Help! is this Normal/legal?

  1. Hi guys I have had my license since July. I was working home health but was bored to death. I got a job at an assisted living facility. I was reading other post for assisted living and think something is wrong. So if anybody can answer some of the following questions I would greatly appreciate it.

    My job description/ duties.
    I work in the Alzeheimers/ Dementia ward. (basically the charge nurse)I have three seperate halls. I have a total of 52 residents. We have only 1 (one) LVN per shift for all three halls and two RA's (residential assistants) per hall, No RN. But have Ph#'s to call for questions. All doors are locked and alarmed. My residents range in ADL's from a gentle reminder to needing to be dressed and fed.

    MY job duties:
    I pass all of the meds to all 52 residents according to the MAR. They all take tons of meds. If I don't get any interruptions I will finish 8 a.m's about 11:30 (but I am constantly having to stop to answer the phone, speak with family etc..)
    I do all of the BP's, BS's and Pulses and insulin of those who need them.
    I answer the phone and make calls to the family when the residents want to speak with them.
    I do all of the initial assessments and put together the charts for new residents.
    I call orders for refills on meds, talk to the D.R.s and families.
    Keep track of who is in or out of the facility, who they are with and why.
    I monitor and pass meds for daycare and respites and give the family a report when they pick them up.
    If a door alarm goes off I am to stop what I am doing and see where and why it went off.
    I have to sign for all meds and equipment being delivered
    We use focus charting, so I usually only have to do notes in 10 or 15 charts a day.
    I have to coordinate care with VNA/hospice/family/M.D..
    I do all of the wound care.
    If somebody calls off then I have to find a replacement for their shift.
    Not mention all of the general paperwork that would keep a normal person busy for hours.
    I understand that these are all in my scope of practice but isn't one person being responsible for 52 pt's (plus any extras for daycare and respite) a little crazy? Can they have this pt load because they are called an assisted living instead of a SNF? I see some of the others doing assisted living only have 6 pt's!
    Oh by the way this is in California.
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  2. 14 Comments

  3. by   pagandeva2000
    Not sure of whether this is legal or not per se, but this is not a situation that I would feel comfortable working in. Just too many patients, and too many reasons for distraction. I'd take the first boat sailing and run, but I don't know your situation. I hope that you receive more answers to assist you with this one!
  4. by   jamangel
    It is probably legal because if it isn't there is probably some loophole to use. How did you come by this job and is it one in which there has been a high turnover. Unfortunately, I have worked assited living and I have never worked one like this one. I may have had a high patient load but it was a true assisted living facility. I only had to do insulins and the patients took their own meds. We didn't have wounds that required high skilled nursing care. Also, i've never worked at a Assisted Living Facility with Dementia patients. They can do for themselves and the aides do any direct assistance. I did have to deal with the admin part but that was it.
  5. by   TheCommuter
    Nurse/patient ratios only apply to acute care facilities in California. An acute care facility in California would be considered a hospital. You work at an assisted living facility. Therefore, it is legal for them to assign you 52 patients.

    I work at a nursing home in Texas and have 18 patients.
  6. by   txspadequeenRN
    Bottom line you need help.....
  7. by   Avelinne
    How can I make it plainer? Your being %$&*^ at this job and your license is at risk with the ridiculous nurse to patient ratio that your job demands from you. You can't be everywhere, and with 3 halls, well it sounds like a recipe for disaster. (YIKES) I worked an Alzheimer unit of 26 residents with 3 aides and still felt stretched most days. Ditch this job NOW. With the experience you have racked up you will have NO problem getting another job.
    Good Luck!!
  8. by   ns lpn
    I hope to God this is not normal.
    How can you truly feel safe/confident in the tasks you do with so much on the go. I would think their should be another lvn to at least help with meds and dsgs. I've worked where medications have been very heavy and that alone is stressfull, you have way too much on the go-it is an accident waiting to happen, even the best nurses can make mistakes but when your work environment is set up like that your almost guarenteed something will go wrong. If you can't make sucessfull changes in your environment, then change your environment. I would think a nurse with the ability to manage so many tasks at once would easily find work somewhere a little slower paced and much safer.
  9. by   vonxojn
    Oh NO NO!!!. 52 patients is way too much to handle. Either you ask for more help or get another job. I've worked in LTC facility at nights and had to take two halls. It was rough. My med pass usually took 3-4 hours at best. You might need to have a conference with the DON AND Administrator. Worse case scenerior... you'll find a better job with less patient responsibility.:bowingpur. You'll get burned out too quickly if you should stay.
  10. by   lindseylpn
    I worked nights at a nursing home and had 55 pts a night. I had to do all the same but, my cnas got all my vital signs and the nurse supervisors would find replacements for call-ins (sometimes). I took about a year of this and couldn't handle it any more.
  11. by   LegginMF
    Actally now that I've been there for 3 wks it's not as bad as it seems. Instead of answering the phone from family members, I have the RA's do it. Honestly I don't know if your loved ones is wearing the new green sweater or if he ate all of his breakfast. But the RA's do and if somebdy is not eating they come and tell me. All of our meds come bubble pack and once a week they have a girl come in and organize them. That way they are in the sme order in the drawer as on the MAR (med and resident) and it only takes a minute to double check your dosages. Also now that I have the orders of people memorized it doesnt take five minutes to find there meds or figure out if I need to crush themor for that matter who the heck they are. It just cracks me up when I ask the RA's for so and so and they tell it's the lady with the gray hair and a pink sweater. Duh! They all have grey hair and pink sweaters! LOL It now only takes about 3 hrs to pass my meds and I have plenty of time to spend observing and checking my residents for problems or even sit and chat with them. I think I have finally found the place I belong. Jody
    PS gonna start 2 new threads please feel free to answer I love being able to draw off everybodies experince and maybe come up with better solutions than I normally would. Thanks Jody
  12. by   chatter
    i work in a nursing home my pts. about the same range. have about 54 pts. with 4 cna's,1 med-aide, and a secretary. without these people to help me my job would be your job impossible. approach administration about your concerns and if there is no change walk away. mention med-aides they are a life saver
  13. by   LegginMF
    Quote from chatter
    i work in a nursing home my pts. about the same range. have about 54 pts. with 4 cna's,1 med-aide, and a secretary. without these people to help me my job would be your job impossible. approach administration about your concerns and if there is no change walk away. mention med-aides they are a life saver
    actually that's what they had before and are now getting rid of the med aides and using lvn's instead. what was happening is that the med aides can't do insulin so the director who is an lvn was having to scramble everyday to give insulin. i also have 6 ra's 2 for each court. also according to the director anybody who works at the facility whether it be janitor or cook are considered care givers. everybody pitches in. jody
  14. by   CaPsychLVN
    I, too, have 50 patients in a SNF. I give out 262 meds in "2 hours" (really 3.5 if I don't have interruptions). Some of the meds are in cards and others (vitamins & aspirin/tylenol) are in bulk. I take B/P with a manual cuff on about 20 patients. I do finger sticks and insulin, charting, weekly charting, med re-ordering, phone calls, etc.

    I, too, as a fairly new nurse (May graduate) didn't realize that this was not normal. In fact my DON just criticized me for not knowing by face all 99 residents (2 halls, one which I work less). Perhaps, I'm not a bad nurse. I love some of my residents and it is so hard to be so torn between time with them and getting everything done.


    Any suggestions appreciated.

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