Ok people, face facts: Staffing in LTC is always going to be outrageous!

[southernbeegirl]

All these threads about staffing ratios are driving me nuts! I have worked LTC for 16 years now. Staffing is what it is people. It is not going to change or get better. It is what it is. The decision you need to make is "Do I want to work in LTC?". Be realistic about the job. If you continually have these feelings of things are unfair and you think you can do something about it when noone has been able to for years and years, then you are always going to be disappointed. There is no middle ground...you love it or you hate it. I hate to sound jaded but all these whining staff posts are driving me nuts! Continually complaining will do nothing but put you on a radar at work you do not want to be on. And if you think going over your DON's head to the administrator is the right choice, think again people. It's time to look at the job logically. Life is unfair. Grow up. if you accept the job...then do it! If you don't like it...then stop whining and do something about your own life....get a new job! sorry for the rant....

[mazy]

I'm hoping to get a critical care fellowship position. I can't take LTC anymore. I'm hoping my new position is better but oif the nurses who worked in LTC for years and years are happy with the way it is and are willing to take the abuse and be the nurse who doesn't have time for anything, they can stay there cause it's just plain UNSAFE and most new nurses I know are just are not interested in being pill-passing robots. Not trying to be offensive to LTC nurses in any way cause some are awesome, but the environment is awful where I've been and I became a nurse to help people, not so I could give out 60 simvastatins everyday and hate my job.

The nurses who've worked in LTC for years and years are NOT happy. That is why we complain, only to be told by people like the OP to get over ourselves. I have worked in LTC/SNF for years and I love what I do when I have the tools to do it well. I've worked in other areas of nursing and I keep coming back to this because I like the job and I love my residents and I think it's a damn shame what we do to the elderly in this country.

I hate the conditions, but I value the lives of my residents so I'm going to stand where I'm standing and I'm going to fight for them to get better care. Doesn't mean I'm happy, doesn't mean I'm going to quit my complaining, just means that I'm not going to run away from this fight. These people matter. And I matter too. I deserve to be treated with respect by my supervisors too so that I can do a better job.

We all have our areas of interest. Wherever you work, hopefully you bring your best game and fight to do your job well. That's what it's all about. Valuing your patients and advocating for them...and also, along the way, advocating for yourself.

[KeepItRealRN, BSN, RN]

Find a good facility. Mine has a 1:5 CNA to resident ratio. Residents get up when THEY want to; go to bed when THEY want to. The staffing is wonderful and the residents all get the care they need. It's not always easy since putting the resident at the center of the day is not a usual thing in this business, but it makes for happy residents and happier staff.

Must be a private pay facility where you work. Any facility that takes Medicaid will not have staffing like this. Last time I checked, in 2008 Medicaid paid $147/day or $4500/month for LTC. This reimbursement does not comepletely cover the costs of patient's who require skilled nursing care. Costs include, meals, room, utilities, nursing care, PT, activities, and all overhead involved in running a nursing home. So run the numbers and you will see why staffing and conditions in these places is abysmal. So let's say that you have to care for 30 residents at at time.

30 residents x $4,500 = $135,000/month

costs

RN care $20/hr x 8 hrs = $160/shift. I am going to round this up to $200 because there are extra costs involved with employment including benefits, unemployment insurance, and an additional 7.5% In Social Security the employer has to pay Social Security.

RN care $200/shift x 3 shifts = 600/day x 30 days = $18,000/month

CNA care assuming CNA's average 10 patients each

$8/hr x 8hr = $64 x 3 shifts = $192/day round up to $200 to include employer costs x 3 CNA's = $600/day

$600/day x 30 days = $18,000/month.

So let's add it up so far

$18,000/month RN

$18,000/month CNA

Now lets add in food. It probably costs at least $20/day to feed each resident assuming all you serve are casseroles. So $20/day x 30 residents = $600/day x 30 days = $18,000/month for food

$18,000/month RN

$18,000/month CNA

$18,000/month food

You can see that so far we have used up $54,000 of the $135,000/month we're getting from Medicaid and all we have paid for are salaries which are very conservative in these estimates, and food.

So now we have to pay for the building, pay utilities and taxes. Pay other people who do not do direct patient care like administration, secretaries, housekeeping, laundry, grounds maintainence and I am sure that these 30 residents share of all of this is at least another $50,000. So add that to the $54,000 we've already spent and we are left now with $34,000/month to work with.

