New to ratios?? - page 2

Hi to everyone, Just want to broaden my knowledge and have a question on Nursing ratios as they apply to long term care facilities. Any comments?... Read More

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    7-3 at our facility is 2 nurses each nurse had 20 subacute patients (read med/surg and take medically stable as fiction) and 10 long term care. 7-3 also has a unit clerk and a treatment nurse. 3-11 its the 2 nurses again with 20 subacute patients and 10 long term care residents. 11-7 is 1 nurse to all 60 patients. There is also a house sup on all shifts to handle admits, discharges, incidents and accidents. But as mentioned with call offs and other is usually less than ideal....


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    Oh, I would love to post a copy of this thread at my facility. We have 90 beds, but our census is always closer to 80. On 7-3 there are two supervisors, four primary care nurses, two unit clerks, ten nursing assistants and two bath aids, and two unit assistants. There is a wound nurse three days a week. On 3-11 there is one supervisor, unit clerks stay till six, four primary care nurses, ten nursing assistants. On 11-7 there is one supervisor and two primary care nurses, along with five nursing assistants. We usually have extra help on all shifts with "pre nats", kind of act like unit aids. These are people we have on the units before the nurse aid training program starts or they are students in the local tech school's NA program. We also have hospice during the day and so they send an aid each weekday to do our five or so hospice residents. We have students from the Vo tech to help with care one day a week and LPN students from a local college here one day a week. We have no sub acute. We also have a nurse practitioner working for Evercare, in which twenty of our patients are now enrolled.
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    Greetings ~

    In my LTC facility there are two stations. One station has 36 pts. 1st shift has one lpn, one med tech, and either 3 or 4 aides. 2nd shift has one lpn, a med tech until 4pm, and either 3 or 4 aides. Third shift has one lpn and two aides.

    The other station has 56 pts. It's supposed to go like this: 1st shift 2 lpns, 2 med techs, 6 aides. 2nd shift (where I work) 2 lpns, 1 med tech, 4 aides. 3rd shift has 1 lpn and 3 aides. If the other nurse calls off though, you're usually by yourself. It can get pretty busy, I'll tell you. Especially when you get admissions.
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    DON....I'm moving to your part of PA!!
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    At my facility on 1st shift there are 38 rsndts, 2 lpn, 3-4 stnas, 1 rn on one side. On 2nd it's the same except only 1 house supervisor. And on 3rd its 1 lpn, 2-3 stnas and house supervisor. That's a pretty good ratio from what i have been reading.
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    Quote from cheerfuldoer
    I recently spent four days orienting to a health facility that has long and short care patients....many are skilled nursing patients which is nothing more than a step down med/surg unit from what I could tell. Each nurse has 20 patients no matter the shift. Needless to say, due to many things I witnessed and heard during my four day experience there, I chose not to stick around for more abuse.
    Or to (witness the subtle) abuse...Wanna talk about being used? I'm a critical care animal by nature, but I've had plenty of excitement in my life, and so I go in for an interview due to the great 'Chance of a Lifetime' promises. The DON immediately starts talking in terms of 'when you start', obviously desperate, assuming I took the job. I get offered a pretty good starting salary, and an evening shift. I should have known when the DON asked if I "can make aides work", followed up later by a denial of a problem in that regard.

    One week later, things are going well, then concurrently, the State arrives, folowed by 4 Atty. Generals. The Atty Generals were there for a drug diversion case. The drug thing happened before I got there. Although there are bags of narcs sitting out all over the place.

    So, First week goes well, (although they are required to have an R.N. in the house at all times, which means the salary RNS take 'call' and have to sit there and do nothing (as they do so well) to satisfy requirements. I was asked to do this for the weekend after my first half a shift)

    Then a Nursing Home closes, 2nd week, and we get an influx of over 50 pts, and although I asked to go over the papers, I had never admitted a pt. No one even seems to know where the full admit packets are. End of the week I go to a facility suit and ask "Why are the most common responses here 'It should be there', and 'I don't know'?" She almost does a Danny Thomas 'spit take'. Coming in at 3rd is 'That's not my patient.' I try to tactfully remind them that everyone in the building is their patient, even though perhaps not assigned. Nurses were no better, wouldn't even reset a feeding pump that wasn't 'theirs'.

    Meanwhile, I'm getting all my TX and charting done, admitting pts as best I can, and we don't have a roll of tape in the joint. I even had to buy my own pill crusher. When I'm running this hard, and nurses and aides have time to hold the wall up and talk about so-and so's new baby, someone has too few patients, or they're skipping TX.

    Week 3 I go to DON and another suit, and directly ask how I was doing, never having worked LTC. I got all kinds of praise for my ability to learn quickly, reasssured, blah blah. I asked for an orientation to papers to satisfy Medicare, was told to come in early 15 min next week (amazing what can be accomplished in 15 min). The suit supposed to show me paperwork is outside smoking, and Hellzapoppin' on the floor.

    I get a call the beginning of week 4 that I could turn in my resignation. I was apparently dealing with some of those papers from hell, and was adjudged of a 'med error' althought it consisted of assuming an LVN to be an adult and put it on her med sheet. No erroneous med was witheld or given. Additionally 2 residents (Not staff) thought I acted 'strange' (as if they could even recognise me), who have a history of reporting everything from being smothered by others to having their minds controlled by the FBI. That at least warrants my 'right' to a pee test, which I didn't get, they cost money). Additionally, I had told my ADON that if I didn't do something right, I usually only needed to be told once, and I would do my best to correct it, i.e. feeding pumps, protocols, et.c. This informal statement was twisted into a general statement that in any event, just tell me once.' Like I can do heart surgery if you just tell me how once.

    This was immediately after the state left, and all the influx were admitted. The knee slapper is I was immediately offered a night shift (I assume at a different salary), and again later told anytime I wanted to rehire, just come on in. I was used to

    1.Get them over a hump
    2.Let them relax at home rather than be on call
    3.Get them through the state inspection
    4.Admit a large amount of patients.

    I would probably be rehired at a lower rate, but no one pees on my head and tells me it's raining. My benefit was that they paid me a sign on bonus anyhow, and I have made my wife promise that if I begin to come to the state I see some of those residents caught in, well, 'nuff said. When you have near 40 patients whose family never visits, stuck in a bed without socialization, and TV Rap stations the aides leave on, well Dante` missed a level of hell.
    Last edit by Crumbwannabe on May 4, '05

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