Nursing staffing

All of you make excellent points. I'm also in subacute LTC. I also can not do a wound vac in 5 minutes, it takes me almost that amount of time to get the old dressing off, especially if I don't want the pt. to scream. Not to mention, if that were me, I would appreciate more then 5 minutes of a nurses time when treating my wound.
I'm still fairly new, less then 2yrs exp. so I attribute some of my "slowness" to the learning curve. That being said, I find it difficult to believe it is possible to do cares/treatments on as many patients as some of you take care of. The most I have cared for is 10, no break, no lunch, no charting till after I reported to next shift, thank god no IV blew, PT/OT helped and no CNA had called off that day. Yeah it's "doable, but who could really work under those conditions every day??
I did not come into nursing thinking it was an easy job and I've always been a hard worker, no problems there. What I have found, is exactly what others here have said; The DON/CRN is really not aware of the pt. load and the time involved. Or, maybe they do look at the pt. load and think it only takes 5min for wound vac. 1 minute for BSX10-20 pts.,med pass 20mins,bathing 2pt 20mins.passing brfst/lunch trays10min.TPN 3min. etc...you get the picture.

All the nurses I work with, got into nursing because they "cared" They want the best for their pt. What I'm finding is the "powers that be" expect more and more...and eventually...as some have posted...it is virtually impossible. Sure the DON/staff should step in to help, but they have their meetings and schedules too.

I believe the nurses complaining here are good and competent nurses Even in school, my instructors said the complexity of the pt. has increased significantly. What I see here is, my fellow nurse looking for supportIf we don't support each other, there will be even more calling in "sick" At what point will the "powers that be" say "stop, the staff can not safely handle the pt. load?"????? Stop saying it's "doable", get rid of those who aren't team players, and support those of us out here who truely do care and aren't burnt out yet

I expect my staff to work as hard as I do. I also expect them to be able to get their breaks, which they do. I have one nurse that routinely can not get her work completed in the time frame that everyone else does, this is not due to the workload, it is her time management skills. Does it put her job in jeopardy? Yes. Every facility has a different "climate" and staffing set-up. It is not fair to lump them in one pile. I can and will say it is doable as I know what the acquity levels are for my residents and staff accordingly. My floor nurses do not complete weekly assessments or MDS's. I have a nurse manager on each floor and an MDS and Medicare Coordinators. I also have some ancillary staff to ease the load. Myself and my ADON are available to assist with work needed to be taken care of. I started in this career as a CNA and it is not beneath me to toilet, feed, make beds, etc. The last facility I was in I also helped clean out the garage of old equipment, went dumpster diving multiple times for dentures, got on a ladder to tear down a sheetrock ceiling, shampooed carpets, ran the kitchen and cooked supper one night when the cook did a No Show... the list goes on.

I work in this field to help with a better quality of life for those who need our help. I listen to my staff and do what I can to make it an even playing field for all of them. But, in the end, the residents come first and if that means I need to add the staff to take care of them, then I better be able to explain why I have and I do. Don't anyone ever tell me that what I expect of the nurses in our facility is not "doable".

There are always two sides to every story. I appreciate you giving your side and I agree we need to support our fellow nurse. There may be no easy answer to the problems some of the OP's nurses are having.

LTC increasingly taking in sub acute - staffing remains the same - yup The Dept. of Health and Human Services may be satisfied with the minimum staffing levels maintained -
Lazy Nurses - I don't think so
Sleeping cnas - yup - they were told not to sleep in day room - so they sleep in gerichairs in hall.
things don't get done, residents get dehydrated -oh the URIs How many nebulizer tx in a shift - and the UTIs - How many BS and coverage - coverage 30 min before a meal well my shift is over at 7 and breakfast is 8a.
duh Frequent PT INR sticks
If resident does not want to take meds - oh welll most nurses put Refused (I do try and try and try but get real)
Confused, sick pts. dumped (sooner than they should be released from hospital) NO meds - hospital notes = combative - well no doubt probaby scared but no one listens or cares. Now someone has to babysit - we had to take turns
Got 2 peg feedings and a TPN- change an IV - I guess I shoud be thankful that I don't have moreIVs. No one stays in bed bells ringing verbal abuse - got one down the hall actively dying freq. med for pain.
she was one of my favorite residents no time to sit with her but "Nurses are licensed people with certain skills. As cold as it sounds, Medicare does NOT pay us to spend time with the residents/patients."
Have to do my chart checking other administrative duties... So and so has a colostomy liquid drain q 2 hours or you will have to re do the bag. Oh shoot they wanted me to complete my MDSs...This one thinks his basement is flooding unable to reorient - gets up falls down VS q 15 call MD - he is P*****incicent report cna refuses to write a her part of report
bells ringing confused new patient walking halls - slaps nurse, call 911 - paperwork to send to psych hospital
do charts
reminded that I should be able to complete my duties 1/2 hour after shift change or punch out - come back in and complete the job - something I refused to do (kinda illegal anddangerous for me if hurt after punching out)

go home sleep - UM calls to complainabout something...You did this wrong ....
Chaos on wheels
tierd overwhealmed nurses
accident waiting to happen - no accidents happen
Survival nursing
Oh did I mention herding cats
a very negative environment - with toxic -non supportative - crititical managemnent.
I found my LTC subacute environment to be a very scary dangerous place for me and and many residents
Oh yeah right - I am just lazy and want to blame someone
I left - to save my body and my sanity
I will never return to the scene of the crime - sounds like I am a tad angry
oh well
no not working - not a good time to save my sanity

mercy, is it possible that there is one bad apple in the bunch? I whining ringleader?

WOW, SuesquatchRN, you really hit the "nail on the head" there "mercy, is it possible that there is one bad apple in the bunch? I whining ringleader?"

despite some very busy/stressful days, i feel our job is "doable". When there is a certain nurse/aide who comes to work with a bad attitude, or the one who never answers her call lights because "toileting is a CNA's job or some other lame excuse" the whole atmosphere of the unit takes a nose dive. When that person is off, it seems as though the work gets done and the team is working like a well oiled machine.

It really does take "one bad apple" Send them packing just kidding, maybe they need a promotion they may be so bored in their position, work is no longer a "fun" challenge, but, rather a burden to them. Or as SuesquatchRN says, "I whining ringleader", who should be sent to an "effective communication" course, so her leadership skills could be put to better use

I wish that the place where I'm at had more support from managers. The nurses, especially on the 3 to 11 shift, are responsible for everything. This means meds, treatments, new orders, admissions, and recaps. Even in the subacute section, one nurse is expected to pass meds up to 20 people, in addition to doing as many as 2 admissions. And sometimes the admissions come in after 7 pm (the place accepts admissions on all shifts). We don't have any managers or supervisors on the 3 to 11 or 11 to 7 shift to help us.

Yes, many nurses clock out late because it's impossible to get everything done in 8 hours. Plus, during the past week, it was recap time (I was off work, thank goodness!), so the nurses had to stay even later to get them done, or come in on their days off to finish them. How can any one nurse do meds, treatments, admissions, and recaps in an 8-hour shift? And if someone falls or has to be sent out, that adds more time. Even the more experienced nurses (10-15 years) I work with can't get it all done.