Licensed staff/skilled nursing residents

Mandychelle79, ASN, RN · Jan 9, 2011

When I worked in a nursing home, the was no difference between skilled and no skilled residents when it came to staffing ( In Pa) staffing levels had to be above 2.7 hours per patient per day ( combined care of all nursing staff).

Pennsylvania uses a combination of direct care hours and specific staff-to-patient ratios. It requires 2. 7 hours of direct resident care daily. At least one nursing staff employee must be on duty for each 20 residents, and at least two nursing service personnel must be on duty at all times.

Regulations also set specific nurse-to-patient ratios, depending on the facility census and shift. The ratios range from one RN or LPN on each shift in facilities with fewer than 150 residents to two RNs on each shift in facilities with 251 to 500 residents, and eight RNs on the day shift in facilities with 1,001 or more residents (28 PA Code 211. 12).

SE_BSN_RN, BSN · Jan 9, 2011

I know there exists more than one thread that discuss legal staff/patient ratios, but I couldn't find any answers specifically addressing specifically:
how many SKILLED residents per licensed staff? Does the RN supervisor count if she is not involved in care/meds? Am I making sense? I found no answers on BOH or any of the state websites (PA).

I don't think that there really is one....if you are talking about LTC. But there really, REALLY needs to be!!

Loving.Very.Nice · Jan 9, 2011

I have worked as an LVN and RN in LTC for five years and always wondered why there was no true licensed nursing staff to patient ratios. I am very aware of the PPD (patient per day) and I've even had to do the calculations for the facility administrator. What happens when these patients go out to a hospital, come back and receive PT/OT/ST and are as critical as a Med surg patient? How does a licensed nurse give good care to 30-40 Rehab and LTC patients on one shift?

I wish there was a combined LVN/LPN/RN LTC/SNF/Rehab/subacute union to tackle patient ratios.

Forever Sunshine, ASN, RN · Jan 9, 2011

I have worked as an LVN and RN in LTC for five years and always wondered why there was no true licensed nursing staff to patient ratios. I am very aware of the PPD (patient per day) and I've even had to do the calculations for the facility administrator. What happens when these patients go out to a hospital, come back and receive PT/OT/ST and are as critical as a Med surg patient? How does a licensed nurse give good care to 30-40 Rehab and LTC patients on one shift?
I wish there was a combined LVN/LPN/RN LTC/SNF/Rehab/subacute union to tackle patient ratios.

I agree with you. Another areas of nursing have defined nursing/patient ratios. I'm not saying I want 2 patients. God I'd be bored out of my skin. I am very comfortable with 1:20.

Nurse_Candice · Jan 10, 2011

I think it would become very involved if they were to implement this and would have to include MDS as 20 rehab pt who are alert and oriented and need minor asst with adls, having little or no wound care to speak of would not require the same time or skill as 20 Peg/trach/vent/ hospice pts with decubs, intricate braces? post surgical wounds, wound vacs etc.

I do feel its a step that should have been taken ages ago however! I think things are getting better as far as ratios go. When I speak to older nurses they tell me all kind of horror stories, but its still a long ongoing process that could be made easier if we had representation.

Forever Sunshine, ASN, RN · Jan 10, 2011

I think it would become very involved if they were to implement this and would have to include MDS as 20 rehab pt who are alert and oriented and need minor asst with adls, having little or no wound care to speak of would not require the same time or skill as 20 Peg/trach/vent/ hospice pts with decubs, intricate braces? post surgical wounds, wound vacs etc.
I do feel its a step that should have been taken ages ago however! I think things are getting better as far as ratios go. When I speak to older nurses they tell me all kind of horror stories, but its still a long ongoing process that could be made easier if we had representation.

Not all 20 residents that are A&Ox3 and do their own ADLs, or long term. We have one hallway like that and I'm always finished with meds by 9pm. Whenever I do that hallway I leave no later than 11:30. Theres another hallway like the latter you described and that assignment is a beast.

20 residents with a mix of short term rehab, long term and skilled nursing. is what I mean.

debRN0417 · Jan 11, 2011

I think that California may have mandated staffing ratios, but in my state and most others there is no mandated ratio. The SOM (State Operations Manual) has an F tag 353 regarding staffing, but it states, "The facility must have sufficient nursing staff to provide nursing and related services to attain or maintain the highest practicable physicial, mental, and psychosocial well-being of each resident as determined by resident assessments and individual care plans." It does not specify a ratio. The only regulation that specifies a "ratio" is for RN which mandates that an RN be on duty at least 8 hours a day seven days a week under F354. Also under F354 it says, "...the determining factor in sufficiency of staff (including both numbers of staff and their qualifications) will be the ability of the facility to provided needed care for residents. If you read this regulation, it provides some guideance on "determining staffing suffiency". Example: Are staff responsive to residents' needs for assistance, and call bells answered promptly? There are more.

There is no differentiation for skilled versus LTC residents. The staffing is whatever the facility can get by with and get the job done with good resident outcomes...what a shame. Killing the staff....

cro7690 · May 31, 2012

I too am trying to find a ratio for skilled nursing. When I was hired I was told I would never have more than 24 but my normal number about 18. Well I am coming off a 12 hour shift with 32. Thankfully I have some very good aids but the three of them and one of me had a difficult time with the range of problems my residents had. Almost all had treatments, I had someone on a vent. This was not a safe situation. We also had patients in the facility that had PICC lines running and No RN in the building (two called off). I am a newer nurse and I was highly uncomfortable with this situation. My 12 hour shift ended up being 16 and still not everything was done. I had to pass report and get myself to bed. I hope this isn't the normal out there.

buytheshoes11, MSN, RN · May 31, 2012

For the skilled nursing at my facility the maximum the nurse can have is 18. This may not sound like a lot compared to some of the halls where I work (some halls have up to 28 patients), but the acuity of some residents on the skilled nursing hall can rival that of some med-surg patients. In CA, there are no set ratios for LTC/SNFs.