Are most LTC understaffed? Are most nurses in LTC overworked, understaffed?

kstec, LPN · Jan 19, 2007

I'm going to attempt to find out what the ratio is for nurse/pts. I actually was contacted by a LTC facility that told me that their nurse is responsible for 60 patients on days. Needless to say I didn't start there. My question is do more experienced nurses actually get all their meds passes, all their treatments done, charting, calls to doctors and of course the out of the scheduled routine of sending someone out to the hospital? I'm comparing to the nurses that I work with, they have 36-40 patients on day shift, with 3 CNA's. Do they really get it done or do they sign that they get it done? I hope one day that I too will be super nurse and be able to get all that done, but somewhere in all of that I would love to actually have some interaction with my patients other than "Good morning Mr or Mrs whoever, here are your meds" I've only worked LTC a very short time and consider myself very energetic and a fast learner, but I can't ever see doing all this work in a 8 hour day. So basically my concern is you get in trouble if you fudge your paperwork and you get in trouble if your honest and say you did not have time. So far I have just not been signing things if I didn't do it, but it wasn't because I'm lazy, it's because I have no time. And of course you get in trouble if you work overtime. How can you win? I don't think LTC is for me. Like I've said before if I get old shoot me before you put me in a nursing home, please!!!!

kriss1976 · Jan 19, 2007

The LTC facility I work in is a 100 bed facility. There are two different ends and supposed to be 2 nurses, 2 CMA's and 5-6 CNA's on each end for days and pm's (except pm's don't have CMA's) with 1 nurse and 3 CNA's on each end on noc's. So there is supposed to be 2 nurses, 2 CMA's and 5-6 CNA's to about 50 pt's. That is ideal and happens about 2 to 3 days a week when there are no call in's. We usually work with 1 nurse, 2 CMA's and 4 CNA's to 50 pt's. That is not horrible but it is very busy. We have alot of treatments, tube feedings, trach cares, vital signs, medicare charting, tab and chair alerts going off, you know the story.

As nurses we are usually done an hour or two after our 12 hour shift ends. We had a meeting a couple weeks ago about why we are getting done so late. We are now going to be talked to by the administrator and DON everytime we are done late to give them an explanation. I can see alot going undone just so the nurses don't have to answer to why they can't get things done in their shift. This is definately not what the patients deserve.

I am glad that I don't work with some to the staff patient ratios I have read about on here.

nitewarrior · Jan 19, 2007

It seems like every LTC has the same problems mine does. If we do get mgmt to hire extra nurses and aides, somebody gets mad and quits because they still end up pulling a night short staffed. We have a 60 bed facility and I have worked it with only 1 other CNA and 1 nurse. And of course that is the night that everyone decides to go crazy. Fullmoonitis.

I have tried to find the staffing regs on my state's website but they arent listed.

Right now we generally have enough aides on the floor but our nurse has been by herself for 3 nightshifts. She cant get med pass done in time frame and we are due for a state inspection. Still with mgmt knowing this, they wont help. Too many bosses and not enough workers, is our biggest problem.

Bala Shark · Jan 19, 2007

I'm going to attempt to find out what the ratio is for nurse/pts. I actually was contacted by a LTC facility that told me that their nurse is responsible for 60 patients on days. Needless to say I didn't start there. My question is do more experienced nurses actually get all their meds passes, all their treatments done, charting, calls to doctors and of course the out of the scheduled routine of sending someone out to the hospital? I'm comparing to the nurses that I work with, they have 36-40 patients on day shift, with 3 CNA's. Do they really get it done or do they sign that they get it done? I hope one day that I too will be super nurse and be able to get all that done, but somewhere in all of that I would love to actually have some interaction with my patients other than "Good morning Mr or Mrs whoever, here are your meds" I've only worked LTC a very short time and consider myself very energetic and a fast learner, but I can't ever see doing all this work in a 8 hour day. So basically my concern is you get in trouble if you fudge your paperwork and you get in trouble if your honest and say you did not have time. So far I have just not been signing things if I didn't do it, but it wasn't because I'm lazy, it's because I have no time. And of course you get in trouble if you work overtime. How can you win? I don't think LTC is for me. Like I've said before if I get old shoot me before you put me in a nursing home, please!!!!

