LTC facility trying to fire me over refusing to take on 50 residents

[NurseGeorgiapeach]

I have to get opinions, i cannot find much about the GA law against LTC facilities and nurse to resident ratios. So, my situation was basically an employee called out for the unit that is on the same floor as my unit. I get to work and they tell me that I have to take on both units all night! Both units contain 49 residents and one of the residents is very violent and has attacked many nurses. Management even threatened that if I did not take the keys to other hall that they would report me to state for abandonment, yet I was NOT scheduled to work that unit, and there and the day Nurse was still there. Also, I work 12 hr shifts, I had gotten called in on my day off just the day before this mess happened. This happened on a Thurs. I had already worked Mon, Tues, off wed, Supposed to work Thurs, Friday, Sat, and Sun. and they wanted me to take on 2 units by myself. Is this NOT crazy!!!

[HappyWife77, BSN, RN]

Geaorgiapeach- I haven't read all the other replys....but I noticed you said "that night" you arrived to work. And if it's night shift, that is a normal assignment for many of the LTCs I've worked in. It's a lot I know. I never work nights, but I have filled in and it was a very busy night without breaks for me. I would rather have 26 patients and am shift than double patients during the night. That's just me though.

I know a lot of states do not have ratios or we would have more help in ltc. I would just stand your ground. Let management come in and help you. It's not your 100% responsibility if they DO NOT usually staff like that. They ultimately need to provide their "normal staffing numbers".

I think whoever was on call that night at your facilty should have covered. Not the regular staff nurses. That's a good way to lose your nurses. If they fire you, that's a blessing to you. You wouldn't want to work there anyways. I hope everything works out for the best. I hate seeing LTC nurses stressed out, our jobs are stressful enough without added drama.

[joyouter]

Long Term Care facilities really need to be more closely examined. The position you hold presently indicates according to your hours which are 12 hr shifts with a day off in between if I understand correctly. You were asked to come in for an additional 12 hr shift. No one other than factory workers in 3rd world countries today should be expected to work such loads with large patient populations plus unknown variables / outcomes for all patients.

The time factor is not being addressed here. That would indicate a very exhausted nurse whose ability to work well would be compromised through overwork, staff shortage and fatigue. This would lead to patient safety beinbg compromised with the overall risk of the nurse being fired either through her refusal to accept a patient load or risk being fired for an error made under duress and fatigue. This system and management bully nurses to work while refusing to deal with the long term reality. Nothing positive to be achieved unless management is agreeable to listen to the nurses and attempt to respect and work with them instead of bullying and incompetence in management of the facility and the over arching responsibility of operating a LTC unit.

Good luck and continue to fight legally for improvement...

[smarkland]

As a nurse of 43 years who has seen just about every situation, I applaude you for standing firm and refusing the unsafe assignmnet. The other comments here are right. You cannot be accused of abandonment when it wasn't your original assignment and when they tried to give it to you, you refused. Additionally, your place of employment is not going to turn you in for anything because believe me, they do not want to admit that they are demanding unsafe assignments from their staff. Sounds like the local Medicare office should know about the unsafe practices at your LTC facilty. Think twice befor you quit though. You will go to your next LTC facility and find the same problems. They are all alike. Understaffed and underpaid. Passionate nurses like yourself can take steps to change that. Congratulations on being a passionate, caring, and safe nurse!

[dorrybnursing]

I have had this situation happen to me also. Only it is 70 residents. Ive done it, I haven't liked it and as someone else said kudos to you for taking that stand. The problem is dealing so harshly with you and not addressing the obvious call off issue. Why do people call off so frequently with no penalty.

[sallyrnrrt, ADN, RN]

Ever have 98? seems a bit much to me.

ktw we must of worked at the same place , took an act of God, and explanation of wgat safehabor would entale for the facility, to get 2nd nurse

[ppfd, BSN, EMT-P]

I tried working in a nursing home once. The money was pretty good for part time work.

I made it through 3 days of training with another nurse and never went back.

You all working LTC have my total respect. I knew there was a problem when there were more "RN managers" on duty than floor RN's.

Funny story, this place had such a turn over that one shift I worked 2 aids got into a fight over a particular unit they both wanted to work in. Well, they called the main boss and threatened to quit. She said hold on she would be there in about an hour.

This woman baked cookies for them and begged them to work. The agreed to split the shift in said unit.

[icu/don]

No, California does not have nursing ratios for nursing homes. Actually the ratios got written into the law, but are not enforceable because of budgetary restraints. The binding staffing in California is hours per patient day. You take all of the direct care RNs, LVN's and CNAs for a 24 hour period and divide by the number of residents. This has to equal 3.2 hours per resident.

The state was sued because they did not come up with staffing ratios as required by law. After being sued they attempted to set ratios based on the 3.2 hours per patient day and this is what they came up with for 8 hour shifts:

Day shift: Licensed nurse to resident 20:1 & CNA to resident 9:1

Evening shift: Licensed nurse to resident 25:1 & CNA 10:1

Noc shift: 30:1 & CNA 15:1

As you can imagine this would have been a nightmare for our 33 bed facility. It also didn't take into account any 12 hour shifts or overlapping shifts.

[Anna S, RN]

No, California does not have nursing ratios for nursing homes. Actually the ratios got written into the law, but are not enforceable because of budgetary restraints. The binding staffing in California is hours per patient day. You take all of the direct care RNs, LVN's and CNAs for a 24 hour period and divide by the number of residents. This has to equal 3.2 hours per resident.

