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

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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 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.
    elprup and
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  3. 41 Comments so far...

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    As a brand new grad, you should certainly have 4-6 weeks of training. 2 days is unacceptable, and 1RN to 34 patients is just down right dangerous! Check out the california licensing and regulation to see what the laws are for RN-patient ratios in LTC.
    And start looking for another job immediately! You worked way too hard/long to lose your license, and more importantly the elderly deserve safe and competent care that can only come with more experience/training. (not an insult to you by any means)
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    I have worked in LTC in CA...it sux. Im not aware of any pt. ratio. I feel if they fired all the dead weight, starting at the top, then the facilities could hire more nurses and give safe pt. care. But, who the cares about pt. safety when one can make big $$$$ for the corporations.
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    First your question about ratios. Unfortunately there is no nurse-to-patient ratio in California for skilled nursing, but the California Nurses Association (CNA) has proposed a ratio of 1:5 for "Rehab Unit & Skilled Nursing".

    You can find information on current and proposed ratios in the California Nursing Association's "Ratios Booklet" here: http://www.calnurses.org/assets/pdf/...os_booklet.pdf. If that direct link doesn't work, go to http://www.calnurses.org/ and scroll down to "Resources."

    I realize this doesn't help with your immediate problem, but it answers your question. I'm not sure what I would do in your situation. I'd be very concerned about jeopardizing my license, and also about working for an institution that thinks 1:34 for a new grad is acceptable after two days of orientation. I'm also a Bay Area new grad, and I know that the job market is especially tight for us here. We're competing in a market inundated with other new grads, experienced nurses, and nurses from out of state who come here for the high wages. That would make me very nervous to leave a paycheck, but if you really think you're going to get yourself into a situation where you could lose your license, avoiding that is the priority. I think I would probably leave.
    mmm333 likes this.
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    In Massachusetts the proposed ratio in a HOSPITAL is something like 7 or 8 to 1.
    They are proposing a 1:5 ratio on a rehab unit and skilled nursing???????????? Who is going to pay for this? Certainly NOT Medicare OR any of the managed care companies. Do these people really have a clue?
    Last edit by CapeCodMermaid on Jun 30, '09 : Reason: had more to say
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    I know EXACTLY what you are going through right now. I myself graduated last year and worked so hard for the past 10 months to find a job. What I ultimately found was that while I have always desired to work in a hospital, there were no openings for new grads. This is why I ultimately had to take the long-term care route and have been working in such a facility for the past 3 weeks. I consistenly go to work and find myself juggling 30 patients. Every thing from the med-pass, to charting, and administering treatments is all left for me to complete in my 8 hour shifts. Additionally, I also feeling like I am loosing nursing knowledge. I really never expected my nurisng career to solely consist of handing out meds, and I really long for true patient contact and educational oppurtunities. I truly wish you the best of luck, and keep me posted on how things turn out for you, it would really help me to see how someone else is handling the same situation I am. Best wishes!!
    mmm333 likes this.
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    When I worked in a SNF in California in the mid-90's, I was the charge nurse for 44 patients on the 3-11 shift as an LVN. Every night I was rushed and stressed, and felt like my license was on the line. I quit after a year. This was shortly before the ratios were enacted in CA, so I'm curious what the answer is. Since I went to home care and never looked back, I don't know, but I always assumed there were ratios for LTC as well as hospitals. That would be shameful if it's not the case. I can say, though, that your orientation was definitely inadequate. Good luck!
    mmm333 likes this.
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    I feel your pain. Your post is exactly like what I'm going through right now. New grad, can't find a job in a hospital, had to this LTC job, received 6 days orientation (they wanted to give me 3, but I fought for 6.....still NOT enough), and have 30 patients. The place I work for is a rehab (post acute)/nursing home. On the post acute side there's 20:1. It's so overwhelming. I was checking this website to see if anyone had any advice. I think this experience will help us get a job in a hospital, but in the meantime, we have to be extremely careful to protect our license. I wish you the best of luck finding a job soon. The nurses I work with say if you can handle this, the hospital will be much less stressful. I hope their right.
    Anne36 and mmm333 like this.
  11. 0
    Quote from CapeCodMermaid
    In Massachusetts the proposed ratio in a HOSPITAL is something like 7 or 8 to 1.
    They are proposing a 1:5 ratio on a rehab unit and skilled nursing???????????? Who is going to pay for this? Certainly NOT Medicare OR any of the managed care companies. Do these people really have a clue?
    No.

    Maybe they're thinking that SNFs could follow the total patient care model and there would be, at least on days, one nurse for every five residents and no CNAs.

    Pros: More time to spend with residents, especially those with high acuity. Fewer mistakes. Better assessments. No one taking shortcuts on care because they have 35 other people for whom they must provide care.

    Cons: Cost. And what happens with our UAPs? CNAs are the backbone of direct care in SNFs. I can't see how facilities would transition from utilizing CNAs for direct care to using licensed nurses.

    I would like to see some sort of ratios in rehab and SNFs but these would have to be realistic, based on acuity, not just based on numbers. That ratio should include licensed as well as non-licensed personnel who are doing direct care.
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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.
    mmm333 and ws582 like this.


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