Am I just being a big baby?

[mamarhonda]

Ok, I am an RN in a LTC facility and have worked there for 6 months (first job as an RN.) I am responsible for 27 residents of my own. I have gotten a pretty good routine down and have learned how to manage my time well. This is not my issue. Our facility has a total of 74 residents that means there are 23 residents and 24 residents on the other "halls." When I first started I had 3 aides for my hall on the 2-10pm shift well about a month and a half into it they reduced me to 2 aides only and put the 3rd on the hall with 23 residents. Management was saying my hall is way too easy. Fast forward to now I have the most residents in my hall and still only have 2 aides. The other two halls are scheduled 3 aides everyday. My hall has become very heavy as far as care from the aides while we have alot of independent residents they still are requiring a ton of care. I have begged and pleaded to get a 3rd aid with nothing more than "we have discussed it at meetings" as a response. I am at a loss, I don't know what to do, my aides are threatening to leave (and they are wonderful aides) but it has become too much for them. For example we got a new resident today she is a 2 person hoyer lift that means when she is to get out of bed both my aides need to be in the room and I have no one on the floor, how is this safe!?!?! My aides have 13 and 14 residents a piece while the other halls have 7-8 a piece. It's really frustrating to see them sitting in the nurses station while I watch my aides run their butts off. I have tried to give the two other halls 2-3 people but that only resulted in them throwing a fit about why they need to take these people. I'm at a loss for what to do. I talked to my nurse leader who talked to the DON who has done nothing. I am going in tomorrow for a meeting and a mock fire drill and I think I might go and talk to the administrator about this issue, maybe she doesn't even know what's happening? Any suggestions of anything else I can do, if the economy didn't suck (and job searching) I would probably put my two weeks in I'm just sick of it and I have finally come to hate going into work now. Sorry I rambled but I need your opinions please!

Thanks!

[TheCommuter, BSN, RN]

I am going in tomorrow for a meeting and a mock fire drill and I think I might go and talk to the administrator about this issue, maybe she doesn't even know what's happening?

Believe me when I say that your administrator, in all likelihood, knows what is happening. In nursing homes and other LTC facilities, it is the administrator who prepares the budget and knows exactly how the money is being spent. The budget includes things such as labor costs. They cut one CNA from your hall to reduce labor costs and stay under budget. In addition, if your administrator stays under budget for the fiscal quarter, she typically receives a nice monetary bonus from corporate.

Do you see where I am going with this? It is all about the money. Cash rules everything around you and I. Quality patient care is secondary, or possibly even tertiary in nursing homes.

In addition, is your hall a long-term care hall? If so, this is the reason why you have more residents than the other two nurses. Do the other two nurses have skilled short-term Medicare halls? If I had a choice between 20 skilled Medicare residents and 30 long-term care residents, I'd pick the 30 long-term residents anytime! Skilled units are full of admissions, discharges, recent post-surgical cases, and residents who tend to be slightly more acute than your average LTC resident.

[wooh, BSN, RN]

Suggest, since the division is "fair," that the aides should rotate halls, perhaps on a weekly basis. That way it's not the same aides always getting the crap assignment. Perhaps if more than just the two get stuck with it all the time, the other aides won't be so quick to defend the status quo. Who knows, maybe they'll even start working together (although I wouldn't hold my breath on that one.)

[Sanuk]

I definitely don't think you're being a baby. I haven't worked LTC, but I would imagine that administrators are the same everywhere. Therefore, I recommend that when you go talk to them (and I would!) that you have hard facts about the acuity of your hall compared to the other halls. Give them data about daily tasks required and show them why you need 3 aides to complete them in a safe manner. Good luck.

[nola1202]

Nope, you're not a baby at all. You care about your CNA's and appreciate the hard work they do. Adminstration is all about the bottom line. Saving money on one aide is worth it, burnout isn't a factor in their book, they'll just find another cog for the wheel. Don't feel you have to quit to defend or protest conditions. It's like spitting into the wind.

[kristine_bean, RN]

At the LTC facility that I worked at, as an aide, we all divided the care equally. Normally we would have 2 aides caring for 20 medicare beds and 5-6 aides caring for 60 patients but every now and then the census would get low and we would mix a couple aides into doing some LTC rooms and some medicare rooms. That way you wouldnt have 2 aides caring for 12 (6 each) and 5 caring for 60 (12 each). We also got rotated on which patients we cared for so that way if its a tough group, at least you don't have it every day. You may want to make a couple suggestions like this to your management. Unless of course the halls are not a close enough proximity to have CNAs splitting areas like that. Another really great thing is to have a float. This is a person who has no assignment and just helps answer call lights and assist with 2person lifts. I LOVED days when we had enough aides for a float it was wonderful. Also a nice thing about the Nursing home that I worked for, was that the nurses made the decisions about where the aides would be and what the assigments were. Because they were the ASSISTANTS OF THE NURSE, so why not be able to make those kinds of decisions for your assistants. I hope this was helpful, I kind of rambled on too >.

[Marshall1]

Since management isn't listening or taking action have you considered contacting the Ombudsman for your facility? Going to anyone else in the company sounds like a waste of time - for yourself, the aides and the residents the care needs to be balanced. No, you are not being a baby.

[Forever Sunshine, ASN, RN]

I completely understand your frustration. On my unit theres 53 patients. We used to have 5 CNAs but of course due to the ole' economy.. we are 4 CNAs( and lucky to have that.) Administration is aware that the CNAs are being worked to the bone.. on all shifts.. not just mine. Its pathetic seeing the staffing schedule but it is what it is and us floor nurses can't really do much about it.

I help where I can but I cant do it all because .. I have a whopping assignment as well.

I gave them the idea of a float during an anonymous survey we had last year. The float would work 11am-7pm.. primarily to assist in the dining room during lunch and dinner, and toilet and answer call bells in the afternoon and remain on the floor during shift change, of course that would cost them money so I'm sure that idea went right into the "suggestion box" (read: trash can)

[DizzyLizzyNurse]

If you go talk to them again bring your aides and if possible other nurses and aides from the other units. More power in numbers.

[SuesquatchRN, BSN, RN]

If you have one two-person transfer your level really isn't that heavy. But it's still tough. I would suggest that you sit down and write out: how many need feeding, how many total assistance with dressing and bathing, etc., how may need incontinence care, how many toileting. Actually look at it and then, when you have clear ammunititon, go to your boss. Do not go over her head to the admin. I'm just sayin'. All you'll do is pi$$ everyone off.

[MonkeyLPN]

I have the opposite problem. I have 3 aids and love to see them sitting at the nurses station having a good ol' time or "pretending" to chart while call lights are going off, while I am running my tail off with so much work. While I know they have plenty to do. Like maybe get me some vitals. Gotta love LTC.

[KareBear0609]

My nurses would love to have the patient load you have ~ they each have SIXTY residents. And, no, this isn't an assisted living facility. This is a total care facility. We have two floors with SIXTY residents on EACH floor, there is one nurse on each floor. And four aides per floor.... 15 residents each.