LTC Nurse: Patient Ratios

[ringaring]

I have not found any state (OR) requirements for nurse:patient ratios in LTC facilities. By 'nurse' I am referring to RNs and LPNs. From what I have read, it seems one nurse for up to 30 patients is generally accepted by the industry. Acuity is not taken into account - it's simply a numbers game for the accountants. I work in a facility that accepts such an unreasonable and unsafe workload which in turn prohibits patient from receiving the competent and thorough care they are entitled to and paying for. What to do . . .?

I could report this to some agency however, this corporation and most like it have been dancing around the regulations for years and can far outwit any inspectors.

I have addressed the issue with administration only to be told the facility is 'in compliance with nursing:patient ratios', and, we are 'not budgeted for more staff'.

I can bring the problem to a forum such as this and ask for input - which is why I'm here.

Any suggestions to facilitate changes in LTC nursing policy are welcome.

. . . and please, no 'suck it up and deal with it' attitudes! That kind of tolerance to an abusive industry is unacceptable and shameful in professional nursing.

[DoGoodThenGo]

The only way I see to effectively change these horrendous and scandalous ratios would require 'whistleblower' status on your part, which could effectively end your nursing career (i.e., your getting blacklisted from all facilities in your area, or losing your license over BS charges).

#1. You could contact local, state, and national media to highlight the unsafe conditions and how our elderly residents are being neglected and mistreated (institutional elder abuse).

#2 You could contact your state representatives in your state General Assembly in an attempt to get sane nurse: resident ratio laws passed for all nursing facilities in your state. This would in effect call for highter Medicaid reimbursements for institutional long-term care (money that your state is likely not to have), so you would face an uphill battle on this one.

Thank you for caring.

Number "Two" wraps things up in a nutshell.

Patients are transferred out of hospitals to LTC/Rehab for many reasons but the primary one is because the latter are less expensive. Well they would be wouldn't they? Instead of 1:7 or whatever RN to patient ratio have 1:15 or more.

There are only two viable ways to deal with this from a patient care angle; leave them in hospital until they are well enough to discharge home (the old days and very expensive), or increase staffing at LTC/Rehab to reflect patient loads and acuity (also costly).

[Nascar nurse, ASN, RN]

Money talks and bullcrap walks, and until more money is infused into the Medicaid system to provide for the care of elders, expect to continue caring for plenty of residents.

Exactly. I've always heard it rumored that often times a state medicaid system will pay more for a convicted criminal care in jail on a daily basis than it does for a LTC resident on a daily basis. I don't have a source to quote for that tho.

[miasmom]

WOW! Perfect timing! The thing is the government is broke. Still talking of more cuts! I still remember when we tested urine for diabetes! The stuff that used to be in acute care for years is now outpatient or same day. The stuff we get in a SNF used to be in ICU and now no changes in staffing. we are not getting the sweet little old lady recovering from a hip Fx or some that needs a place to stay help with ADL and meds. I see people 20 years younger than me. That have major issues Held to higher standards. I realize it is a numbers game for bean counters but please this is someone life. A way for someone to support themselves. Something has to change. If something goes wrong it is blame the nurse. Not what is wrong and what can we do to prevent this from happening again. Forget Boss respecting labor law or even the nurse. Tired. Home Health is looking good now. One patient at a time. Sounds good but might miss running or benefits.

[miasmom]

Nascar. I have heard that too. I have also seen years ago that it costs a lot more to have in locked up than give them an education. Maybe I am to much of idealist. I know can not take care of everyone or take care of everything but I am worried about our future as a country and world. I do not see myself as to extreme polictally but there has to be a balance.

[amygarside]

true. understaffing leads to stress for nurses and the quality of service may be affected as well.

[Alnitak7]

I was talking with a co worker about the need for more people and was told the state actually forbids this.

They're supposed to be concerned about patient safety. They are not even there so they should let the staff decide

about the ratio.

[amygarside]

i agree. they should have experienced it first hand..

[jax4224]

I have found the ratios to be very alarming in the facilities here. I live in Jacksonville Florida. I started as an LPN in a LTC/rehab. I would have at least 24-30 residents. And on the rehab side, I would have a min of 19. It was very challenging. I have gained much respect for the nurses that stay. I felt like there was never enough time in the day. I sometimes get anxiety when I think of some my days there. I am now awaiting to start a position at a hospital. I understand that in a hospital I will have higher acuity patients. But I will be very happy with a better ratio. I've always thought it was ridiculous how staffing is handled in a facility. Not to mention that most staffing coordinators are power struck CNAs. I remember when I was CNA, I had so much respect for the nurses I worked under. I don't feel that is the case now. Very sad is all I can say. At the end the patient is the one who doesn't always get the best care.

[Tired nurse]

I have 30 LTC residents on a regular basis. It is impossible to complete all tasks and it hurts the residents but the company only cares about profits. I refuse to work over and report off. LTC will implode from its own greed. Not in the budget is crap when your CEO made millions last yr.

 

[No Stars In My Eyes]

I stuck out 6 months of 28-32 patients to one nurse, and finally got canned.  I tried and tried and tried to keep up; I'm still not convinced the other nurses were short-cutting somehow, because they seemed to be able to sit out the last half hour at the nursing station, talking and giggling.

Definitely NOT FAIR for the patients that nurses don't have any time for them except the time it takes to throw pills down somebody's throat. 

[Tired nurse]

It is 2023 and nursing homes continue to lie about staffing while now taking high acuity pts they know they donnot have staff or equipment to care for. I have had as many as 60 to care for and still got yelled at I was not working fast enough, they got told to find another nurse that day! I am burnt out and fed up the corporation only cares about money and staff and LTC residents suffer neglect because the step down pts get the best care and LTC gets neglected. This is corporate greed not the staffs fault for being short of help. They can blame the government but it is simply greed on the part of nursing homes they have lied for years and continue to lie when they purposely give nurses an impossible work load every day! I partly blame the ANA for trying and exceeding  in demonizing LPNs so much they are totally treated like dirt when if they were RNs this would not happen!

[Tired nurse]

Why in the hell would anyone think 1 nurse can care for 30 or more people is a safe nursing assignment! I see this every ***ing day in LTC. Of course it is all LPNs that are bullied and belittled by the only RN the DON. Honestly how corporate managers in these places can talk to staff about caring when everyday they watch as nurses struggle with an impossible load while they try and quilt the nurses into working beyond their scope of practice. I never see a manager unless they come to tell you they have more work for you!  Or when they lie and say we are fully staffed when there are 60-70 pts 2 LPNs and only 1 CNA on each hall. This is why LTC sucks! I have been sounding the alarm for years about this but no one but the LPNs seem to care, The only RNs are corporate managers that never touch a resident and think this OK, for an LPN to have this many people. But would refuse to care for this many themselves.