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Discussion

Corporate took over my facility...

I would like to know how other places operate.

I work in Palm Beach county. Currently a CNA that has been promoted to unit clerk for two wings in a SNF. We have 26 acute care patients on North side and 36 LTC/acute care on South. They cleaned house after they made some semi-private rooms into private rooms to compete more with other facilities in our area. Positions were eliminated such as, Risk manager, wound care nurse, restorative aide. They are looking to become a LTC faculty. But currently have been taking on acute care patients after all the cuts we are now 2 nurses with 5 cnas on 36 patients. (When before we were 43 on south with 6-7 CNAs and 3 nurses. North was 28 patients with 2 nurses and 4-5 CNAs.) Cnas are now doing restorative care and nurses now doing own treatments. When there's a call off I'm put on the floor to work an assignment as CNA. With 26 patients on North there's 2 nurses and 3 cnas. This is day shift. Night shift 11-7 there's only one nurse on each hall with 2 or 3 CNAs. We have have 1 supervisor on each side but they are always in meetings not really on the units. They told us last week that nurse to patient ratio is 40:1 and CNA is 20:1. Wondering if that's correct. We have a rehabilitation in house and all acute care patients and some LTC pts are expected to go usually 2x per day. Be up and ready by certain times. I couldn't imagine having 20 patients in a LTC/SNF facility when pts need to be ready for rehab and breakfast/Lunch dining room duties and getting weights etc.

I was wanting to know how is it in other facilties? This is the only place I've worked since becoming CNA in 2009. Ever since they've taken over there has been a lot of changes and almost every staff member is stressed out with added jobs on their plates. I'm starting school in October looking forward to further my career in health care. Does it get better then this?

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    Do you mean sub-acute? When you say acute care, I'm thinking hospital/ med-surg unit. Staffing for acute care is different than sub acute snf, skilled care or LTC. The regulations are very different too.

    If they are truly acute care/ hospital patients...that staffing ratio is insane and you need to check with your state to see if it is even legal.

    In LTC/ skilled or sub-acute, the ratios you gave are pretty much the norm.

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    That actually sounds like great staffing for a long term care facility.

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    • Author

    Okay. With all the changes that were made everyone is trying to adjust. Yes sub-acute care. Wanted to check what the normal was with other people's staffing.

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    I used to be a CNA for a hybrid LTC/skilled rehab facility. We had 2 wings, 32 beds each, and usually staffed 1 RN/LPN and 2 CNAs per wing. There was also 1 med tech per unit on day shift. Night shift it wasn't uncommon to be the only CNA on a wing.

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    • Expert

    Moved to the LTC forum for more replies.

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    Night shift will have to help get people up and dressed, ready for Rehab/PT/OT.

    I don't know if it gets better but good luck.

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    • Guides

    Wow. Those ratios are insane. In my state, the CNA-to-resident ratio is 1:7 on days, 1:9.5 on evenings, and 1:15 on nights. Nurses, however, can have up to 35 on days and as many as 60 at night, and there's no state mandate...in one LTC I worked at back in the '90s, I was responsible for 90 residents. I had seven CNAs and a med aide for all 90 which included up to a dozen skilled patients. Of course, the acuity level wasn't as high as it is now, and we didn't have as many behavioral issues back then; most with severe cognitive and behavior problems were sent to facilities with higher security, and those with hospital-level care needs weren't discharged until they were fit to go to rehab.

    Nowadays I would be terrified to care for that many residents; in fact, I don't think decent care could be given under the conditions nurses and aides must work with now. I'm sorry the OP has to deal with those circumstances.

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    When I was doing agency a few years ago (extra money) I was the only nurse for 48 residents with 2 STNAs (there was a 3rd STNA in the building so they were allowed to count her to be legal.) I felt totally unsafe, no resident wore a name band, if anyone had gotten into another resident's bed I never would have known. But I just did the best I could...... I feel an experienced nurse could handle 32 residents if necessary, but 24 would be much safer/better with 2-3 STNAs.

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    I have worked LTC for a few years, first as a CNA and then as nurse. These ratios seem pretty normal to me.

    Some things may need to be adjusted. Many places do 1/2 of the baths in the morning and 1/2 in the evening. They get baths twice a week. The night nurse does all the 0600 meds and blood glucose tests. Each shift is that way, The nurse going off does the meds for the ones scheduled at that time.

    I work agency also and have been responsible for anywhere between 19 to 35 as the nurse and 1-2 CNAs. We have a lot of smaller facilities where I live. Many of the facilities will have 1 nurse and 4 CNAs on days, 1 nurse and 3 CNAs on evenings and 1 nurse with 1 or 2 CNAs on nights, usually only 1.

    As a CNA, I worked in a facility where it would be 1 nurse to 45 or so. They usually had a med aid on days.

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    Staffing rates as mentioned here may seem average. I found in recent years that CNA's, STNA's, or Nursing Asst's would get assignments until 30" into shift one is pulled without communication.

    You mentioned Unit Secretary pulled frequently and Restorative, Risk Mgmt, and other Resident Care functions cut.

    All these factors lead to burnout and reduced work-life balance.

    The best way of furthering education may be a Master's Degree to be successful and satisfied by your career. Best wishes with a suitable study track in your future!

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