Are most LTC understaffed? Are most nurses in LTC overworked, understaffed?

[Bala Shark]

I am a recent grad and my first job was in a LTC facility..I have to say that the facility was understaffed..The nurse who worked there even told me that it is an understaffed facility..I know the owner or organization wants to make money so they hire less people..But that is not right at all..Is this the reason why most LTC facilites are understaffed..I dont want to mention anything bad about the faclity I was working in but because of the understaffing, it lead to a lot of negative things..

Anyway, please tell me that in some LTC, there is adequate staff..I already was let go from the LTC facility and I dont want to to back..

[shoreh2000]

Hi

They just don't prioritize their work. If the staff (DON/Administrators) knew how to use the QI reports it would help the staff tremendously. And, if SNF's knew how to decrease their erroneous meds it would leave more time for hands on patient care. :-)

[Simba&NalasMom, LPN]

I wish I could tell you what you want to hear, but the sad reality is most LTC facilities are, indeed, understaffed, and are too busy worrying about their bottom lines and keeping the state off their backs to worry about patient care.

I've mentioned this in other posts: there is a special place in heaven reserved for LTC workers who are able to stick it out and deliver great patient care in these facilities. I honestly don't know how they do it!

:bowingpur

[tatgirl]

the answer is yes, yes, yes. I am a charge nurse on the 3-11 shift in a ltc. Right now I have 43 patients total for my one unit. There were 2 nurses on the floor, and only 3 cnas. Each cna had 14 residents apiece. I busted my tail to get my meds done and my treatments done, then I helped out feeding residents, and giving showers. By the end of the night, I was beat. I dont mind helping out my cnas at all. I was angry because mgt went home and didnt give us a second thought. They cut out our unit managers in the name of the almighty dollar. Nurses in ltc are stretched too thin, and to top it off, mgt makes us do other depts jobs as well.

Wendy

LPN

[Valerie Salva, BSN, RN]

re: are most ltc understaffed?

yes.

are most nurses in ltc overworked, understaffed?

yes, yes.

[Simplepleasures]

There are degrees to this , some facilities are better, some worse, but most have poor staffing and overworked, under respected nurses. Some folks who work in the better facilities do not understand just how bad it can get out in the rest of the LTC facilities. We can only hope that our day will come when there are mandated nurse/ patient ratios and state/ federal laws that protect the ethical nurse.

[nightmare, RN]

The management will tell you that you are not "understaffed" that you have "the correct staff to resident ratio". I would say there is a big difference between adequate staffing and minimal staffing and the difference shows in patient care.

[CapeCodMermaid, RN]

We're going through this now in my building. I say one nurse to 34 patients on a 3-11 shift is more than adequate. We need to look at acuity as opposed to just numbers of people in the beds. On my long term floor there are 4 residents. There are 2 nurses the first half and one the second half. My dementia unit is the same. All the nurses are up in arms. I've been a nurse for 25 years and when I worked on a true sub acute unit, I had 30 patients for meds, treatments, and MDSs. I had 5 IV's all with q4 antibiotics, 3 Gtubes, fresh traches, and a few people at the end of their lives from AIDS. I got it all done (well and on time I might add). Now my nurses complain about 34 old people who aren't subacute in the least.

[Simba&NalasMom, LPN]

We're going through this now in my building. I say one nurse to 34 patients on a 3-11 shift is more than adequate. We need to look at acuity as opposed to just numbers of people in the beds. On my long term floor there are 4 residents. There are 2 nurses the first half and one the second half. My dementia unit is the same. All the nurses are up in arms. I've been a nurse for 25 years and when I worked on a true sub acute unit, I had 30 patients for meds, treatments, and MDSs. I had 5 IV's all with q4 antibiotics, 3 Gtubes, fresh traches, and a few people at the end of their lives from AIDS. I got it all done (well and on time I might add). Now my nurses complain about 34 old people who aren't subacute in the least.

I suppose, like you say, it depends on acuity. On swing shift with 34 it COULD go either way...in my experience, every nursing home with that kind of census had 6-10 diabetics (so that meant finger sticks and sliding scale at 1630 and 2000); plus we had 1700 and 2000 meds, with the average resident taking 4-6 pills at each pass plus BP meds which more often than not had a BID BP check along with giving the med. Then there were typically 2-6 tube feeders, and a PICC line or two thrown in with vanco or similar being hung QID. I would typically have around 15 on alert charting and some of those on Medicare/skilled charting as well. Then there are all the unexpected things; falls, fevers, unexplained injuries, etc.

What I have noticed is that there are a few nurses, such as yourself, who are capable of handling such a workload, and doing it well. God bless them and you for doing it, because in my experience (and I include myself) there are those for whom it is just way too much.

[CapeCodMermaid, RN]

No acuity..one CBG,no IV's,no dressings,no new joints, maybe 2 skilled charts to document in. I don't understand why she can't get her work done. Oh and please don't suggest I show her better time management skills. She has already told me she has worked in an ICU and as a surgical nurse (not in this country) and knows more about the building and how it should run than I do.

[Simba&NalasMom, LPN]

No acuity..one CBG,no IV's,no dressings,no new joints, maybe 2 skilled charts to document in. I don't understand why she can't get her work done. Oh and please don't suggest I show her better time management skills. She has already told me she has worked in an ICU and as a surgical nurse (not in this country) and knows more about the building and how it should run than I do.

Humph. I got nuttin. It's always fun trying to work with somebody who already knows everything. Maybe gently suggest that if she feels more "at home" in the ICU, maybe she should go back?

Seriously, though...like I said, not everybody is a good fit for LTC; it's so much harder than it looks on the surface for some of us. I was actually let go from the last NH I worked at, but the DON and Admin were very kind about it. They assured me that I was not a bad nurse but it was just a poor fit and they told me that I would be happier outside of LTC. They were right.

[CapeCodMermaid, RN]

Humph. I got nuttin. It's always fun trying to work with somebody who already knows everything. Maybe gently suggest that if she feels more "at home" in the ICU, maybe she should go back?

Seriously, though...like I said, not everybody is a good fit for LTC; it's so much harder than it looks on the surface for some of us. I was actually let go from the last NH I worked at, but the DON and Admin were very kind about it. They assured me that I was not a bad nurse but it was just a poor fit and they told me that I would be happier outside of LTC. They were right.

You're right...LTC isn't for everyone. If you don't want to work your butt off every day every shift then it's not for you.