And yes...it is all legal.

Published

Vent ahead....

Wow...if I wanted Med Surg, then I would be in the hospital.

Came to work with a full house. Me and a LPN for 48 pts and we had 3 cnas. I had one pt with TPN and lipids, a continuous narc infusion, NPO except for sips with po meds, requiring q 2 hr IVP for pain, prn nausea meds, prn ativan and then to top that off..a few other IVPB meds

I spent at least 4 hrs just on that one pt..Then I had 5 more pts with IV meds, some getting 2 or three abtx thru the shift and I had to do a few IV push meds for my LPN....a whole bunch of wound care, labs to follow up on, families to deal with, IV sites that blew or needed restarts because they were 5+ days old and should have been switched to midlines, incident reports, and with that 20 other LTC residents. OOO...I had to deal with fighting CNAs too.

Yes...I know this is LTC, but in some states in acute care settings, they have mandatory staffing ratios. I'm sure 8 Med Surg pts along with 20 plus LTC patients wouldn't be legal, but in LTC...it is. :scrying:

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That's because nursing homes are like dumping grounds for any and everything. I work in one that doesn't hapen to be too bad (2 nurses and 3 aides to about 45 pts.) but I know what the pill passing marathon is like.

Kind of reminds me of a livestock barn where you slop the hogs in one pen and go off to slop them in another. Terrible fate to have to go through, I say.

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Specializes in LTC/SNF, Psychiatric, Pharmaceutical.
Vent ahead....

Wow...if I wanted Med Surg, then I would be in the hospital.

Came to work with a full house. Me and a LPN for 48 pts and we had 3 cnas. I had one pt with TPN and lipids, a continuous narc infusion, NPO except for sips with po meds, requiring q 2 hr IVP for pain, prn nausea meds, prn ativan and then to top that off..a few other IVPB meds

I spent at least 4 hrs just on that one pt..Then I had 5 more pts with IV meds, some getting 2 or three abtx thru the shift and I had to do a few IV push meds for my LPN....a whole bunch of wound care, labs to follow up on, families to deal with, IV sites that blew or needed restarts because they were 5+ days old and should have been switched to midlines, incident reports, and with that 20 other LTC residents. OOO...I had to deal with fighting CNAs too.

Yes...I know this is LTC, but in some states in acute care settings, they have mandatory staffing ratios. I'm sure 8 Med Surg pts along with 20 plus LTC patients wouldn't be legal, but in LTC...it is. :scrying:

I sympathize with you completely. Today's NH residents would have been yesterday's hospital residents, with the way LTC acuity has increased. Nowadays, nursing homes are home to the sickest of the sick, while they typical nursing home resident of the 80's lives in ALFs today.

The increase of skilled/subacute care - where a patient is sent to a nursing home for high-level care that would have been finished in a hospital not so long ago - is only making things worse, since staffing laws for NHs have not been strengthened to reflect the increase in IVs, major wound care/wound vacs, and even vents that have been showing up in NHs. You're being expected to handle hospital-level work on a patient load that would provoke open rebellion in a hospital.

And since you're handling all that, med-surg nurses at the hospital are likewise seeing a surge in acuity of their own, and again, staffing mandates are not changing to reflect this. Many med-surg patients would have been in ICU not too long ago.

All I got to say is, I'm glad that part of my life is over.

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Specializes in Geriatrics, ICU, OR, PACU.
That's because nursing homes are like dumping grounds for any and everything. I work in one that doesn't hapen to be too bad (2 nurses and 3 aides to about 45 pts.) but I know what the pill passing marathon is like.

Kind of reminds me of a livestock barn where you slop the hogs in one pen and go off to slop them in another. Terrible fate to have to go through, I say.

I really hate this sort of bashing, or better yet, painting with a broad brush. Not all SNFs are like the ones described. I am blessed, I guess, with being in FL, and working for a great building. Our ratios are do-able, and realistic, and state-mandated (although I staff higher than state mandates). In FL, you can be put on an admissions moratorium for staffing below state minimums.

I staff short term rehab 1:20 for nursing, and 1:8 for CNAs. On our LTC wing, it's 1:30 for nursing and 1:7 for CNAs. I have a full time desk nurse, treatment nurse, transportation CNA, and 2 activities CNAs. All my supervisors are free-floating, and are available to help out in whatever capacity they are needed for.

I love working in a SNF, and wouldn't go back to hospital nursing for all the tea in china. There ARE great ones out there....I hope you find one.

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Well, that's the nature (and reality) of nursing homes. Old sick and unwanted people go there to die.

If it wasn't for the people who care (employees) things could be a lot worse for these poor souls.

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Specializes in Geriatrics.

I work in a very good LTC /Rehab facility. Ratios are Days- Rehab- Nursing- 1:12 max, CNA 1:6 max, LTC- Nursing 1:24, CNA- 1:7, plus 2 restorative CNAs and 5 Activities CNAs. I have been at the same facility for 7 years beacuse of our quality care and the fact that staff is treated well. Though just like any where else, there is the problem of working at "less than desired " due to call ins, etc.

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Don't get me wrong, I love LTC. Really. Its just that it seems to cycle with the type of admissions we get. When census gets low, they will take anything and the type of residents we get that are higher skiled means $$$$. If we didn't have the other LTC residents with behaviors, if we didn't have all the call offs, if we had the supplies etc....wow...what a difference.

Its just when you have these weekends from heck, thats when there are complaints of why this wasn't done and that wasn't done. LOL...

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Specializes in psych, long term care, developmental dis.

NurseExec:

Is that day shift only? Probably lose alot of that staffing on the other 2 shifts?

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Specializes in Geriatrics, ICU, OR, PACU.
NurseExec:

Is that day shift only? Probably lose alot of that staffing on the other 2 shifts?

Yes, that is day shift only. However, my desk nurse does a split shift, 11a-730p, as most of our admissions come after 3. I have activities CNAs till 7p, transportation CNA based on appt times, and free-floating supervisor. Nursing staff are the same all three shifts, however, CNA staffing changes on 3-11 to 1:9, and 11-7 1:10. Wound nurse also works a split shift from 5a to 1:30p.

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Specializes in Gerontology, Med surg, Home Health.

Does your wound nurse strictly assess wounds or does she do other things? I see her time is from 5AM to 1pm. I hope she's not doing any wound care at 5 am-residents need to sleep.

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