Am I just being a big baby?

[mamarhonda]

Ok, I am an RN in a LTC facility and have worked there for 6 months (first job as an RN.) I am responsible for 27 residents of my own. I have gotten a pretty good routine down and have learned how to manage my time well. This is not my issue. Our facility has a total of 74 residents that means there are 23 residents and 24 residents on the other "halls." When I first started I had 3 aides for my hall on the 2-10pm shift well about a month and a half into it they reduced me to 2 aides only and put the 3rd on the hall with 23 residents. Management was saying my hall is way too easy. Fast forward to now I have the most residents in my hall and still only have 2 aides. The other two halls are scheduled 3 aides everyday. My hall has become very heavy as far as care from the aides while we have alot of independent residents they still are requiring a ton of care. I have begged and pleaded to get a 3rd aid with nothing more than "we have discussed it at meetings" as a response. I am at a loss, I don't know what to do, my aides are threatening to leave (and they are wonderful aides) but it has become too much for them. For example we got a new resident today she is a 2 person hoyer lift that means when she is to get out of bed both my aides need to be in the room and I have no one on the floor, how is this safe!?!?! My aides have 13 and 14 residents a piece while the other halls have 7-8 a piece. It's really frustrating to see them sitting in the nurses station while I watch my aides run their butts off. I have tried to give the two other halls 2-3 people but that only resulted in them throwing a fit about why they need to take these people. I'm at a loss for what to do. I talked to my nurse leader who talked to the DON who has done nothing. I am going in tomorrow for a meeting and a mock fire drill and I think I might go and talk to the administrator about this issue, maybe she doesn't even know what's happening? Any suggestions of anything else I can do, if the economy didn't suck (and job searching) I would probably put my two weeks in I'm just sick of it and I have finally come to hate going into work now. Sorry I rambled but I need your opinions please!

Thanks!

[fuzzywuzzy, CNA]

Where I work sometimes they schedule and aide to move to another floor halfway through the shift. It's actually a big help.

[CapeCodMermaid, RN]

Make a list of all your residents. Indicate who is a one or two assist.( You say there are many independent people but they still need a lot of help? It's one or the other.) Give the list to the DNS and the Administrator...the Ombudsman, frankly, is powerless when it comes to staffing. Be logical and dispassionate. If that doesn't work, I'd agree with the others who recommended floating or mixing up the CNAs so they all get the chance to have a heavy assignment.

At my facility for days and evenings, we maintain a 1:5 or 1:6 ratio of CNAs to residents. In my career, which is close to 30 years long, I've never been in a better staffed building. It really makes a difference for the residents AND the staff. The care they receive is amazing and the staff, for the most part, is happy.

[NotFlo]

My nurses would love to have the patient load you have ~ they each have SIXTY residents. And, no, this isn't an assisted living facility. This is a total care facility. We have two floors with SIXTY residents on EACH floor, there is one nurse on each floor. And four aides per floor.... 15 residents each.

This is on which shift? If this is first or second shift, that is shameful. I feel really sorry for "your" staff and residents.

[SuesquatchRN, BSN, RN]

This is on which shift? If this is first or second shift, that is shameful. I feel really sorry for "your" staff and residents.

Come to Texas. WHile I detest the NYS DOH no one was getting rich at the expense of the residents' well-being. Here, I wonder how, with the usual staffing I see ( visit facilities as a hospice nurse), the poor folks aren't just big decubs. It's a disgrace, some places. I NEVER saw that in the NE.

[mamarhonda]

Thanks for all your suggestions folks. I went in yesterday to go to a dietary/evening shift nursing meeting (which was cancelled and they didn't bother to tell anyone) and instead ended up talking to my DON. She stated that they were trying to get approval for a 3rd aide on evening shifts from our Administrator. I didn't work last night but I am working tonight and my plan of action today is to split my hall up a little bit. I will be giving 2 of the residents to the other floors that have 3 aides. I had tried that before but was getting the snide remarks from the aides from the other halls who took on the 2 people. I have the support of my DON in doing this until something else can be arranged and she said she would come over today when I am assigning the aides to residents to make sure everyone understands. In the meantime I have begun filling out applications at hospitals. Thanks again!

[DixieRedHead, ASN, RN]

If you have one two-person transfer your level really isn't that heavy. But it's still tough. I would suggest that you sit down and write out: how many need feeding, how many total assistance with dressing and bathing, etc., how may need incontinence care, how many toileting. Actually look at it and then, when you have clear ammunititon, go to your boss. Do not go over her head to the admin. I'm just sayin'. All you'll do is pi$$ everyone off.

This works. It worked in practice for me. I am an ADON at and LTC/AL facility. We needed a third aide. I sat down with a room list list of each patient and had a code for all total care residents, all that had to be pushed to and from meals (up for first seating in the AM), hoyer lifts, those who had to have assist toileting, incontinent residents, etc. When I had done my homework, the third aide was approved. Remember it's not you, and not the aide that will be considered, base it on the resident's need. I hope this helps.

[SuesquatchRN, BSN, RN]

This works. It worked in practice for me

Same here.

:)

[LTCangel, ADN, BSN, LPN]

On Night Shift where I work if there is a 3rd aide on the other LTC hall or on ours then they do a split, where they divide the total of both halls by 5 and one of them takes care of some residents on each hall and the others have to help answer her call lights if she is not on a particular hall at that time. Make sense?

[Jaimie.RN]

60 patients, even non-total care patients, for one nurse is simply a DISGRACE!