Advice - Patient Ratio and BS Check in ALF

HelloM1M1 · Jun 8, 2012

i'm a new grad & my first RN job right now is at a short-term rehab unit. I only got 2 accuchecks, medpass to 22 residents, treatments to about 10 residents and I already feel overwhelmed. So yes, 9 accuchecks to me is momumental!

Dragonmom · Jun 8, 2012

I'm looking for a new position because of a simular situation. We have no admissions person, admissions are taken 24/7, on PM we have 2 nurses and 2 aides (if we're lucky) to 38 residents. We currently have 10 diabetics, 20 with dementia/alz, wound vac, tube feeding, many dressing changes and the like. This "for-profit" facility allows needed supplies to RUN OUT before they order more. Last night we had no safety lancets, so they provided us with the lancets one would use at home, but no holder to use the lancets, this was the second day of this (I was off the day before). Very unsafe situation, just a needle stick waiting to happen. Last week we were out of incontinent wipes, they bought 2 packages of the cheepest wipes they could find and we had to make them last the weekend, then on Monday laundry complained about all the washclothes that were used over the weekend. The week before we were out of catheter leg bags, one of the resident's spouses went and bought some for her husband. The week before that we were out of bedpans. Last night we ran out of med cups. The answer from administration is always along the lines of "it was ordered and didn't show up" or "it's not in the budget" or "it will come on tomorrows shipment". There have been times that we were out of bandages, medical tape, gauze, leg wraps, breifs, denture tablets, mouth wash, toothpaste, the list goes on. We are now low on oxygen tanks and are told to "make them last" (don't know who they think we should reduce the O2 rate on).

So to deal with short or no supplies, all the meds and treatments going on and now take the 2-3 hours somewhere in your shift to do all the admission paper work and skin check and vitals and order the new meds from the pharmacy and get everything into the computer and do this on the short shift they just handed you because "it's not in the budget for you to work a full shift", skip your breaks and lunch do your best, get out of there late and then get chewed out the next day because you took care of business instead of your breaks and watching the clock and working for free the last few hours to get the work done.

It been like this for the last 6 months and no sign of it getting better...

I am looking for something with a non-profit facility, hoping that will be a little better, but won't hold my breath. Welcome to the club, it could be worse, but hang in there because those being cared for need you and if you're lucky will actually say "thank you" someday.

pfeliks · Jun 8, 2012

I work in a small, not for profit facility. Our census has a max of 40 patients. On days we have 2 nurses and 5 cnas. Evenings we have 2 nurses and 4 cnas. Overnight we have one nurse and 2 cnas. I always get out on time.

BrandonLPN, LPN · Jun 8, 2012

On my unit I pass meds (on 3-11) to 40 residents with up to 18 accuchecks at 4pm (depending on the day of the week). Usually 6 or 7 accuchecks again at HS.

I get out on time almost every night.

Once you've done a med pass with a particular group of pts enough times, anyone should be able to finish on time most shifts. Of course, stuff happens. Falls, admissions, sending people out, etc.

Just remember even when stuff happens, there's a lot that can wait until AFTER med pass. Non-emergent things CAN wait an hour or two. I never take phone calls from resident's families or even the pharmacy during med pass (unless of course I called them first and they're returning my call) It is OK to just take a message. The only thing that should EVER interrupt your med pass is an EMERGENCY!!

JZ_RN · Jun 9, 2012

I have 11 brittle diabetics with accuchecks and 53 residents. it's not safe.

LFalcon · Jun 9, 2012

I find it all very interesting all of our experiences and how similar they all are. My facility is "for-profit" hence the moving around and transfers of recent.. combining 2 memory units into one very large one is a money maker. ECC giving the "space" for extra nursing care that I wish we had time for that we do not is also a money maker...

Seriously, I get excited when I have the opportunity to give a Vanco IM.. this is a rare occasion. Only as I am mixing - and pulling and doing something than popping a pill out of a card.

M1M1 - I could be wrong, IMHO 22 residents, 2 accuchecks and 10 TX seems stressful, but do-able? For me, it has been - keeping it as safe as I can.. keeping my license.. I don't think I have ever had fewer than 36 residents...once I had only 3 BS, but then I had 2 floors and 6 aides and 46 residents on 2-10.. hang in there - get your experience!!!

Dragonmom - I feel you - we don't have an admissions person either - we are the end all be all. Lately I have even been "showing" apartments?? WTH! Admissions have been showing up on Sunday... and no warning.. which makes me wonder... how do you verify meds? We get 1823's but to verify?? no dr ever calls me on a Sunday. Anyways, If I were you I'd explore my options - I think I feel better when I have options.