Signs of a severly understaffed LTC, for example:

1. Nurses dont have any breaks, lunch or regular 10 minute breaks.

2. Things that suppose to be done, are not done..(Dont want to go into detail about this but nurses in understaffed LTC should know what I am talking about..

3. Feeling rushed most of the time

4. Not completing or finishing the work in an 8 hour day..Staying over time or just leaving things not done

If you experience any of this or all, it is understaffed and I suggest you find another job..The admins, and DON dont want to increase staffing..That is a shame when you are at a job like this..I believe even the best nurse withe the best intentions could not do well in an understaffed LTC if understaffing is a problem..

kiszi, RN · Jan 19, 2007

the ltc i work in is fairly well-staffed. the largest unit has 40 beds, and there are always 2 nurses with 3-4 cna's on days & evenings. i work the night shift, so i have all 40 beds. i almost always have 3 cna's, with the occasional exception that leaves me with 2, which happened the last few shifts d/t a flu outbreak. :lol2: it's not too bad, since there aren't a lot of treatments on nights, no meals, etc. i usually leave on time, or at the most 1/2 hour after my shift.

if a nurse calls off, and none of the prn or regular staff can come in, the supervisor works a floor, or the shift will be covered by the wound nurse, staff dev. nurse, or restorative nurse, depending on whose turn it is. we recently had our night supervisor "resign" (whole other story!!), and the 2nd shift super and some 1st shift nurses have been coming in to cover.

some nights i leave thinking i could have gotten more done, for instance the other night i left a huge pile of paperwork that needed filed. (night shift is responsible for all the filing.) but i just had to let it go and leave knowing the important stuff got done and that the paperwork would surely be waiting for me when i got back after a night off.

so my point is, well-staffed, or at least adequately staffed facilities do exist, but it may take some searching to find the right one. good luck!

k

____________________________________________________________

go indianapolis colts!

beat those patriots!

banditrn · Jan 19, 2007

The LTC I work in is fairly well-staffed. The largest unit has 40 beds, and there are always 2 nurses with 3-4 cna's on days & evenings. I work the night shift, so I have all 40 beds. I almost always have 3 cna's, with the occasional exception that leaves me with 2, which happened the last few shifts d/t a flu outbreak. It's not too bad, since there aren't a lot of treatments on nights, no meals, etc. I usually leave on time, or at the most 1/2 hour after my shift.
If a nurse calls off, and none of the prn or regular staff can come in, the supervisor works a floor, or the shift will be covered by the wound nurse, staff dev. nurse, or restorative nurse, depending on whose turn it is. We recently had our night supervisor "resign" (whole other story!!), and the 2nd shift super and some 1st shift nurses have been coming in to cover.
Some nights I leave thinking I could have gotten more done, for instance the other night I left a huge pile of paperwork that needed filed. (Night shift is responsible for all the filing.) But I just had to let it go and leave knowing the important stuff got done and that the paperwork would surely be waiting for me when I got back after a night off.
So my point is, well-staffed, or at least adequately staffed facilities do exist, but it may take some searching to find the right one. Good luck!
k
____________________________________________________________
Wow, that staffing sounds awesome!! The last place I worked had that many residents with only one CNA at nite.
The facility where I work now is larger - the unit where I work has 42 residents and at nite I have 2 CNA's, and sometimes I think I'm in hog-heaven! There are a couple of them that think I'm a LOL, and I have a hard time convincing them that I AM physically capable of doing some lifting and turning!:wink2:

freedom-fighterLPN · Jan 21, 2007

This is my first posting and I have to speak out or I will combust!!!

I have decided to quit my charge nurse position at a 134 bed LTC working 12 hr. weekend night shifts. I am "fresh fish" so to speak-- only graduating in May. I thought I could make a difference but have found myself attempting the impossible with the same problems mentioned in previous postings and all the while I have tried to hang on to my sanity?what sanity? ( maybe I am as buggy as a loo) as well as taking care of 30 pts. at a time-- 16 total care with the help of 2 cna's/

