What is the state guidelines for nurse to patient ratio in SNF's/LTC for California?

Specialties Geriatric

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I am a new-grad and just started a position at a SNF in the Bay Area. I was wondering what the nurse to patient ratio, according to state guidelines, is in California. I have been working in this facility for about 2-3 weeks or so and I have to say that I am starting to regret it. I was oriented for only 2 days on the unit and they put me by myself for a PM shift. I figured I would have more time for orientation, right? Our current census is 68 patients and there are only 2 charge nurses for 3 stations. That's a 1:34 ratio!!!!

I have concerns about being overwhelmed with 34 patients with only 2 days of orientation. I still do not know how to do anything in the nurses station and all my meds are being given 2 hours late. I am worried that I may make a mistake that may jeopardize my license or even worse jeopardize a residents life!!! I'm not confident the management would have my back if something goes wrong, meaning I am placing my RN license, that I worked so hard for, at risk as I working here. I continue to ask for more days of orientation to my DON, but she insist I will do fine and start to get the hang of it soon.

I feel more on time after I have cared for about 20-25 residents. But then I think about the other 15 I have to attend to and it just get pushes back all my responsibilities. I have spoken to some of the nurses that have worked there for a long time and they said they used to have 3 nurses for each station (1:22 ratio). But not anymore:uhoh3: since the facility underwent new management.

I guess I'm looking for advice on what to do as well. I go to work scared, full of anxiety and uncertain. Now, as a new grad, I don't think that is a healthy way to begin a career. I don't want to loose my license. I originally wanted to work in a hospital, but none were taking new grads. I would be devastated if I lose my RN license over a job I didn't want in the first place. If this is the way SNF's operate, then I may have to consider looking for another one or just not consider SNF's at all.

Thanks for reading. Any advice or insight will help a lot.

Specializes in Rehab/LTC, Post OH, Med/Surg, Hospice.

What is working "registry"? Is that at a hospital? I was wondering if 33 LTC patients is more or less hectic than 6-8 acute patients at the hospital.

Thank you for the info :)

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i had 4 days of orientation. i was hired as a floater with varying shifts... sometimes 3-11, sometimes 7-3, sometimes 11-7.... i usually have anywhere from 30 to 40 patients on any given day.... i've been here less than a month and i'm so overwhelmed! everyone either insists that i'll get used to it and things will get better, or they tell me that i need to "work faster" so i won't finish so late. the only reason i finish my med passes before my shift ends is because i've had to start cutting corners like all the veteran nurses there. i'm scared that i'm gonna fall flat on my face when i finally find a job in a hospital. i pretty much just pass meds for 8 hours (no break, no lunch.... unless you count the couple of minutes i take to clock out/in for lunch... but i just work right through my lunch anyway) and i don't really do any other nursing skills. there just isn't any time for it! they need to get these ratios down, because 1:35 patients is hard enough.... 1:40 is darn near impossible for me...

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Specializes in Geriatrics, Wound Care.
What is working "registry"? Is that at a hospital? I was wondering if 33 LTC patients is more or less hectic than 6-8 acute patients at the hospital.

Thank you for the info :)

Sorry I wasn't more specific! I was referring to registry in a hospital setting. 33 patients in LTC is MUCH more hectic! I was rather bored with 6-8 patients. It made for a long day! :)

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Just wondering if this is pretty standard for LTC/rehab care: no breaks, just 30 minute lunch during an 8 hour shift and no shift differentials for working the 3-11pm or NOC shift or weekends?

I started at a nursing home 2 weeks ago; they are giving me 2 weeks of training (10 days) and after that will be on my own with 18-20 pts. I have just finished day 5 and am only doing meds/charting on 7 pts and don't know how I am going to work up to 20. I do know I am lucky to be working as an RN in California, but man it is tough; My thinking is that if I can handle this and stick it out, I can get time management and delegating skills....

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I didn't realize there were so many other people in the same boat! I just got my license in January and was so discouraged....months and months of applying, no call backs, so I finally started to apply to LTC facilities. I got a job for $30/hr at a LTC facility for 30-36 residents and it is so hard!

I only got 5 days orientation, and then I was let loose on my own. I have to say, during my first couple of weeks, I wanted to die. I felt so overwhelmed, stressed out, frustrated and inadequate and UNSAFE. I didn't understand how people could take two 10 minute breaks in addition to their 30 minute lunch! It eventually got a *little* easier - I've been working for about 3 months, but I still don't take any breaks, and I still run at a breakneck pace all day. My only solace is the 30 minutes I go to my car and eat my lunch in silence. Plus I have to work every weekend, which also makes me sad. :(

I want to help answer call bells, and I try to, but every bell I answer sets me back even further in my day. Sometimes there are good days, where everything goes smoothly, and sometimes there are bad days where everyone needs a PRN med (after I've already given them their meds), call bells are ringing like Christmas lights, and people are throwing up and having diarrhea, and there is a new admission. I struggle every day with thinking about how long I should hang in there. We'll see I guess!

