ethical issues or just a case of being new cna (and a nursing student)???

[soon2brnangel]

I have been a CNA for 8 years and practiced collectively for 3, but have been in the public health arena for most of that 8. My cna experience has been limited to medical offices and assisted living, until recently. I am returning to school to become an RN and working at a facility that has multiple types of patients that change fairly often (LTC, Restorative, Rehab, Post-Surgical). I chose this facility to work at because of its rating and impression from with working with them in a public health role. I just finished orientation and now being regularly assigned. From what I have researched NC does not have a patient/cna ratio (if they do please let me know). My past two shifts have been quite challenging; not due to patient needs but the staff/patient ratio. I work 2nd shift. When we have normal on coming shift duties (ice pass, obtaining vitals, and anywhere from 4-5 baths on this particular unit--could be 6-8 depending on unit). There are approximately 30 clients and 2 cna's. Most of them are bed pan/toilet continent and just need supervision but due to their size are 2 person assist/transfers, with 3 total lifts and the majority are in wheelchairs but have locomotion. A cna from each hallway is assigned to the dining for assistance or feeding. The other is to stay on the hall to get call lights, get patients to bathroom, pass trays, and feed/supervise those who don't utilize the dining room. All clients are highly encouraged to get out of their rooms, as part of their therapy, and go to dining, they are not "required" due to patient "right to refuse." Many of them never go to dining. During meal times patient ratio or this hall can be as high as 1:18. With 2 cna's we cannot get it ALL done. Patient lights and emergency lights take priority over ice/vitals/bathing/. I morally and ethically have issues with: leaving patients in the bathroom 10-15 minutes waiting on assistance to get up/wipe or sitting in their excrement for lengthy periods; not getting a bath on their bath day, being so busy that vitals that are supposed to be done by 6pm aren't completed until 10pm; not getting required evening snack passed; and not getting other shift duties completed. This increases risk of falls and other negligence issues and could potentially hinder my nursing career if I stay. If that was one of my family members I would feel like they weren't getting the care and time they deserved. Staff who have been there a while hate working this hallway because you never get a break, constantly running, and not getting out until 11:30 or 12. The point is to get them better so they can go home not to let them regress.

I know how to contact my local ombudsmen and am going to report it but after all that rant I just want to know the opinion of more experienced folks if this is truly an issue that is worth the fight (in administration) and that anything can be done. My heart gets so heavy and angry when I am working on that unit. I strive to do my best but the needs are so great I feel inadequate. Any thoughts or advice is greatly appreciated.

[nclady31]

This may have changed over the past few years, but there is not a true staff/patient ratio per shift. It is the number of staff over 24 hours per patients. So even if days has a few extra staff and evenings are short 2, nights are normal, the facility is within the correct ratio. I don't remember the exact staff: patient but it is very high and as short staff as I have worked, it has not been close to being below what the state requires. In a skilled nursing facility, which is what sounds like where you may be, evening shift ideally had 1 CNA per 10-12 patients.