I worked in one of those new "Victorian" beautiful buildings in assisted living for almost two years . At first I loved my job and couldn't believe I got paid for doing something I loved so much-well got over that real fast-lol. What I love about assisted living is that the nurse can focus on total health, the whole person, psychosocial, physical, pain, quality of life, etc.
We had on RN per shift- sounds to me what you may experience. The residident co-ordinators gave all meds except coumadin, insulin, B-12s, and narcotics. They were the aids, and were trained sometimes less than a week. The premise is that these people are stable and able to live somewhat without constant supervision. (not true at least 25% of the time.) Also, each resident had their own mini apartment with bathroom, kitchenette etc. Alot of holes in the system. If they didn't subscribe to the breakfast plan- they went hungry until noon. I even made breakfast for some of my diabetics that I knew were cognitively incapable of getting their own. But it was not on the care plan or anything. I don't know what happened when I wasn't there, even if I put it on the care plan or asked for a care plan meeting. If I questioned this eyes were rolled or attempts at assuring me that the aids gave Mrs. Green breakfast were given, even though I never saw evidence of that! I worked part time and was "over ruled " on most suggestions of care by the nurse who wasn't in charge but really was!
The aid shortage extended here , and our census kept rising to over 80 residents (behind apartment doors) and the aids kept dwindling. I was afraid to go in after a while for fear that there would be no aids. Most were working "guilt" overtime, and some were in there late 50's and 60's, and were just plain tired, and I don't blame them, they were tired and useless, and mad as hell. Just a warm body for the state requirements. One RN and eighty residents, who pay up to $2400 month for a married couple, is ridiculous. You need to know who is sick, go assess them , call the MD, get new orders or send them out, paperwork, check up on others who are back from the hospital , deliver new meds, give instructions, help the aids, activities, provide emotional support (hopefully) and is a big part because many of the people have little or no family and are lonely and scared and suffer from diminishing capabilities. Many have dementia and should be in other facilities, but the families desire that they stay there because it is their home. One woman was found at the end of the country road by other resident families more than once. Terminal care ( without IVs) is common because the resident wishes to die in their own bed. I have fed, toileted, consoled, turned, medicated, and sat with residents that, by law do not need constant care, but do. An aware family will hire an aid to be with them , which would help, but I didn't count on it. This is in addition to keeping an eye on the entire building as the RN is in charge, knowing what is going on with the other residents, who in the winter suffer from respiratory ailments etc etc etc. Wound care is provided also, usually in conjunction with home health two or three times a week. At the same time I had to take phone calls from family members and doctors, PT, the pharmacy etc. The phone rang constantly. If someone was going downhill they required alot of attention, and with eighty residents, there were usually three or four.
I did like the autonomy but the staff shortage finally did me in. They became vicious and mean, unpleasant, untrained, and usually not present. I was forced to work double shifts if the oncoming nurse called off, or the no one could be scheduled.
The staffing was unsafe, and the atmosphere dangerous. My health suffered and I had to quit. I even considered legal action against the administrator. She pit the employees against each other, and that is only the beginning; I won't elaborate there. I miss the residents greatly, and believe I have found my niche: just be careful what type of company you work for. I can't believe all companies are this bad, but remember, profit is the bottom line; that is okay, that is how the system works. But if you are working yourself to the bone to be an advocate within your own facility all the time, something is wrong.
Good luck, I hope this helps. Contact me if you want further information.