The state was sued because they did not come up with staffing ratios as required by law. After being sued they attempted to set ratios based on the 3.2 hours per patient day and this is what they came up with for 8 hour shifts:

Day shift: Licensed nurse to resident 20:1 & CNA to resident 9:1

Evening shift: Licensed nurse to resident 25:1 & CNA 10:1

Noc shift: 30:1 & CNA 15:1

As you can imagine this would have been a nightmare for our 33 bed facility. It also didn't take into account any 12 hour shifts or overlapping shifts.

Those ratios are fantastic!

Back when I was an LPN, I was the only nurse on nocs for 65. I had 9 tube feeders, 2 trachs, and numerous wanderers/ fallers. 3 CNAS. I did it, but did not get a lunch break the entire 2 years I worked there.

[ClearBlueOctoberSky]

For those that say the on-call nurse or management should have worked the shift, let me give you a true scenario.

When I am On-call, I still work my regular hours. I work five days a week, including a weekend day. My hours are not nine to five, typically I come in early and work close to 12 hours a day for the entire five day week. Our call out policy states a minimum of two hours before start of shift.

The last time I was on-call, we had just come out of Survey, so I had pretty much worked seven days, and split a night shift with an evening nurse due to a call out in the middle of that week. I had one day off, started working my regular schedule. Midway through the week had a night shift nurse call out. Unable to find a replacement, I then proceeded to work that 8 hour shift, after being at work for 12 hours, and not able to take a nap before the start of shift. I was up for 24 hours. After the shift was over, I was able to go home and sleep for about five hours before being called in to work again to assist with admissions. The next day, due to a call out, I worked a 12 hour day shift. I had a day off, and then was called in to work an 8 hour shift.

I still have all of my other work to do, so I can't just go home after I get off the cart.

Yes, as management, it is part of my job, however, think about this before you say Management doesn't do anything.

In my opinion, 56 Residents at night on a long term care neighborhood is manageable. Is it better to have one nurse cover those 56 Residents, or have a nurse come in who hasn't slept in over 24 hours?

[ktwlpn, LPN]

Our managers must take turns taking "on call' and they do receive a stipend. As salaried employees they have the freedom and flexibility to take the next day off or come in a few hours late of even leave early.Every one of our unit managers and supervisors who spent any time at all as floor nurses will now openly admit they can ride a desk many more hours a week than they could safely work a lot of overtime on the floor. At least you can go in your office, shut the door and sit down in relative peace.

If your 'regular hours" are 5 -12 hour shifts a week I hope you are still being paid hourly, unless you are staying late because you are having difficulty meeting all of your obligations.If that's the case I'll repeat exactly what management tells us if we work late (because the doc rounded on 35 residents or we had a hospital return, a new admission and a few falls) "Perhaps you need some help with your time management skills, let me call staff development to meet with you"

In my state it's not legal to be on the clock for more than 16 hours. Like the OP,many of us need to practice the word "no". Maybe the both of you need to brush up those resumes and look for greener pastures.

[morte, LPN, LVN]

please remember this was a 12 hour shift, meaning she would have had ALL the HS meds to pass. nope not gonna happen.

For those that say the on-call nurse or management should have worked the shift, let me give you a true scenario.

When I am On-call, I still work my regular hours. I work five days a week, including a weekend day. My hours are not nine to five, typically I come in early and work close to 12 hours a day for the entire five day week. Our call out policy states a minimum of two hours before start of shift.

The last time I was on-call, we had just come out of Survey, so I had pretty much worked seven days, and split a night shift with an evening nurse due to a call out in the middle of that week. I had one day off, started working my regular schedule. Midway through the week had a night shift nurse call out. Unable to find a replacement, I then proceeded to work that 8 hour shift, after being at work for 12 hours, and not able to take a nap before the start of shift. I was up for 24 hours. After the shift was over, I was able to go home and sleep for about five hours before being called in to work again to assist with admissions. The next day, due to a call out, I worked a 12 hour day shift. I had a day off, and then was called in to work an 8 hour shift.

I still have all of my other work to do, so I can't just go home after I get off the cart.

Yes, as management, it is part of my job, however, think about this before you say Management doesn't do anything.

In my opinion, 56 Residents at night on a long term care neighborhood is manageable. Is it better to have one nurse cover those 56 Residents, or have a nurse come in who hasn't slept in over 24 hours?

[HawaiiGuy]

We had a similar situation in our facility a few years ago. On the night shift 6pm-630am we have 34 Residents on one unit and in a locked down Alzheimer's/Dementia unit we have 20 Residents. In the past, whenever the Dementia unit nurse was out, the SNF/Rehab unit nurse would have to cover both units (total 54). One year the Dementia unit nurse had to go out on medical leave and for 3 months, every night I worked, I had to cover 54 Res. There was one night when I was running back and forth between the locked unit and the regular unit dealing with 2 falls (each fall adding 2 hrs paperwork), a Resident becoming violent, one near-coma with an HS blood sugar of 30 and two dying with multiple family members present, and one coughing up blood -- the thought of that night still gives me nightmares. All the while, others asking for PRN pain meds and upset that I was late getting to them, and personal alarms and call lights going of. We have 2 CNAs in each unit at NOC. I was so stressed out, I was ready to quit the next morning. The other NOC nurse (who was very healthy and normally calm) was so stressed, several nights she worked her BP was so dangerously elevated she had to be sent out to the ER twice. This nurse eventually sued the facility, and won a unspecified settlement. The facility was forced by the court to staff both units at all times. But, just recently, after 3 years of full staffing, I was forced to cover both units again (granted only for 5 hours until the day nurse came in early), but they're sliding back to old habits. Next time this happens, I'll report them. So, depending upon the acuity of the unit -- 50+ Residents can be unmanageable.