ALF 1:85 night shift sounds allright

NurseLoveJoy88, ASN, RN · Nov 12, 2011

I have worked at two ALF. One was a 1:64 with med techs and the other was 1:100 with med tech. It was alot of work. I think there should be two nurses in the building. These ratios were a bit much for me. If a med tech or CNA called out, I had to step in.

agldragonRN · Nov 12, 2011

wow! i never worked alf but that sounds too much patients. i have 25 patients (3-11) who are not supposed to be "acute" and it's too much for me.

my sister in law works both alf and ltc and she said the acuity of the patients are almost the same.

with this economy, you cannot really be choosy especially when you are a new grad like yourself.

good luck to you. i hope it works out for you. you might be interested in reading more posts regarding alf in this forum, link: https://allnurses.com/geriatric-nurses-ltc/

xtxrn, ASN, RN · Nov 12, 2011

The numbers may sound high, but what are the meds and treatments like? If they're light, you could have 150, and be fine. Most A & O patients aren't going to be awakened at night much. ALFs have admission criteria- some won't take incontinent patients; others get closer to ECF (extended care facilities).

agldragonRN · Nov 12, 2011

op, have you seen this thread?

link: https://allnurses.com/geriatric-nurses-ltc/assited-living-new-638127.html

DixieRedHead, ASN, RN · Nov 12, 2011

RUN, do not walk, RUN away.

sweetnurse63, BSN, RN · Nov 12, 2011

I just came back from a interview at Assisted living facility. I'll more than likely do evening or night shift as a new bee (LPN). There are going to be myself in charge of the 85 patients at night shift, I'll have two CNAs. There will be two LPNs or 1 LPN + 1 med tech+3 CNA for 3-11 shift. Also, If next shift calls off, I'll have to find someone to replace her. (yeah, I'll be called LPN supervisor) I was told that the patients are not acute. There might be one or two who have IVs or G-tubes, definitely no trach, Vent, etc. When I walked around, I noticed that a lot of pts are wheelchair bound, and some have dementia.
I wonder whether this nurse to client ratio is normal for ALF. thanks.

In my opinion, this is not normal for an LPN to have 85 pts in ALF, not to mention only 2 cna's? I work overnight in LTC and can have up to 41 pts and it is not easy. It is enough work to keep me busy during the entire shift, I mean seldomly taking a lunch break and sometimes not even drinking a cup of coffee. All you need is to have a few pts fall or have to send someone out to the hospital along with your other duties and you will quickly become over whelmed. I would never consider being charge over 85 pts, too risky in my opinion. :nurse:

treeye · Nov 12, 2011

I do think that a lot of residents there need total care and almost all of them are at high risk for fall. They may not have trach or G-tube, but surely many of them need insulin and lots of pills. When I walked through the hallway, I noticed the unpleasant nursing home smell. I'm sure the residents can't get the care they need.

yes, I think I'll need to keep on looking. thanks for the links and your input.

GoddessLilithLPN · Nov 12, 2011

The last job I had before my current one was at an ALF. I was the only LPN on the 3-11 shift with 2 CNA's and 42 residents. It was great until the marketing director started admitting residents that should have NOT been admitted. Like the violent alzheimers resident and many, MANY residents that were total care and assist! On top of all the meds and tx's, charting, Dr calls, pharmacy calls and family members asking me a bajillion questions, I also had to clean up after dinner which meant clearing the tables and doing the dishes and help the CNA's with care and showers if I wasn't busy with my regular nursing duties. I have to admit-I did like working there. I was such a relaxed and friendly environment:)

9livesRN, BSN, RN · Nov 13, 2011

1:40 = high chance to loose your license, anymore then that, flush it on the toilet your self....

Good Morning, Gil · Nov 13, 2011

Never worked LTC, but did work rehab, and dementia patients and/or dependent patients are a lot of work, more than 1 nurse could handle for 85 patients, and when they say 1 or 2 LPN's, it's probably going to be 1 lol. Dementia patients take a lot of re-orienting to prevent falls, etc, and dependent patients obviously are very time-consuming helping them to the BR, turn q 2 hrs (which good nurses do!!), etc (which is going to fall on you a lot, too). and only 3 cnas? this sounds terrible. I wouldn't take this position with a ratio like that (and I would definitely clarify..is it 1 or 2 lpns? how often are there 2, etc?, especially since you are ultimately responsible for your patient's outcomes.

I feel very bad for our elderly. I do know that there are very nice LTCs out there, but you just have to be careful which ones you choose to work in, and which one you choose to send a parent or grandparent. Yikes. I know not all falls can be prevented, but safe staffing makes a big difference. I know I had 12 patients at night in rehab, and I couldn't imagine any more than that since many take at least 5 mins (sometimes 10) just to transfer them to the BR (not out again, that's another 5 mins lol), not to mention some that you can't leave alone on the toilet d/t confusion from CVA, etc. I was very busy with 12 patients, charting, meds (polypharmacy in the elderly), many diabetics/bs checks, toilet/transfers, helping cna's, AM blood draws, etc, and the occasional emergency....And, my CNA also had the same 12 patients, each of us had 1:12 ratio, and we stayed very busy. Maybe they don't need as much help in ALF's? Doubtful, though. Just giving you a frame of reference.

Good Morning, Gil · Nov 13, 2011

Did not see your post about the nursing home/urine smell. Yes, definitely run far, far away from there. If residents are being properly cared for, it would not smell. Good for you for not taking the job just to get a paycheck (although I would understand if you really needed the money; I guess in that situation, you just provide the best care you can). Places like that disgust me, just trying to make a dollar. I remember my grandmother payed over $3,000 a month for her ALF (and it was a nice place. at least it was nice, so it's not as bad that it was expensive...and this was 5 years ago now.

There are still those awful ones that cost a lot that are really bad (like the one we had to pull her from d/t poor care, ick...this is how we re-pay our elderly? I don't know how those administrators sleep at night. I guess they sleep as well as the big time executives that lay off a bunch of employees rather than take a pay cut themselves, going from 6 million dollars a year, maybe to 3 million to save a few jobs maybe? Greed...it's disgusting.