CNA/Patient Ratio Laws

pickledpepperRN · May 5, 2004

We have an HPPD (hours per patient day0 system in the law for long term care such as SNFs.

They count the RN DON who does ZERO care as well as the clerk.

I gave my two week notice my first week as a CNA in a nursing home. We had 12 to 15 patients to bath, feed, and groom. Linen was locked up and the "Highly educated LVN" would allow is 6 sheets for 12 incontinent patients. She would not give PRN medication to patients in pain.

The RN on the weekends had us sit everyone on a towel in a wheelchair all day. She medicated the residents so they slept all day. At 2:00 we would clean everyone, put them back to bed, and mop under the wheelchairs where the urine dripped off. PMs would find clean patients in bed. Nights had patients awake all night because they slept all day.

I am told it is nearly as bad now.

The public needs to be aware and write, e-mail, and telephone elected officials to increase staffing.

mandykal, ADN, RN · May 8, 2004

DRAMA! I feel you

chris_at_lucas_RN, RN · May 8, 2004

Spacenurse, that needs to be reported to whatever your state calls the Department of Human Services or Aged, Blind and Disabled.

These people are being neglected, and they are the "vulnerable" that the law protects.

DO IT! PLEASE!

pickledpepperRN · May 20, 2004

Spacenurse, that needs to be reported to whatever your state calls the Department of Human Services or Aged, Blind and Disabled.
These people are being neglected, and they are the "vulnerable" that the law protects.
DO IT! PLEASE!

Well it was many years ago.

I DID report it and many other horrors about that place to the state DHS.

kathy_79 · May 28, 2004

at illinois to my knowledge is allowed 4-5 pts per 1 cna,

in real world it's not real.

i worked at ltc for 3 years and finally i escaped from there, oh God i am so glad.

first place was nice and pts ratio was ok (12/1), but we always help each other so that is why it was not so heavy, staff was ok, i liked it there.

second place, God bless who is send there,

no cooperation, no help, most of cna just was coming there for "private party", pts left unattended, unchanged, undressed, cnas go smoke, talki, coffe, etc... i swear God i never go back again there and never send anyone there,

i work hard no matter what job i do, but this place was just horrible, even don could not control it, so you can imagene how was it. i got 15 pts if i was lucky, if not 24-30, i worked my a... for other lazy rats, i just could not stand it. believe me, i have never seen place like that before and i hope i won't,

i cannot understand why some of cna do those inpropriate things, pts are human beings like anyone like we are and respect and dignity are our priority to others,

i am nursing student now, but i am still working as cna this time at hospital, much better,

wish you the best, :)

VickyRN, MSN, DNP, RN · Jun 4, 2004

is there a cna/pt ratio law in your state? to my knowledge, there is not one here in nc. i'm currently in nursing school, and have opted not to get my cna certification back due to poor work conditions. i got burned out! i was working in a nursing home, where we would end up with two aides on the night shift, with almost 50 patients, most of whom were alzheimer's or total care. we would start out with three, but management would send home someone (fire them) without telling us we were now short staffed. it wasn't fair to us and employees, and definitly was not fair to the patients! we physically weren't able to care for them all, turn, change, etc. i quit before something happened to a patient that was somehow related to poor care. i feel horrible for the way things went there, and i am ashamed to say i even worked there and put up with the crap for as long as i did. we were written up for not taking supper breaks (we didn't have time between the two of us), so we'd clock out and go back on the floor, then clock back in after 30 minutes. this is one of my reasons for even choosing nursing school, was to somehow try and help change the poor conditions i have seen. back to the original question, is the a law where you live? how do you feel about it?

report the situation to the ncbon (specifically to donna mooney) and the department of facility services asap.

donna mooney: http://www.ncbon.com/disc-guidelines.asp (don't report the staff nurses or cna's--just report it as an unsafe staffing situation.)

dfs: jeff horton 919-733-7461 [email protected]

here are some excellent links about reporting problem nursing homes:

http://nursinghomeaction.org/public/50_156_450.cfm

http://nursinghomeaction.org/public/50_155_433.cfm

many nc longterm care nursing facilities are understaffed to the point of endangering the health of patients. when i worked icu, i saw some pitiful cases come in from nursing homes--severe dehydration, bed sores, etc.

the problem is not with the staff who work in these nursing homes, it is with the staffing ratios which are set by the nc state legislature ("minimum staffing" ratios). a good link: http://www.nccnhr.org/uploads/nhstatestaffingtables.pdf go to page 18.

these are the current nc nursing home staffing standards:

licensed staff (rn, lpn/lvn)

1 don rn full time included in

for 1-59 occupancy: don may be charge nurse

1 rn 8 consecutive hrs 7d/wk included in

1 rn/lpn 24 hours/7d/wk

total 2.1 hprd [hours per resident per day]

[note: the minimum level for safe care should be at least a total of 4.1 hours of direct care per resident per day... see this important link: http://www.nccnhr.org/govpolicy/246_1275_7800.cfm

nurse assistant staff (na/cna)

no minimum requirement in this category

direct care staff

2.1 hprd including licensed staff but exclude don if

over 60 beds and exclude administrators, clerks,

and nurse educators. for multi-storied facilities, 1

direct care staff on duty every floor 24 hrs/7days/wk.

