Good care with staffing ratios?

I have worked as a staff RN at several LTC's where the nurse/patient ratio was about one nurse to 20-25 residents, give or take. In every facility, the RN/LPN staff had to cut major corners in order to get everything done. Doubling up on med pass times, skipping some treatments, and definately not having the time to check up on multiple items in the treatment book, like protective heel cushions, siderail positioning, skin checks and many other things
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If we had a resident or family who had TLC needs that needed a little extra time..taking the extra time was very difficult, although I tried my best It broke my heart!! This was true with every nurse, even the fastest and most experienced. I felt like I was giving bare bones care that neglected the needs of my residents.

Also, from a legal standpoint, nurses were constantly having to sign off on things that they had not done, since management expected everything to be done by end of shift. We can ask nursing assistants if things were done, but that is not a substitute for our legal responsibility for personally checking on items in the treatment book.

I would like to stay in LTC-I love working with residents and I would like to be a good floor nurse or manager some day who makes sure that the best of care is given. My heart is really in this.

But my experiences make me wonder...

I would love to hear if you have been able to set things up at your facility so that good care is done without the need for shortcuts, or what challenges you face with this issue.

Thanks!

Pooksmom