staffing

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    Well, the heat is off, state is gone, and we passed survey. So much for the good ol' days. As soon as they exited the building and adm. was assured that we'd passed, the cut backs began.
    With adequate staffing, we've had no incident reports, no incident-related hospital trips, major decrease in skin breakdown and skin tears. Now we're headed down the same path that brought state to our doorstep to begin with; increased falls, breakdown, family complaints.
    I looked on the net for SOME sort of government guidance on staffing ratios. I know there isn't a law at this time, but you would have thought they'd atleast have some sort of recommendation for families to look for when comparing nursing facilities.
    Color me depressed, Gang. Here I was so proud of the achievements that we've made in the past few months, and in the end it was just a dustcover to appease state, not improve resident care.
    Last edit by SYDNEY on Aug 4, '01
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    I am a DNS in NYS. We have "minimum" staffing of 11 CNA's for day shift, 9 for evenings and 5 for nights.(These numbers are for the whole house- divided between the 2 units) We have 85 residents. It is becoming increasingly difficult to maintain this ratio.It seems to be feast or famine. When I put the schedule out, other than weekends, I am usually above these numbers. I am curious as to what other facilities staff. We have mandatory overtime but.....Our minimum staffing for nurses is 3 for days, and 2 for evening and nights.
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    [I am curious as to what other facilities staff. We have mandatory overtime but.....Our minimum staffing for nurses is 3 for days, and 2 for evening and nights.

    We have twice your resident count. There have been 7 nurses on days with 17 CNA's, not counting "supervisors, unit managers," etc. On evenings, there have been 6 nurses, one supervisor and 11 CNA's. On nights, we had 3 nurses, one supervisor and 7 CNA's..then 4 CNA's. That was awaiting and during our visit from the state. With that overwith, nurse count hasn't changed as of yet, but the CNA's are taking one less per shift.
    The thing is, if the basis of income is government funded MC/MCaid), then isn't it in a facility's best interest to maintain the standards that those agencies expect so you don't lose funding or get hit with penalties. Hmm...provide enough staffing to maintain level of care, or pay daily penalty fees for not providing standard care. - Or, in a crunch, pay out the nose of agency nursing to make it LOOK like you have the staffing to provide optimal care.
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    Hey guys... I am new to ltc... we are constantly shuffling to adequately cover each shift. The hardest are the 2-10 shifts. Our schedules are full when they're posted and as the week goes on, we have many call-ins and no-shows. Mostly from the CNA's. The nurses are more professional, thank goodness! We are putting together a recruiting committee at my facility. Administrator says we just need to "get them in the door." Well, how do we do that? We are advertising and corporate HR sends people out to job fairs and colleges, we have a referral bonus program in place. What else can we do? I think the problem is that there is precious little "retention" activity going on. Birthdays aren't recognized, no staff parties or contests or fun days, etc. I hear from people at other facilities about all the fun stuff they do and I wonder if maybe I'm in the wrong place... oh, and by the way... what part of the country are you two in? It is frustrating that there are no set numbers required for staffing. Just that we "have enough" to ensure quality care. Aaaaaaargh! That depends on how good your team is that's working a particular shift! If you have a bunch of lazybones, it's never "enough." And if you've got go-getters, you can get by with half...
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    South Carolina does have some minimum staffing requirements but with the acuity level of the residents entering facilities now days, it's not near enough. Here goes...

    First shift.... 1 nurse for every 50 residents
    1 CNA for every 9 residents

    Second Shift... 1 nurse for every 50 residents
    1 CNA for every 15 residents

    Third Shift... 1 nurse for every 50 residents
    1 CNA for every 22 residents


    Leaves a lot to be desired...
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    Indiana here. Yeah, we've been through all that incentive stuff, too. The sign on bonus sounds great, but the majority of people who come on through that stay around long enough to get their bonus and then move on to the next one. - and they've started a new "employee fun committee" as was mentioned in one post. It kind of irritates some of us, in a way. They talk about our moral being low and needing a boost and this is their solution to it. They don't seem to get it that our moral would increase tremendously if we were able to provide the kind of care we know we're suppose to be providing.
    We have the no call, no show issues, also. Oddly enough, the majority of them are daystaffers. Maybe thats just because there are so many more of them than there are on nights; but when there are only 8 or 9 of you in the entire building, you know how much your coworkers are depending on you to be there, so we don't have too much of a problem. - and speaking of which, its time for me to get ready to go.
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    Hi-we have a 130 bed facility...units of 60 down to 22 beds...we also have positions for nurses in charge-they routinely do not work on the floors....Staff nurses do meds,tx,orders,routine paper work(7 day assessments,portions of the MDS)deal with orders and any emergencies and anything else that pops up...The charge nurse goes to leadership meetings to discuss with our DON what we all hope to accomplish but never get done due to short staffing on the units..I have never seen a faciity of this small size with so many non-working staff members....Is this a trend elsewhere? other facilities in the area have units of up to 60 residents with working charge nurses and 1 or 2 other nurses functioning as med nurses...-this seems to make better sense to me...
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    [QUOTE]Originally posted by ktwlpn
    ...we also have positions for nurses in charge-they routinely do not work on the floors....Staff nurses do meds,tx,orders,routine paper work(7 day assessments,portions of the MDS)deal with orders and any emergencies and anything else that pops up...The charge nurse goes to leadership meetings to discuss with our DON what we all hope to accomplish but never get done due to short staffing on the units..I have never seen a faciity of this small size with so many non-working staff members....Is this a trend elsewhere?