So lets say that we take a look at the staffing situation. The nurses are complaining that taking care of 30 residents a shift is unsafe and demand that the max be 15. What happens here is that you double the cost of your RN care per month from $18k to $36k which would leave $16,000 left in our slush fund. See fixing your staffing issues is greater than a 50% hit. That is why it is never going to happen. Let's say that you also think you deserve a raise. Now that comes out of that fund too.

The truth is that Medicaid reimbursement is not going up, it is actually going down, even when the costs of taking care of residents is going up. Food costs, salary increases, higher utilities, etc. I'm not saying that this is right, but it is reality.

[CT Pixie, BSN, RN]

I've worked SNF since 1985. In every facility I have worked in over the years as a CNA, all the facilities I did my clinicals in during my LPN schooling, and the facility I currently work in the ratio always runs from about 1:30 to 1:34.

It wasn't a matter of people calling out. There was one nurse scheduled to work the floor with 30 (+/-) patients.

I would love to have 1:15 but its obvious that is likely to never happen. It hasn't changed one iota in the past 26 years from what I've seen. But regardless of the ratio changing or not, someone has to care for our elderly. I just try my best to give each and every one of my patients my 100%. It can be very difficult at times, on several occasions I've wanted to march up to the supervisor, hand her my licence and walk out the door. And every time, I take a second, regroup and forge on. Like I said, someone needs to care for our elderly, I chose to be one of those people.

[CT Pixie, BSN, RN]

Find a good facility. Mine has a 1:5 CNA to resident ratio. Residents get up when THEY want to; go to bed when THEY want to. The staffing is wonderful and the residents all get the care they need. It's not always easy since putting the resident at the center of the day is not a usual thing in this business, but it makes for happy residents and happier staff.

Awesome CNA to resident ratio. I would have loved that ratio when I was a CNA. What's the nurse to resident ratio?

[CapeCodMermaid, RN]

NOT a private pay facility. We have a good payer mix but the majority IS Medicaid. It's about the philosophy of the company....put the resident first. The beds will stay filled and staff turn over will be minimum.

[Racklebrown]

I agree that staffing will never be what we all know it needs to be however, you need to be aware of the point when sucky staffing becomes patient in danger staffing. If and or when it gets to that point you have choices to make. If you have no other option then your management should come in to help. In my experience that causes more problems than it solves. Outside of that, try working with the "powers that be" to weed out the unreliable co-workers and always praise the ones you can count on. It won't solve things overnight but I have personally seen units turn around pretty quickly that way.

You also always have the option of refusing the assignment if you honestly believe that staffing is that horrible. If you have tried what you can and it doesn't work then the state is always willing to listen. I wouldn't count on keeping that job but if it's that bad you are lucky to get out with your license intact anyway.

[erinofanubis]

Staffing at my facility is awful. There is one charge nurse for 40 patients and 3 CNA's for 80 patients many of whom are total care or locked unit. The state says the ratios are good "we're legal" is the favorite saying. 3 CNA's for 73 patients is legal. It sucks. It is not going to change fast or maybe even at all. but someone must be there. If you are not there giving your all for the 8 hours or so per day then who is? is it the nurse that just wants an "easy night job" or the new nurse waiting for something good to come along? Where is the nurse that says it is bad but what can I do tonight to make it a little better. The bottom line may be more important to the company, the administrator and such. You can and should lobby for better staffing but who is going to be there tonight. This job sucks, these residents are unsafe. I quit. There are a few of us that say that it sucks but we can suck it up one more night and tonight they will get a little more of the care they deserve because you are there and with your CNA's you will make it as good as it can get with what you have.

[lumbarpain, ADN, RN]

I do agree, however staffing is critical for optimal work performance among workers and it decreases morale severely also. I have been there, done that and its over. Complaining does nothing to the higher ups after 17 years of hell. So the result will just be less nurses working and it will trickle down to the auxially personnel resulting in even more call outs and resignations. People are only human and can take so much.......we just lose more of nurses that really want to work and be satisfied with their jobs unfortunately and then the whole nation suffers. I have opted out.....but brighter days are coming..

[blue4nurses]

Hi southernbeegirl I'm also in tnpap right now and could use some feedback. Could you email me?