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I graduated in December 2008, got my license as an RN in March and started working in LTC in April. I have 35 pts and handle all treatments, meds, etc. I don't get a lunch, or breaks, I just eat while I chart. I was not sure I could ever get into the groove, but I can honestly say after 3 months on the job... I LOVE IT. I am very attached to my patients, have days when I am so exhausted, days when I have to pull a double, or even have a beloved pt pass away, but I feel that I am in the right place and I enjoy the balance I have between work and home. I have a wonderful DON and work with some incredible nurses and CNA's. I am writing this so that as a new grad RN you have another more positive point of view on LTC. It is not a hospital....but maybe that can be a good thing. Look at the positive of the situation you find your self in and you might be surprised and how happy you can be. Good Luck to all.

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Oh my goodness... there's a lot of us going through the exact same thing as new grads working at SNFs.

I feel exactly the same way of feeling overwhelmed and anxious every time I go to work. I dread going to work... although I always try tell myself that I should not complain and that I am lucky I have a job. But then again, I fear that I might loose my license and I know I am not giving my very best to provide quality patient care (as I was thought in school), because otherwise, I won't be able to go home in time (and I rarely do).

I really have no advice, but I know there are SNFs who have supportive DONs and staff, which would be very helpful as a new grad working in nursing homes.

Good luck to us.

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Nice to know I am not so alone in this. The facility I work (rehab/LTC) for has a total of 120 beds which is in 3 units. There are TWO nurses during the NOC shift that I work from 10pm to 6:30am. I am a new grad and many of the times I work am or will be the only RN and the other is an LPN. Aids are always calling in sick so sometimes there is only 1 to 2 aids on each unit. I mainly work unit 1 which has 44 beds (but currently 40 filled beds) and until 2:30 am I work unit 2 as well which has 24 beds (but currently 18 filled beds). That is a total of 58 people I am responsible for. At 2:30am I pass off Unit 2 to the other RN or LPN that is working Unit 1. That still leaves me with 40 patients! My main unit is mostly rehab so I have a couple people on IV antibiotics and a lot of post-op patients who need pain meds to sleep. I don't stit down until I can squeeze some charting in. Besides passing prn narcs all night along with other scheduled meds, I have IV bags to hang, wound dressing changes, edema assessments and other "office work" such as getting paperwork done for the patients doctor appointment the next day, paperwork ready if there is a discharge the next day, labs, restocking my three med carts, recording report and so much more. I had a patient who's blood sugar was 34 and it took me two hours to get to 134. Not only stressfull but time consuming. I only had 6 days of orientation (was only supposed to have 5). I took lots of "to do" notes during my orientation days but I am just exhausted when the shift is over. I just had my first night on my own a few days ago. It was busier that night than any of my orientation nights. I managed to get everything done by 6:30am but I don't feel like i did it as safely and thouroughly as I should have. This can't be safe, right? I am trying to get on at a hospital so my fingers are crossed. Even my seassoned nurse orienter has a hard time keeping up but after 12 years of dealing with it I am taking her place. How can I be a charge nurse as a new grad with this patient load!!??? Doesn't make sense to me. :banghead:

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Specializes in Gerontology, Med surg, Home Health.

It doesn't make sense to most of us but it is what it is and it will get even worse if the government cuts back on Medicare and Medicaid payments. Those two main insurers haven't caught up with the times and the acuity of the people we now have in our buildings. Call your senators and congressmen and urge them to preserve (and even increase) the reimbursements. I'm lucky to be well staffed in my building. It's a very small community and even the townspeople get involved. They would flip if I cut the staffing.

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Hi. I'm a new grad RN and I am thinking about applying to a couple snfs. I noticed that a lot you are also new grads (or were) when you started working at a snf. I created a thread asking for some advice regarding questions I should ask before jumping head first into a SNF RN position. I would really appreciate any advice.

The thread>> https://allnurses.com/general-nursing-discussion/snf-questions-ask-416324.html

Thank you.

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i can relate as well. i also live in the bay area, am a new grad, and just started at a rehab/skilled nursing facility. 6 days orientation, 1:20-25 ratio, and i feel extremely overwhelmed. everyone says i'll get the hang of it but i just can't see that happening right now. i want more than anything to work in a hospital but because of the economy this is what we have to do :(

i don't have any advice, but hang in there. take it one day at a time. hopefully things will turn around soon in the hospitals.

You WILL get the hang of it. I work at a SNF/LTC AND I have 24 and after about 6 months I got to where I could take my lunch, sit down and read the newspaper and in general have a pretty laid back shift. Sometimes it gets busy but for the most part I am comfortable with the amount of attention I can give the patients and comfortable with their safety.

We dont have a desk nuse and last night (PMs)I was doing a new admit and had one pass away in the middle of my admit so I had no free time but I was suprised at the end of the night I wasn't stressed at all. I think I have totaly adapted. 50 percent of it is knowing your patients and having good CNAs working for you. The rest is time management, prioritizing and nursing skills. After awhile you can do your routine charting, treatments and med passes with your eyes closed. The first three months were ABSOLUTE HELL though.

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http://www.calnurses.org/nursing-practice/ratios/ratios_index.html

All you need to know about nursing ratios in ca,,,,,

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