the nursing staff are (most of the time) caring individuals who are doing the best that they can under impossible circumstances (such as what you described--horrendous and common). the facility will only do what is minimally required and unfortunately, these "minimal" values were legislated back in the 90's at a time when nursing homes housed residents who were not as sick and feeble as the typical population is today. new legislation was introduced in the nc legislature recently (within the past 3 years) to improve the staffing ratios, but unfortunately (for our vulnerable elders), this legislation failred to pass.

in some nursing homes, having dysphagia is a death sentence, because there is not enough staff to feed and hydrate properly--so the patient will die of dehydration or aspiration pneumonia from either not being fed or watered at all or being fed too rapidly.

yes, i agree, the staffing ratios in most nc longterm care facilities are a shame and a disgrace.

petaybee · Aug 15, 2004

I work in a nursing home in Utah and I feel that the CNA to resident ratio is horrible. There are 2 aides on the floor I work and currently 28 residents. We usually try to share the work, but the CNA I'm usually teamed up with spends most of his time on the phone, out smoking or finding other ways to avoid actually working. So I end up doing most of the work for all 28 residents. Very exhausting and frustrating! We have a good majority of these residents that can't stand without assistance, can't do anything to help care for themselves and are incontintent. This makes the job even harder, though I don't mind doing these things, I just need more help in order to get everything done that needs to be done. We usually have about 6 showers to do during the morning shift and about an hour to complete them in. We get written up if we don't take our lunch break and get in trouble if we don't complete our showers. I always feel as though I'm letting the residents down when it comes to caring for them properly. There's always things that get missed because we just don't have the time to do it all. I try to always keep my residents in clean briefs and safe, those are the two most important things we can do, but there are so many others.

I greatly feel that there needs to be a requirment for the CNA/resident ratio. I dream of the day I only have 10 residents to care for.

CHATSDALE · Aug 15, 2004

I work in a nursing home in Utah and I feel that the CNA to resident ratio is horrible. There are 2 aides on the floor I work and currently 28 residents. We usually try to share the work, but the CNA I'm usually teamed up with spends most of his time on the phone, out smoking or finding other ways to avoid actually working. So I end up doing most of the work for all 28 residents. Very exhausting and frustrating! We have a good majority of these residents that can't stand without assistance, can't do anything to help care for themselves and are incontintent. This makes the job even harder, though I don't mind doing these things, I just need more help in order to get everything done that needs to be done. We usually have about 6 showers to do during the morning shift and about an hour to complete them in. We get written up if we don't take our lunch break and get in trouble if we don't complete our showers. I always feel as though I'm letting the residents down when it comes to caring for them properly. There's always things that get missed because we just don't have the time to do it all. I try to always keep my residents in clean briefs and safe, those are the two most important things we can do, but there are so many others.
I greatly feel that there needs to be a requirment for the CNA/resident ratio. I dream of the day I only have 10 residents to care for.

I HAVE WORKED WITH THE TYPE OF NURSE WHO WOULD LEAVE YOU WITH MORE THAN YOUR SHARE OR DIVIDE UP THE PATIENTS AND LEAVE YOU WITH THE BEDBOUND AND TAKE THE AMBULATORY (GO TAKE A SHOWER, MR SMITH) SOMETIMES YOU JUST HAVE TO STAND UP AND RAISE A LITTLE HELLE THEY WILL BACK DOWN OR IF THEY GO TO DON WHAT ARE THEY GOING TO SAY I DIDN'T FEEL LIKE WORKING????

wonderbee, BSN, RN · Aug 15, 2004

Spare me oh Lord and any of my kin from ever being a resident in a LTC facility with those kinds of stats.

LorraineCNA · Aug 16, 2004

just direct care hours which I believe vary by state. As someone else stated, they count in personnel who don't actually do any direct care. Which is why I'm no longer working as a CNA. The staffing is horrid and terribly unsafe.

Lorraine

denise53 · Aug 16, 2004

Hello,

I was in your shoes. As an CNA I had worked all 3 shifts at one time or another. In the daytime, when the Big Dogs were there, you had more than enough people. The night shift was the same as yours, 2 CNA's to 50 people. Now to get away with that, they would count the LPN's as a CNA if needed. It was so bad. Lights going off all at the same time. If there was a real emergency then we were really up a creek. I had one night when we had to also take care of any problems with assisted living people on the other end of the building. We got a call, Mrs.X's husband called to say she had died. I ran over there to find a confused Husband, He could not tell me where she was in the apt. I found her sitting in her chair, checked her pulse and she looked up at me saying "Thank you for stopping by" Tears of laughter and relief rolled down my cheeks. :)

I love school, and want to make a difference when I get out.

Take care.

Is there a CNA/Pt ratio law in your state? To my knowledge, there is not one here in NC. I'm currently in nursing school, and have opted not to get my CNA certification back due to poor work conditions. I got burned out! I was working in a nursing home, where we would end up with two aides on the night shift, with almost 50 patients, most of whom were alzheimer's or total care. We would start out with three, but management would send home someone (fire them) without telling us we were now short staffed. It wasn't fair to us and employees, and definitly was not fair to the patients! We physically weren't able to care for them all, turn, change, etc. I quit before something happened to a patient that was somehow related to poor care. I feel horrible for the way things went there, and I am ashamed to say I even worked there and put up with the crap for as long as I did. We were written up for not taking supper breaks (we didn't have time between the two of us), so we'd clock out and go back on the floor, then clock back in after 30 minutes. This is one of my reasons for even choosing nursing school, was to somehow try and help change the poor conditions I have seen. Back to the original question, is the a law where you live? How do you feel about it?