I have on one night 3 that are medicare/ 5 alz's.. 4 non total- pt.s that stay on the call light /2 peg feeders both with UTI's , 10 to 15 pt.s w tx's, 1 dementia Non MRSA's in geri chair housed with a dementia MRSA pt in wc-- meaning contact. (family wants to know why , I want to know why? we have 3 other empty beds and admin. doesn't seem to care) 6 c chronic eye infections and repeated eye infections!!, More crushed meds. than meds. repeated UTI's each one worse than the one before with 1 pt. that has had one for over 2 months, 4 hospice pt's. 3 pt's. that fall at least 2 to 4 times a week,one in wc flipped over twice in 1 week hanging by lapbelt ....changed lap belts but still no resolve--2 more flips, and to mention those training wheels ---an act of congress to get by facility--( we are told medicare say's they have a right to fall) another family doesn't want any restraints used despite knowing every night (granny crawls out or slides out of bed) only siderails x 2, lowered bed and mat on floor, but wants to know why they have received 3 calls that week of minor injuries? (sometimes the body alarms work and sometimes not..see previous act of congress)

Thank God only minor-- we have to report all out of bed incidents regardless of injuries--- I am weekend shift and have to look up the previous incident reports for I haven't a clue and indicating someone's lack to explain to the family or families inabilty to communicate to other family members. I certainly don't have a problem with thier interest in granny but what are we suppose to do when we can't be everywhere at once and no use of restraints or at times working body alarms ??

(State has been out twice in last year and we have more "incidences than our surrounding counterparts almost double but we still operate.!!")

.Lastly I have 3 on updrafts and of course the insulins and accuchecks etc.... not to foreget one IV pump only between two wings and when we needed a second we went to I think they called it an air flow that was put on a pt. that kept their arm curled resulting in horrible infiltration..

I thought it was infiltration but another night nurse ( 3 yrs.) said no it wasnt..Independent edema.. Well turned out horrible infiltration...We recently had meeting that our license is on the line and the 2 cna's on my hall that are overworked are my responsibilty ("what they do and don't do and what they know or don't know)" . remember that I have hardly any time to interact with my pt's, much less the cna's ... I feel like only a drug and pen pusher .. Always 1 to 2 hrs. after shift-- charting , medicare charting and the incident reports. Other nurses done before me that have been here longer and I wonder do they really perform the pt's 5 eye tx's scheduled at 3 to 5 min.intervals why on her night she is out in two?

not to mention the other time consuming tx.s and other applications that seem to be done..I mean done in less than 1 hour? I realized several things 1 being in order to avoid administration breathing down my neck, I have several options ..I have to deliver sub-standard care and/or fudge and say I did the care or have a nervous breakdown from a suspended state of the "ole" hamster in wheel trick. Or get the he#@ out and never look back. I cry continually over the lack of care that our pt's get and don't see it getting ANY better( esp. after reading these posts) and the ones that I work with that have been here a while have become hardened as well as I could expect them to in order to stay and SURVIVE. I would never consider sub standard care so I am bailing out with the thought of those ppl. and the horrendous care they receive forever singed in my memory. What on earth have we become? That the result of greed can reduce ppl. to nothing more than the inhumane care they receive? I CAN"T take it anymore!!!!