    We all are "charge nurses" - responsible for our units that we are assigned to. We do the meds, the treatments, the charting, etc. We also have a great deal of LOL what you call "non-working staff" . On the day shift, especially.
    On nights we pushed to have a supervisor for the simple reason that there was too much finger pointing going on at us, and we wanted someone positioned to be our voice, so to speak. We have one RN on our shift and wanted her to be acknowledged AND PAID to be supervisor like all the other shifts had, and we finally got what we wanted..sort of.
    When they decided to acknowledge her as a supervisor, they took her off of the floor, which blew us away. When we asked for a supervisor, we only meant that we wanted the voice to be acknowledged, not have an excellent nurse pulled off of the floor.
    Fortunately she's still an excellent nurse. The other shifts complain about the supervisors never being available, unable to locate, or sitting in their offices with the door shut and or locked. We don't have that problem, as she refused to move into an office, refused to even take a key to an office, and is still always on the floor. I am blessed with the ability to turn to her and say, "heh, I have x amount of things going on right now, could you do this..." and she steps right in.
    We're still trying..I have a lot of respect for our DON and know she also wants the best for the residents, so she does listen, even if after listening she has to explain to us why we can't do what seems logical, due to state regulations or corporate policies. I think what is unfortunate is that with all of the "non-working" staff in place, when there are meetings, the adminstrators and corp. people only hear what these supervisors are telling them..and in the total scope of things, they usually don't know what our needs are or a lot of times, what's really going on with the residents - so they get a warped view of things. I sat in on one meeting where the DON was looking for ways to organize one of my units.
    Every idea she had come up with, we were saying - we already do that, we tried that and this is what happened..etc. - Talking to the staff actually working the floor she found out more about what was going on than she ever knew talking to the "supervisors". - and I know there's a DON or supervisor about to read this who's going to be highly offended by me saying that. It's just the pyramid of care..the docs rely on the nurses to fill in the gaps, we charge nurses rely on the CNA's to fill in the gaps..logic would follow then that the ones above us who aren't involved in daily adminstration of care would/should rely on us to fill in gaps for them as well.
    We're able to tell you interesting things, like..old people? They don't sleep all night. Infact, most of them hardly sleep at all during the night. Therefore, it would be in their best interest if you let them take a nap during the day. - And since they aren't sleeping at night and I'm not talking to doctors in the middle of the night very often, I have a lot more time to hear resident concerns and discuss their goals with them.
    The state says we can't give them bed baths or showers in the middle of the night..yet if they aren't asleep and they aren't comfortable, wouldn't it be in their best interest to give them the opportunity to be freshened up..and then maybe they would sleep better?
    Those are the types of things that frustrate me the most, I think..passing on information to day shift that never gets acknowledged. I think many assume that because I work nights, I must not be a very good nurse, and therefore what I say, think or suggest can be disregarded. - And then when an issue surfaces finally that I have already addressed, they wonder why my jaw hits the floor.
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    Originally posted by SYDNEY

    Those are the types of things that frustrate me the most, I think..passing on information to day shift that never gets acknowledged. I think many assume that because I work nights, I must not be a very good nurse, and therefore what I say, think or suggest can be disregarded. - And then when an issue surfaces finally that I have already addressed, they wonder why my jaw hits the floor.
    Ahhh, Sydney.... you're singin' my song. *grin*

    I've worked nights in a LTC facility for over 18 years... and I know exactly what you're saying here. And do you feel "out of the loop" when it comes to inservices and staff meetings? I know I do.
    And then there are the times when new paperwork is introduced, and everyone but me has been shown how to process it.... and I'm expected to figure it out on my own.

    I've got a thousand stories... as I'm sure you do.
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    staffing always goes to the dogs when the state leaves. I believe the new mandates here are 20 patients to one CNA.....pretty ridiculous eh? Of course when states here there are only 6 or 7 patients per CNA......? It's all about the money, not the care. It ires me terribly that administration wants everything accomplished woth minimum staffing. SHOOT Minimum? Half the time we work shorthanded and agency is a big no no. No one suffers as much as the patients. If administrators would staff as though state were there, 24/7, we'd be in peaches. Imagine being able to go home knowing that your tasks have been completed and your patients are the better for it!


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