In my last job (which I quit due to inadequate staffing), I had 30 patients to take care of, 60 while the other nurse was at lunch. Our CNAs had 10 residents each, sometimes up to 20. The facility was a combination rehab/long-term-care facility. Approximately 1/3 of my residents were also Alzheimers and/or psychiatric residents. These residents required almost continual supervision. Even if I wanted to, there was no way I could do bedmaking, bedpans, etc. :uhoh21: Still, I did do these things when I had to - but that time cut into my required tasks as a nurse.
The third floor of this facility has 60 beds, usually full. Evening shift (3-11) has only TWO nurses - that means each nurse must care for THIRTY residents all by herself. At night there is only ONE nurse caring for all SIXTY residents.
The facility meets the hour/ratio requirements by hiring nurses in administrative positions - and counting any moving body with any type of direct care license (even if they aren't taking care of patients), making it seem like there are more nurses than there actually are. They count anyone licensed to do any type of direct care and who is in the building - regardless of the fact that some of those people are administrators, OT/PT/RT, or other staff that are not providing daily direct patient care.
It is logistically IMPOSSIBLE for one nurse to provide competent, adequate, thorough, and truly compassionate nursing care to 30 residents. You can come in early, leave late, skip all meals and breaks, and still not do the things you should be doing, still not give the care the residents deserve.
The formula used for nurse/patient ratios presents skewed results. Regulatory agencies should look directly at how many nurses are taking care of how many patients at any one time, not including staff that are not providing direct care at that time. I think New Hampshire's ratio is 3.7 hours, and HCFA says that a number below 3.5 hours is insufficient to provide adequate care. Cutting it close, aren't we? Recent recommondations are 4.1-4.6, I believe.
Nurses on that floor, with 30 residents each: pass medications, do wound assessment and care, do treatments, catheters, resident assessments, incoming lab/radiology/consult results, call physicians to relay information and request orders, take new orders, enact those orders, stock, receive pharmacy deliveries, assist residents with ADLs, pass meal trays, feed residents, deal with resident family needs, requests for various assistance by residents and/or other staff, and deal with physicians. They answer the phones, monitor, assist, and supervise CNAs, and do a myriad of other tasks and miscellaneous resident care including but not limited to assessment, monitoring meeting social needs, performing treatments, and providing emergency care.
There is no secretary, unit clerk, charge nurse, or other person to take care of phone calls/faxes/family/orders or the multitude of other tasks necessary behind the scenes (at the nurse's station). A nurse cannot be in the nurse's station, on the telephone, at a med cart, and in a resident room all at the same time!
And of course this doesn't include all of the paperwork and documentation due at the end of the shift. No wonder staff turn over is high and residents receive inadequate care (carefully covered up by administrators and statistics).
At the end of the day, it's the patient that receives inadequate care, it's the nurses that are exhausted, and it's the nurses license on the line should any legal liability result from the care she is unable to give due to inadequate staffing.
Let's see any of the "adminstrators" who are also nurses work the floor for a week and do everything that they continually remind us to do. They can't. Because it's impossible.
I know this for a fact. And I know for a fact that nurses and aides at that facility are signing off on care that they don't actually provide and tasks that they don't actually perform.
30 patients to one nurse is WAY TOO MANY. 20 patients to one nurse is still too many. Hear it from the front lines - in LTC facilities, nurses should have no more than 15 residents - and in hospitals, no more than 5.
Anyone who states otherwise has 1) never worked as a nurse or aide, 2) never been a resident or patient in an understaffed facility, and 3) is not living in reality.
Oh - one final thought. The third floor of that facility, with 60 beds, has only ONE complete set of vital sign equipment! That is ONE tympanogram, ONE oximeter, ONE working BP cuff, NO large or small cuffs, and few if any functioning stethoscopes. No pen lights for neuro checks. No sharps containers in rooms. Only one hand sanitizer dispenser on each hall. In other words, it's BYOE (bring your own equipment). A long list of problems that made it difficult if not impossible to provide good care...