Staffing Models in ALF---What Works For Your Facility?

[VivaLasViejas, ASN, RN]

I'm the DNS for a 42-bed assisted living facility in Oregon. The administrator and I are considering changing our staffing model from what's basically NO model to a more formal arrangement, e.g. assigning a set of rooms or a floor to each caregiver.

Currently we have 2.5 staff---that's one med aide, one full-shift caregiver, and one short-shift shower aide/caregiver---for day and evening shifts (something I'm working hard to change, as it's NOT enough), and 2 (one med aide and one caregiver) on noc shift. All staff answer the call lights, serve out the meals, help out in the kitchen after meals, and help the residents who need it to get back and forth to meals, activities etc. The short shifter does all the showers/whirlpool baths plus assists with meals and caregiving.

I think it works well and prevents that "Oh, that's not my resident" mentality that seems to occur when staff assignments are divided up. But we, like almost everyone else these days, are trying to do more with less---well, not exactly less, but without adding extra staff. And the staff are getting burned out........several long-time caregivers and med aides are talking about leaving.

Any input would be appreciated. Thanks!

[marjoriemac, LPN]

In my last work, we had lists of residents given to each carer at the start of each shift ( picked without seeing who was on the list) and now we assign carers to each area of the home at the start of each shift. I like it because you know who is where and therefore who is responsible for whom but I do find you get a lot of 'Mrs X needs the loo but she's not on my list and I have enough to do'. I think it is important to identify that residents needing the toilet is everyones issue regardless of who got them up that morning and also if the team works well together they will do favours for each other. We often have girls that say they will get residents up for other teams whilst they are on their break and then the favour is reciprocated. We find that with regards to nurses, the biggest probem with grouping is in care planning, a resident gets a wound and the nurse on duty wont write a care plan for it because she is not their named nurse which is improving through education on the legal aspects of documentation.

[nightmare, RN]

Each of our residents have a daily care plan sheet,this is filled in by the nurse on duty if there are any occurences.Things like wound charts are individual so that ,again ,the nurse on duty fills one out when required.The Named nurse uses this to record in more detail in the care plan.Usually works well and the daily sheets are put into the care plan so that they can be consulted by the named nurse on a monthly review basis.