Simplepleasures · Jan 22, 2007

This is my first posting and I have to speak out or I will combust!!!
I have decided to quit my charge nurse position at a 134 bed LTC working 12 hr. weekend night shifts. I am "fresh fish" so to speak-- only graduating in May. I thought I could make a difference but have found myself attempting the impossible with the same problems mentioned in previous postings and all the while I have tried to hang on to my sanity?what sanity? ( maybe I am as buggy as a loo) as well as taking care of 30 pts. at a time-- 16 total care with the help of 2 cna's/
I have on one night 3 that are medicare/ 5 alz's.. 4 non total- pt.s that stay on the call light /2 peg feeders both with UTI's , 10 to 15 pt.s w tx's, 1 dementia Non MRSA's in geri chair housed with a dementia MRSA pt in wc-- meaning contact. (family wants to know why , I want to know why? we have 3 other empty beds and admin. doesn't seem to care) 6 c chronic eye infections and repeated eye infections!!, More crushed meds. than meds. repeated UTI's each one worse than the one before with 1 pt. that has had one for over 2 months, 4 hospice pt's. 3 pt's. that fall at least 2 to 4 times a week,one in wc flipped over twice in 1 week hanging by lapbelt ....changed lap belts but still no resolve--2 more flips, and to mention those training wheels ---an act of congress to get by facility--( we are told medicare say's they have a right to fall) another family doesn't want any restraints used despite knowing every night (granny crawls out or slides out of bed) only siderails x 2, lowered bed and mat on floor, but wants to know why they have received 3 calls that week of minor injuries? (sometimes the body alarms work and sometimes not..see previous act of congress)
Thank God only minor-- we have to report all out of bed incidents regardless of injuries--- I am weekend shift and have to look up the previous incident reports for I haven't a clue and indicating someone's lack to explain to the family or families inabilty to communicate to other family members. I certainly don't have a problem with thier interest in granny but what are we suppose to do when we can't be everywhere at once and no use of restraints or at times working body alarms ??
(State has been out twice in last year and we have more "incidences than our surrounding counterparts almost double but we still operate.!!")
.Lastly I have 3 on updrafts and of course the insulins and accuchecks etc.... not to foreget one IV pump only between two wings and when we needed a second we went to I think they called it an air flow that was put on a pt. that kept their arm curled resulting in horrible infiltration..
I thought it was infiltration but another night nurse ( 3 yrs.) said no it wasnt..Independent edema.. Well turned out horrible infiltration...We recently had meeting that our license is on the line and the 2 cna's on my hall that are overworked are my responsibilty ("what they do and don't do and what they know or don't know)" . remember that I have hardly any time to interact with my pt's, much less the cna's ... I feel like only a drug and pen pusher .. Always 1 to 2 hrs. after shift-- charting , medicare charting and the incident reports. Other nurses done before me that have been here longer and I wonder do they really perform the pt's 5 eye tx's scheduled at 3 to 5 min.intervals why on her night she is out in two?
not to mention the other time consuming tx.s and other applications that seem to be done..I mean done in less than 1 hour? I realized several things 1 being in order to avoid administration breathing down my neck, I have several options ..I have to deliver sub-standard care and/or fudge and say I did the care or have a nervous breakdown from a suspended state of the "ole" hamster in wheel trick. Or get the he#@ out and never look back. I cry continually over the lack of care that our pt's get and don't see it getting ANY better( esp. after reading these posts) and the ones that I work with that have been here a while have become hardened as well as I could expect them to in order to stay and SURVIVE. I would never consider sub standard care so I am bailing out with the thought of those ppl. and the horrendous care they receive forever singed in my memory. What on earth have we become? That the result of greed can reduce ppl. to nothing more than the inhumane care they receive? I CAN"T take it anymore!!!!

Yup, been there done that. SO SO VERY SAD. :crying2:

caring angel · Jan 22, 2007

Hi,

Understaffing is really critical in this area. Just never seem to have enough hours to get everything done. Most of the LTC here are skilled-Medicare

facilities and really very busy. It is like doing hospital nursing care in a nursing home. Our most critical staffing is not having enough CNA's to care for the patients. For 60 patients in the building, we had 4 CNA's, 2 to a wing. That was hectic!

