Typical Staffing for a SNF/Rehab Wing

  1. I work for a SNF that has three wings, two are LTC and the third is Medicare/Short stay/rehab. The short stay wing has 32 beds. We typically have 3-4 CNAs and either 2 nurses or a nurse and a med tech for the AM and PM shifts and 1 CNA and 1 nurse for the noc shift. Is this typically how staffing looks at other facilities? Right now we are so busy it's not even funny. Multiple admissions a day along with discharges on top of passing meds (unless it's a nurse and a med tech), wound care/tx, there's usually at least one PICC in house, and then there's Doctor rounds, care conferences, and then there's the never ending charting, ect ect ect... We are running like crazy to a point that it's not safe and leaving there hours after the shift has ended. We're getting burned out... Is this how it is other places?!
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  2. 11 Comments

  3. by   TheCommuter
    I typically had 15 to 17 patients in the SNF/subacute rehab setting with 1 CNA, or up to 34 patients with 2 CNAs and a medication aide. So, yes, the staffing you describe does not seem outside the realm of possibilities.
  4. by   Sassafras6
    I relocated to Florida 1 year ago & took a position in a LTC/Rehab facility. I am scheduled to work 12 1/2 shifts & am lucky if I get out in 14 hrs. None of us have time for the break & if we attempt to get paid for that 30 min. my employer claims it is our fault that the break was not taken. The admissions & discharge documentation is over the top with most of it being the same information inputted into 3-4 different areas. Just 1 admission will guarantee 1 1/2 - 3 hrs overtime w/o pay, imagine 3 with 2-3 discharges & 1 emergency thrown into the mix.

    I have been in nursing 38 years & always loved my job. I looked forward to returning to elder care as I expected a trend to have occurred in ensuring todays residents are well cared for. I have never worked so hard in my career. In the past, I would feel a sense of satisfaction at the end of my shifts. Now I drive home discouraged, knowing I did not provide the care I should have & conduct the assessments these residents deserve. I hate that I am in a position that makes it impossible to provide competent nursing care. I learned during orientation, that there is no time to do a good head-to-toe assessment, yet we must still chart lung/heart sounds, etc. If we do everything we chart that we do, we would probably be over 4-6 hrs documenting off the clock. This is the norm at my facility & I hear it is typical for LTC nationwide.

    I have always had a lot of energy & can run circles around those half my age, so I know it is not that I am "too old" or "too slow". I am fortunate that I am in a position in which I do not have to work, but do so because I always enjoyed nursing. I work prn to maintain a decent work/life balance, I cannot imagine having to work FT under these conditions. Early on, I decided to give this a year as every new position feels overwhelming at first. After 1 year, I am considering retiring as I no longer enjoy nursing. I am in fear of my future as I will likely be a resident at some facility one day & I know the work conditions will not improve. Our local hospitals are not much better as the nurse/pt ratio is double compared to what it was at my former facility & the med/surg acuity level is much higher than it was in the past. Higher demands & expectations are placed on nurses & healthcare facilities while reimbursement rates are being reduced & even withheld. The future of medical care looks bleak & unfortunately, that trickles down to the caregivers employed in healthcare.
  5. by   NurseQT
    Sassafrass- you describe pretty much how I feel as well. I have been a nurse for 14 years and have never seen it as bad as it has been these past few months.. It's so disheartening..
  6. by   Sassafras6
    NurseQT, it has gotten worse, I cut down to 8 hour shifts so I can get done in 12. Pt load increased to 25 patients & amount of paperwork, documentation & filing increased such that it takes at least 4 hours after giving report to finish the day. Yesterday I was lucky & left after 2 1/2 hours of charting, but then I decided not to do the massive amount of filing. I took on a teaching position as an adjunct, but that is not working. I am expected to attend & participate in committee, department, & curriculum meetings that add up to 44 hrs w/o pay/semester. Was told adjuncts only get paid for face to face time w/ students, but must attend mandatory meetings as terms of employment & of course contribute time to prep for class & grade papers. Today I will turn in my resignation to the LTC facility & already told my dean that I will not sign up to teach another semester. I will probably not seek employment & be counted as one of the many under 60 years of age who retire from nursing.
  7. by   caffeinatednurse
    Our rehab wing typically has anywhere from 11-16 beds. One RN or LPN and 2 CNAs is normal. If we're lucky, we'll get an aide or LPN that can help out with medications or treatments.

