should have. I'm not a child and I know how to prioritize, you write me up and say I should have found more help. You are the one who sent most of my help home early, where am I suppose to find this so called help. Anyway, that place is water under the bridge for me and now I work somewhere that appreciates what I do for them and if I can get done on time, great. If not, I don't have to go home worrying and loosing sleep that I will be wrote up for things out of my control. Funny how things are in the new place, even management helps if your drowning and doesn't give you the finger wag and treat you like an adolescent when you and they know what they expect out of you is literally impossible. Heck, LTC's anymore are charting much more than a hospital med/surg floor does, mainly because they don't use flow sheets and even with computer, they expect you to chart like you were only taking care of 6 to whatever SNF ressie's and forget the other 40 ICF residents that need constant charting on also.

safe practice a "losing battle" w t h? and a DON said that?! w t h? someone in a high place needs to make A LAW for the ratio for safe care by law. It makes me sick, the nurses are dumped on, and the patients don't get what they are due. Unsafe practice and shortcuts are going to continue. as a nurse, i would never recommend any elders i know to stay at any LTC. I can't belive everyone is managing it and lookin the other way, making any LTC a bad enviroment. w t h. "good luck"? what?! i find the situation deeply disturbing.

Let's not turn this into a DNS vs. floor nurse. You might not realize all the constraints - time, money, and regulatory - we are under. I've done your job and every other job in the facility. I've had 30 sub acute patients of my own..IVs, TPN, wound vacs, trachs, behaviors...it wasn't easy but I got it all done and none of the residents suffered.

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

If the facility can't provide staff to take care of the patients, they need to stop admitting the patients. i think it's greedy for a facility to accept more patients than nurses feel they can safely handle. If you can't afford the staff, what makes them think they can take in the extra patients????!!!! hello?!!!

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.

the federal regulations aren't working

the federal regulations aren't working

they are certainly felt!...sometimes misapplied, sometimes twisted, sometimes administered by ejits. sometimes too much! take away money, and expect more services NEVER works.

I'm a recent LVN grad and I just got my 1st official job as a nurse. Currently, I am caring for 60 residents. That is sooo insane!!! I've only been on the floor for 3days. I'm going crazy. Seriously, i'm very curious how many residents/patients is too many for a nurse?

...make sure you know the code status of all residents.

There's the rub... when you're responsible for the health and safety of a ridiculous number of human beings (and living in a lawsuit-happy world), you can't know enough fast enough. If it feels wrong, unsafe, overwhelming- stay away! I work in a hospital, so the ratios I hear in this forum freak me out. I know the level of care is different, but I would NEVER EVER EVER assume care of dozens of people. I thank you all for the heads up. Won't be searching the job listings for LTC facilities in this lifetime. If our society cares so much about our elderly, why is it so unwilling to pay for the care providers needed to do the job?

+ Add a Comment