RNs vs LPNs

Specialties LTC Directors

Published

So we all live with the same CMS 5 star rating system. Part of the rating is the # of RNs on staff. I've put an ad in the paper and on craiglist for RNs. The LPNs I have working for me on a per diem basis give me the evil eye every time I walk down the hall because I won't hire them for the open slots.

Ladies, I don't make the rules. I have to live with them. We are getting more and more clinically complex residents and I need RNs to care for them.

It is not my fault you chose the path you did.

Quit glaring at me.

PS. These are all fine nurses. But, in this business those initials after your name make all the difference.

I'm done venting.

Oh wait....one more thing....where are all the RNs??

I'm one RN who will no longer work in LTC unless I was on the verge of homelessness. I worked in LTC for six years before throwing my hands up and leaving. Yes the residents are getting more and more complex to the point that many nursing home units resemble med/surg floors. However, the staffing at most facilities does not reflect the increasing acuity levels.[/quote']

I agree with this 100%!! I'm currently in a LTC/rehab and I can't stand the ratios. So as a result I'm currently looking for an acute care position and I'm not looking back on LTC. I will miss my residents an coworkers but I have to do what's best for me. Plus the facilities I've worked at only care about having a body in a position. There's almost no support for professional growth, clinical ladders or anything else the hospitals offer their RNs.

We follow a 5 star staffing model yet in January our managers started allowing our RN shifts to go unfilled. 82 bed LTC with 4 households split into 2 wings. We are scheduled for one RN per wing to oversee the 3-4 LPNs and 10 nursing aide staff. It started as an emergency way to save on OT after a few medical leaves and such but now it has even happening a few times per week.

How often can we run with only one RN for it to affect our CMS rating?

We have been working with our union and have another labor management meeting scheduled so we can talk about this and I would appreciate any feedback you have to offer. Thanks

Specializes in LTC, Education, Management, QAPI.

Correct me if I'm wrong, but the 5 star CMS rating takes two parts of staffing. As long as there is an RN at least 24 hours/ day you meet the RN requirement, but your NHpPD has to be >1.00 total LPN/RN staff to get that star! :-D This is funny since the regs only require an RN 8 hours a day for 5 consecutive days a week.. Go figure

Specializes in Gerontology, Med surg, Home Health.

NurseGuyBri,

Trying to figure out the intricacies of the 5 star rating system would give Pythagoras a screaming headache. Regardless of the regulations, the more RNs on staff, the higher that part of the 5 star rating is. Several hospitals in Massachusetts have gotten a waiver to the 3 day Medicare rule so the patients we will be getting will be sicker than ever. The hospitals expect us to have RNs to care for these still acute people.

Specializes in LTC, Education, Management, QAPI.

Good point CapeCod! I have often wondered how we can increase the number of RN's in the SNF/NF's with the current regulations and barriers in LTC. I know it's asking a lot, but the corporations need to read the research!

Specializes in Care Coordination, MDS, med-surg, Peds.

One thing that also affects the RN "count" for 5 star, is that several administrative type nurses are generally are RN's and they don't count if they are administrative. An SNF I worked out, had several RN's on the floor, but 3 of us were purely administrative titles and didnt count. Also, the total number of residents figures in, so, if you have more residents, the on the floor RNS have to more... UGH.. I agree with Nursebri... you practically need a degree in some type of higher math to figure out how the 5 star ratings are figured.

Specializes in LTC/Sub Acute Rehab.

This sounds like my facility!:yes:

Well, guess eventually I will have to get my RN now!! LOL!! I haven't gotten it yet, because I didn't want to work in the hospital. With all due respect, I know that there is a difference between LPNs and RNs. However, the nurse that currently works our rehab unit full time in an LPN and I think she does a better job then the other nurses who cover that unit on her days off (some of whom are RNs). I have a year of experience in the hospital that I obtained back when LPNs were allowed to work in that setting. I know that I am more than capable of caring for the acuity on the subacute/rehab units. CMS ratings are not always a good indicator in my opinion. My facility puts 1 LPN for 25 res on a rehab unit with no treatment nurse, no admissions nurse, absolutely no support whatsoever-you really are ON YOUR OWN. The funny thing is the RNs won't touch that unit with a 10 ft pole, because they all say they don't want to risk their licenses. Maybe CMS should focus on setting some SANE NURSE/PATIENT ratios instead of worrying how many RNs staff a facility. It doesn't matter whether you have RNs or LPN, what matters is that you staff appropriately for patient safety-something my company is not willing to do. BTW, I like to learn and would go back to get my RN if that is what I need to do to stay employable. I just can't believe that the government can be so stupid as to think that more RNs will matter when they are not willing to pass legislation that will really protect the patient.

I was an LPN for 4 years, then I became an RN to work as an ADON for 2 yrs while getting my BSN. After I was finished with my RN, I realized that I didn't know anything as an LPN (giving pills all day). Now I work in a busy ER-Trauma center, NOW I realized I didn't really know anything as an RN in LTC. No offense to any LPN or RNs, but most facilities are getting really sick patient, and I don't think LPNs have enough training to take care of acute sick patients in SNF. Its very good that the Government is pushing for all RN staffing. Now I work as part time Nurse Educator/everything else in a SNF.

Just my 2 cents....

1 Votes

Wow. I have dealt with drainage tubes, wound vacs, IV's, peritoneal dialysis, etc., in LTC, as a well-trained LPN. After years of dealing with all that, I am now the Staff Developer, which I love doing! So many options, so much to learn everyday. RN's are scarce, most want nothing to do with LTC as you have read above. Someone has to care for these folks.

Specializes in ER LTC MED SURG CLINICS UROLOGY.

I used to love LTC. I'm an RN who recently left a LTC job of six years for a hospital floor nurse position. We had many RNs in our LTC facility, but management worried more about keeping staff happy than providing very good patient care. I always held myself and my staff to a higher standard than what the managers saw fit. I was accused of being a "super nurse" and was told by my supervisor "you're up here, most of the workers here are down here on this level, and we have to work with them." I then proceeded to tell her "yes. But there should be a Bare minimum standard of patient care, and we are not meeting even that." I've seen and reported nurses failing to intervene with critical patients resulting in death. I have seen nurses giving meds without orders, holding narcotics in their lockers, nurses making horrific med errors. All of this was reported to upper managent and I was always told "we have handled it" yet these nurses and staff members continued to work day in and day out (no suspensions or write ups that I know of. This makes me sick to my stomach to know I stayed in that job for so long. RNs LPNs, doesn't matter. We had a four star rating on paper, but in reality it was much lower than that.

Specializes in long trm care.

You cannot be serious about getting more RNs in LTC not even LPNs want to work there unless it's the only place in town.The whole LTC system is in free fall, the cannot get help and insist upon giving hospital pts to LPNs. The LPNs are quitting faster than they can hire them, and most RNs think nursing home work is to hard.

Specializes in long trm care.

The whole idea of having all RN staffing in LTC is totally idiotic there is no way in hell an RN is going to take on the work loads LPNs have on LTC. And LPNs do a lot more than RNs seem to think they do! We all have a job to do and if RNs can hack having 30 to 60 high acuity pts then you can have this f..... Job!

Otherwise keep your complains about the hard working LPNs to you self.

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