Need opinions please? I work in an assisted living caring for 42 patients. 6 diabetics. 5 total cares. Home health involved so also doing wound vacs. Wound care 5 days a week. 2 RCA for 42 residents. All admissions. All patient hospital transfers. Nurses are responsible for 11 direct care patients, including all medical records for all 11 patients ie: chart thinning, all health assessments, all physician orders. All weights and vitals. Now are DON has informed that he cannot do his job and also complete insurance authorizations, so another tasks is added to nurses. I have been a nurse 22 years so I am no means short on time management, prioritizing. Also, just to add to the chaos. Our Executive director has zero medical background and also feels that we must cater to every whim of residents and their families. We are to drop all our tasks if a patient's family wants 20 min or 1 hour of our time. Total counter productive. So now to the issue. Med pass starts immediate after report takes from 3pm to 6 pm to complete.( every nurse that works these carts that is the timeline.) 6 to 7 pm is sending meds back or catch up because we had to drop what we are doing to cater to every need of families no matter how inconsequential. 7pm to 9:30 pm is second med pass. 9:30 to 10 pm is wound care sometimes longer 10:15pm. Oncoming replacement nurse comes in @ 10:30 pm. So now when do I chart? Take off orders. Complete daily medical records duties. And now they want us to take over insurance authorizations. My DON has pretty much outright stated. There will be a lot of punching out @ shift end and staying 3 to 4 hours over each day we work to complete all administrative duties. No staff backup plan in building for call offs. Vacations etc... Just enough nurses RCA's to cover each shift. No prn pool. No agency. I was told I cannot cut my hours to 32 because there is no one to replace me. But DON just let day shift nurse cut her hours to 32. Oh yes, I almost forgot, as you can see no lunch breaks for any nurse. But we must write down we took 30 minutes. If I write no lunch I am disciplined. This is absolute humanly impossible to complete in 8 hours. Everything administrative is months behind etc.... and all that keeps happening are write ups and revolving door of nurses because our Exec director cannot see that expecting your nurses to care for 42 residents and approx. 4 hours of administrative duties daily is not possible to complete in 8 hours period. Oh and also we are not allowed to inform families of severe shortage of staff. If there is one RCA for 42. Same workload expected as if there were 4 RCA's. I forgot to mention, there is absolutely not even 5 minutes allotted for falls, which on average there are 3 to 4 a night due to severe understaffing. We have to take our walkies in to bathroom and must answer even if we are indisposed in the bathroom. You must get up from lunch for every call. We are not allowed to refuse any call to eat.
