Culture shock: staffing ratios, medication passes and teamwork

[pinkiepieRN]

Hi there! I just started working on a rehab/ltc unit at a SNF. Staffing is usually 2 nurses & 3 CNAs for day shift. Right now, the floor is split between two nurses and I've been handling 16 patients with my preceptor. I'm pretty sure I can do meds/treatments within the +/- 1 hour rule for medications, but I have no idea how I'd handle it if a nurse called out sick. I'd like to assume that there's enough staffing for them to pull someone, call someone in, or have a shift supervisor pick up patients, but I also know to expect and prepare for the worst, just in case. Can anyone tell me what kind of staffing you have and how call-outs are handled as far as adjusting the staffing?

I know I'm in for a culture shock, as I come from an inpatient psych background with 6-8 patients to do meds/treatments for, and although they were sometimes reluctant to accept meds, they were all "walky-talky" otherwise. Here, I'm realizing that more than half of my assignment takes their meds crushed and needs the meds "fed" to them. Even the alert/oriented ones are sometimes finicky about taking their meds. I know it will take the patients a while to get to know and trust me, but I'm worried that that will take way longer than I'd initially hoped. Thank goodness the CNAs have been really helpful, but I know I won't always be able to wait for a CNA to help if they're busy doing something else.

I'm also worried about working "independently". As a psych nurse, I was used to working as a "team" and sharing patients with the rest of the staff nurses. Here, it's half the hall belongs to me and the other half to the other nurse. Obviously if there's an emergency, I assume the other nurse would be able to help me out, but again, I just keep thinking "what if"s.

I'm a FT 7-3 nurse, btw.

[CapeCodMermaid, RN]

On my short term unit....46 beds--about 3/4 are really short term....I have 2 med/treatment nurses, a desk nurse, a nurse manager and 5 or 6 CNAs on day shift. If there is a call out, the desk nurse takes the cart. I have a wound team and they will help do complicated dressing changes.

Long term 46 bed unit....2 med/treatment nurses, desk nurse, nurse manager, 6 CNAs. If there is a call out, the desk nurse takes the cart.

[amoLucia]

To CCM - I have to say that you staff pretty well for your census, esp for a desk nurse AND manger (and wound team avail). Better than the facilities that I've been in. Because of your good staffing, I'd like to venture that your surveys probably result in good reports. Having read many of your other posts, you've worked for that goal, so kudos to you.

To dolce - it looks like you have a realistic understanding of your current work environment and that's usually half the battle when making changes. You're NOT starry-eyed! And you've got some solid experience that should help you along. In LTC, when it works, the staff are terrific. The fundamentals of nsg care are the same wherever ... it's the paperwork and individual P&P that vary. And that's the same even for us weathered ones. Don't get worked up by the 'what ifs'. Good luck!