    I work 8 hour shifts, but I usually end up staying 2-3 hours over because of charting. Due to the sheer volume of narcs and PRNs on our unit, I usually take anywhere from 1 and 1/2 hour to 2 hours to get through the 8 PM med pass. Then it takes about 30 minutes to an hour to finish treatments. Then I write up a quick nursing report, jot down important information to pass along to the next shift, give report, do the narc count and disappear to the charting room until I'm finished. The next shift always jokes that I really work on their shift. Some of them joke that they're going to set up an "office" for me in a spare room, since I'm always there.
    Last edit by caffeinatednurse on Oct 23, '16
  8. by   lindseylpn
    SNF/skilled/rehab unit- 50 patients, 1 nurse per 25 patients and 2-3 CNAs
    LTC unit- 55 patients, 1 nurse and 2 CNAs
    Dementia lockdown unit- 40 patients, 1 nurse and 2 CNAs
    (On nights, one more nurse on LTC unit on dayshift and half of 2nd shift)
    This was 11 years ago but, I recently spoke to someone who still works there and ratios are still the same. I work in a group home now.
  9. by   purplegal
    We have 2 units designated for short-term rehab and one unit for long-term care, although we do have LTC patients on our rehab units.
    All units have up to 20 patients.
    Ideally, we have 2 nurses and 2 aides per unit during the day. During the night, one nurse covers one of the rehab units, and another nurse covers the second rehab unit as well as the long term care unit (so it's 40 patients for that nurse), with 1 aide at each unit.
    However, that rarely happens; we often have 1 nurse and 1 aide per unit. At one point, there was 1 nurse for all 60 patients at night.
  10. by   pedsrt2rn
    I work in a short term rehab unit with 52 beds. We are almost always full. Days/evenings have 3 nurses (RN or LPN) and 4-6 CNAs. Nights have 2 nurses with 2-3 CNAs. The workload breaks down to 18-18-16 days/evenings and 26 nights. I do 2 12 hour shifts on weekends and then am the 'desk RN' on Monday evening shift. The desk RN does admissions, schedules transports for the next day, answers phones, checks in meds from pharmacy, and whatever else can be done. It's super helpful, however; when I do it is the only day we have one. The other days the nurses have to do all that stuff AND take care of the patients.
  11. by   littlespitfire
    I've been in rehab for 5 years, our unit has 60 beds. Days has 4 nurses, 8 CNA's and in house wound care. When we are full we have a 5th nurse to help with treatments. We also have an in house NP, a nurse assistant who does accuchecks and helps with CNA stuff, and a discharge/admit nurse. I work nights- we have 2 nurses if census is 48 or less, 3 if we are 49 or more. We rarely are below 49. Our usual CNA count is 4, but occasionally we have 3. We also have a ward secretary until 2130. Our PT dept is awesome and very highly staffed, there's easily a dozen of them. and we have a Physiatrist and his NP who comes in a few times a week to address issues. And then there's the resident support staff- who cook, clean, do laundry and help transport residents in house. (big facility- 250+ beds) I think we are pretty lucky, our ratios are decent.
  12. by   rehab_nurse
    I worked in a SNF in Colorado where the nurseatient ratio was 1:22 with 2 CNAs. The responsibilities included to completing 2 medication administrations per shift, 11 head to toe assessments, wound care/IVs/ACHS blood sugar checks and insulin, calling pharmacy/doctors/lab/family, sending someone out, etc. And of course, 2-3 admissions an evening which each took ~45 minutes including charting, at best. They were 10 hour shifts but I usually stayed for 12 hours. Absolute chaos and I wouldn't wish it on anyone..
  13. by   littlespitfire
    60 bed unit here- subacute/ rehab... days theres 4 floor nurses, 7 CNAs, 1 nurse assistant (cbg, helps with admits, daily weights etc) 1 admissions nurse, and in house wound care and NP. we also have in house PT doc and his NP, but they also have a clinic outside our facility so they're not here every day. I'm on nights- 3 nurses and 4 CNAs with building supervisor to help if needed. we are "high acuity" compared to other facilities in the area. Nurses work 12s, CNAs work either 12s or 8s. Long term nurses work 8s and our facility has 11- 16 bed units just long term. each unit has a nurse with 2 CNAs. afternoons they go up to 22 patients, and nights it hoes between 50- 70 patients depending what area you work in.

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