We have NEVER had safety lancets, what are those? Every resident has own testers like those used at home, as we are an ALF. Do you know how many times I have poked myself? with a clean lancet mind you... but it hurts. Then I'm bleeding... I have learned to be very careful - it's a learned art. We also are not allowed to have dressings for dressing changes (as technically we are not to do them - but we do), we beg for them from HH nurses - and scavenge them from anywhere we can find. We also all bring in our own ABT ointment.. I own my own BP cuff, pulse OX, thermometer - my DON gets very upset as our admissions do not always have weights... we do not have a scale (4 floors, no scale).

:-( That's where I draw the line - I'm not buying a scale!!! We have to take them next door to the SNF.. not always an option.

I too know some in non-profit and they seem to like it better and the environment appears better??? I always think the same... could be worse, right?? I LOVE my residents, which is why I bought all my own stuff - and bring in stuff from home. Such a shame as they pay allot of money to live there. They deserve better....

Thank you - for all you do!!!

BrandonLPN - I'd like to take your post, blow it up to poster size and hang it above the time clock, then on the office door to the nurse station.

Nothing makes me angrier then to have someone hanging up and calling like a psycho for me to answer the phone during my med pass. This happens daily... I really truly want to concentrate on passing meds.. lots of times it's such silly stuff on the phone - the hair salon in my facilty, family members calling to chit-chat, CNA's kids looking for them, residents wanting to know where HH is??? and often I will be standing at my cart, drawing up insulin in a vial and someone will walk up, seeing what I'm doing and start talking to me.. ??? really....

I get in trouble for not answering my phone. I've had the executive director call me and ask me why I am not answering my phone..(keep in mind these are not emergency calls) I really think it's rude to the residents I'm caring for at that time.. If I could do my med-pass uniterruppted I prob could get it all done - BUT with 1500000 phone calls in-between.. not possible. We cannot even count narcs without the phone ringing 5-6 times. It's very frustrating. I've mentioned it to management, my voice is not heard. Again, why the increase in census, and increase in BS checks scares me and feels impossible.

JZ_RN - that scares the heck outtame. I am not sure how you do it???

Well, It's good to get a concensus - and interesting to hear from others. Thanks again for your responses...

LFalcon · Jun 9, 2012

We are now low on oxygen tanks and are told to "make them last" (don't know who they think we should reduce the O2 rate on).
So to deal with short or no supplies, all the meds and treatments going on and now take the 2-3 hours somewhere in your shift to do all the admission paper work and skin check and vitals and order the new meds from the pharmacy and get everything into the computer and do this on the short shift they just handed you because "it's not in the budget for you to work a full shift", skip your breaks and lunch do your best, get out of there late and then get chewed out the next day because you took care of business instead of your breaks and watching the clock and working for free the last few hours to get the work done.
It been like this for the last 6 months and no sign of it getting better...
I am looking for something with a non-profit facility, hoping that will be a little better, but won't hold my breath. Welcome to the club, it could be worse, but hang in there because those being cared for need you and if you're lucky will actually say "thank you" someday.

I meant to say.. holy crap - low on O2?? WOW... that would freak me out!! how did they think you would make it last??? how do you do that?

and the hours thing - that happens to me, and I often wonder... do I clock out and come back up to chart... as it is my license? A fellow nurse was let-go for that... workers-comp issue... I understand that part... so where is that line?? honestly though, these are things I often worry about...

dtroia22 · Jun 11, 2012

I guess I should feel lucky! The unit I manage has 57 residents-23 diabetics with accu-checks achs, 2 gtubes, and about 30 of them have dementia/Alzheimer's! But, we have the charge nurse, treatment nurse (only on days), 2 medication aides on days (1on nights), and 4-5 aides on each shift. We have a routine down and work as a team so on most days, it flows pretty well. Of course, there are always those crazy days where you don't know your butt from a hole in the wall! Sounds like many of you need new jobs! If your employers are willing to put the residents at risk by short staffing and not having the proper supplies to give proper care, they are putting your nursing license in jeopardy! Not all facilities are like that!

JZ_RN · Jun 12, 2012

LFalcon- I do the accuchecks first at medpass. Then I do all the narcs. Then I go around the building and do IV's, finally, everyone gets their other pills afterwardsm (always late, but a cholesterol pill, a colace, and a trazodone can be given at 10 so whatever). Reasons why I am leaving this job in less than a week for a clinic job- gee I wonder how many I can come up with? :)

luvmy2angels · Jun 12, 2012

Once you get a routine down it may not seem as stressful. One question...can't any of these things be delegated to the aides?? I know where i work there are 2 nurses on dayshift and one aide so the nurses get all the accuchecks and vital signs, but the evening shift only has one nurse and one aide and the aide does all the accuchecks and blood pressures. Just a thought....I should mention though, that i work in a PC unit so things may be different.