withasmilelpn · Jan 22, 2007

This is my first posting and I have to speak out or I will combust!!!
I have decided to quit my charge nurse position at a 134 bed LTC working 12 hr. weekend night shifts. I am "fresh fish" so to speak-- only graduating in May. I thought I could make a difference but have found myself attempting the impossible with the same problems mentioned in previous postings and all the while I have tried to hang on to my sanity?what sanity? ( maybe I am as buggy as a loo) as well as taking care of 30 pts. at a time-- 16 total care with the help of 2 cna's/
I have on one night 3 that are medicare/ 5 alz's.. 4 non total- pt.s that stay on the call light /2 peg feeders both with UTI's , 10 to 15 pt.s w tx's, 1 dementia Non MRSA's in geri chair housed with a dementia MRSA pt in wc-- meaning contact. (family wants to know why , I want to know why? we have 3 other empty beds and admin. doesn't seem to care) 6 c chronic eye infections and repeated eye infections!!, More crushed meds. than meds. repeated UTI's each one worse than the one before with 1 pt. that has had one for over 2 months, 4 hospice pt's. 3 pt's. that fall at least 2 to 4 times a week,one in wc flipped over twice in 1 week hanging by lapbelt ....changed lap belts but still no resolve--2 more flips, and to mention those training wheels ---an act of congress to get by facility--( we are told medicare say's they have a right to fall) another family doesn't want any restraints used despite knowing every night (granny crawls out or slides out of bed) only siderails x 2, lowered bed and mat on floor, but wants to know why they have received 3 calls that week of minor injuries? (sometimes the body alarms work and sometimes not..see previous act of congress)
Thank God only minor-- we have to report all out of bed incidents regardless of injuries--- I am weekend shift and have to look up the previous incident reports for I haven't a clue and indicating someone's lack to explain to the family or families inabilty to communicate to other family members. I certainly don't have a problem with thier interest in granny but what are we suppose to do when we can't be everywhere at once and no use of restraints or at times working body alarms ??
(State has been out twice in last year and we have more "incidences than our surrounding counterparts almost double but we still operate.!!")
.Lastly I have 3 on updrafts and of course the insulins and accuchecks etc.... not to foreget one IV pump only between two wings and when we needed a second we went to I think they called it an air flow that was put on a pt. that kept their arm curled resulting in horrible infiltration..
I thought it was infiltration but another night nurse ( 3 yrs.) said no it wasnt..Independent edema.. Well turned out horrible infiltration...We recently had meeting that our license is on the line and the 2 cna's on my hall that are overworked are my responsibilty ("what they do and don't do and what they know or don't know)" . remember that I have hardly any time to interact with my pt's, much less the cna's ... I feel like only a drug and pen pusher .. Always 1 to 2 hrs. after shift-- charting , medicare charting and the incident reports. Other nurses done before me that have been here longer and I wonder do they really perform the pt's 5 eye tx's scheduled at 3 to 5 min.intervals why on her night she is out in two?
not to mention the other time consuming tx.s and other applications that seem to be done..I mean done in less than 1 hour? I realized several things 1 being in order to avoid administration breathing down my neck, I have several options ..I have to deliver sub-standard care and/or fudge and say I did the care or have a nervous breakdown from a suspended state of the "ole" hamster in wheel trick. Or get the he#@ out and never look back. I cry continually over the lack of care that our pt's get and don't see it getting ANY better( esp. after reading these posts) and the ones that I work with that have been here a while have become hardened as well as I could expect them to in order to stay and SURVIVE. I would never consider sub standard care so I am bailing out with the thought of those ppl. and the horrendous care they receive forever singed in my memory. What on earth have we become? That the result of greed can reduce ppl. to nothing more than the inhumane care they receive? I CAN"T take it anymore!!!!

It is very frustrating! When you have that kind of mixed acuity and little support CNA staffing wise, it can be next to impossible. I've said before that in the beginning I bought the "time management skills" line when I was too new to know any better. Now I know better! Good luck to you!

sasha1224 · Jan 22, 2007

I have a different take on this. What would you say if I had to take care of a minimum of 25 infants as a nurse with the help of several CNAs? Would this bother you? Am I saying that the elderly are infants? No, but unfortunantly, many elderly require the same level of care as an infant(feeds, turns, diaper changes). So why is it okay for the infants to have a very low ratio for this type of care but the elderly are not? Do the infants generate more money? I don't know. From a care standpoint, I have worked both LTC and NICU stepdown. These are my observations. When I worked NICU stepdown, I had maybe 3 babies by myself, or 4-6 with an LPN or CNA. When I worked LTC as a supervisor, I had 25 patients of my own with CNA for about every 10 patients(some total care, tube feeds, confused) and was responsible for the rest of the facility(about 200 beds). I guess I am curious why a certain type of population seems more valued than another. Stopping here!

withasmilelpn · Jan 22, 2007

I have a different take on this. What would you say if I had to take care of a minimum of 25 infants as a nurse with the help of several CNAs? Would this bother you? Am I saying that the elderly are infants? No, but unfortunantly, many elderly require the same level of care as an infant(feeds, turns, diaper changes). So why is it okay for the infants to have a very low ratio for this type of care but the elderly are not? Do the infants generate more money? I don't know. From a care standpoint, I have worked both LTC and NICU stepdown. These are my observations. When I worked NICU stepdown, I had maybe 3 babies by myself, or 4-6 with an LPN or CNA. When I worked LTC as a supervisor, I had 25 patients of my own with CNA for about every 10 patients(some total care, tube feeds, confused) and was responsible for the rest of the facility(about 200 beds). I guess I am curious why a certain type of population seems more valued than another. Stopping here!

I"ve always thought the same. Even daycares are staffed better by law. And Preschools too. When my child started this year, the teachers stated that they would not be sending home progress notes every day, because then they would be writing all day and not actually doing anything with the kids. Does anybody see any parallels to nurses' difficulty completing all of our paperwork and taking care of patients too? :uhoh3: