Good care with staffing ratios?

[Pooksmom1996]

I have worked as a staff RN at several LTC's where the nurse/patient ratio was about one nurse to 20-25 residents, give or take. In every facility, the RN/LPN staff had to cut major corners in order to get everything done. Doubling up on med pass times, skipping some treatments, and definately not having the time to check up on multiple items in the treatment book, like protective heel cushions, siderail positioning, skin checks and many other things

.

If we had a resident or family who had TLC needs that needed a little extra time..taking the extra time was very difficult, although I tried my best It broke my heart!! This was true with every nurse, even the fastest and most experienced. I felt like I was giving bare bones care that neglected the needs of my residents.

Also, from a legal standpoint, nurses were constantly having to sign off on things that they had not done, since management expected everything to be done by end of shift. We can ask nursing assistants if things were done, but that is not a substitute for our legal responsibility for personally checking on items in the treatment book.

I would like to stay in LTC-I love working with residents and I would like to be a good floor nurse or manager some day who makes sure that the best of care is given. My heart is really in this.

But my experiences make me wonder...

I would love to hear if you have been able to set things up at your facility so that good care is done without the need for shortcuts, or what challenges you face with this issue.

Thanks!

Pooksmom

[arelle68]

The only way to give the care that I need to give to my 23 residents would be to have 2 nurses instead of one, and 3 CNA's and a shower aide instead of two CNA's and a shower aide. Corporate will not pay for the help we need, as you very well know. We are streched too thin for our care to be our residents deserve, and what their families are paying $6200 a month for. We stand between the corporate monster of greed, and our defensless residents. We have got to stop being intimidated, and fight for the rights of our patients to have the care that they need!

[CoffeeRTC, BSN, RN]

Well...I think acuity has a lot to do with it too. Would be nice if we could staff based on that. Somedays the 24 residents I have is totally doable, others..heck no. Having a desk nurse would help us out or even one that would do treatments or just work part time as a treatment/ desk nurse. Getting all the "other" duties off on nursing would help too.

[lovemyfam]

At the facility I am currently at, staffing ratios seem to have gone down the toilet. We have 3 nurses and 4 to 5 aides for 60 residents on dayshift! I find myself taking 3 hours on my first med pass because I'm setting residents up with water to bathe, toileting, feeding, trying to prevent falls.

[CapeCodMermaid, RN]

OKAY so I know I'll be called old, but I used to have 30 subacute patients for meds, treatments, assessments, notes, IVs, Gtubes and I still had time to do everything and give good care. You have to learn to do more than one thing at a time. The lady who is so slow taking her meds....assess her while you're waiting. Check heel protectors when you're in the room doing something else.

I'm a DNS now and my nurses have it easy. Never more than 21 residents each, 5 CNAs and a nurse manager for the day shift. It amazes me that they think they are over worked.

[VivaLasViejas, ASN, RN]

OKAY so I know I'll be called old, but I used to have 30 subacute patients for meds, treatments, assessments, notes, IVs, Gtubes and I still had time to do everything and give good care. You have to learn to do more than one thing at a time. The lady who is so slow taking her meds....assess her while you're waiting. Check heel protectors when you're in the room doing something else.

I'm a DNS now and my nurses have it easy. Never more than 21 residents each, 5 CNAs and a nurse manager for the day shift. It amazes me that they think they are over worked.

Hey, can I come work for you??

Actually, I don't have it bad at all........currently 24 residents with 2.5 CNAs and a med aide who is shared between two units. I even have time most evenings to hang out with the residents and shoot the breeze while I check FSBS and give meds; thankfully I'm fairly efficient for an old nag with arthritis and a big weight problem, so I really can't complain about ratios when it's all getting done in the allotted time AND I'm not killing myself to accomplish it.

[lovemyfam]

ok...well I know its not just me. None of the nurses seasoned or not get lunch break time.

[CapeCodMermaid, RN]

lol....does 'seasoned' mean old??? I always made sure my nurses got their meal breaks even if I had to cover the floor while they ate. At this facility, it's not an issue.

[lovemyfam]

Thats nice!

[florianslove]

We are lucky in a way, I am the Unit Manager, I have a Unit Secretary and a specific wound care nurse. That does make a difference but the floor nurses still work their a***s off. Med nurses I salute you:bow:

[debRN0417]

I worked as the only nurse for 40 skilled residents with all the skilled charting to do plus med pass (From 7a-7p) had to do the staffing, call docs, treatments, supervise CNA's blah blah you know the scenerio....I had 2 CNA's. It was hard. We did it- I'm not saying I'm supernurse, but like Mermaid said- you gotta do several things at once. I made a quick round before I started med pass to make sure everyone was okay and there was nothing urgent that I needed to attend to, then assessed and observed and checked as I went. Then did it again with treatments, then did it again with meals. I wish they would mandate some kind of minimum staffing ratios- at least it may help somewhat with hiring and maybe pay rates.

[CoffeeRTC, BSN, RN]

OKAY so I know I'll be called old, but I used to have 30 subacute patients for meds, treatments, assessments, notes, IVs, Gtubes and I still had time to do everything and give good care. You have to learn to do more than one thing at a time. The lady who is so slow taking her meds....assess her while you're waiting. Check heel protectors when you're in the room doing something else.

I'm a DNS now and my nurses have it easy. Never more than 21 residents each, 5 CNAs and a nurse manager for the day shift. It amazes me that they think they are over worked.

I will agree with you on this...you must multitask and plan and organize. Years ago, this would have been much easier to handle since most of our pts were LTC or just regular skilled. Today..it seems like most of our residents are more subacute and highly skilled, sicker pts. Tons more trachs, complex wounds, IV meds (sometimes we are hanging one antibitic after another or pushing meds all day long) gtubes, more alert and younger pts and of course.....more charting. The staffing ratios are still the same and sometimes worse than what they were years ago.

Right now...your staffing ratio would be heaven for us and I realize that our staffing ration is heaven to some other places. I do mostly 3-11 and we have two nurses for 48 pts, 3-4 CNAs. That is it. All the office staff, therapies, housekeeping/ maint leave by 4 or so pm.

Do we need more nurses...No, I just would like to see at least 4 cnas and maybe even another one part time on a 3-11 shift. I'd also love to be able to teach new staff a mini class on time management skills. Srlsy...I see some CNAs focus on one thing when they go into the room. If they have two residents in one room, both could be taken care of when they are in there. Res one could be getting undressed while the CNA is helping res 2 into the bath room. Sounds simple, huh? Or..when a nurse goes into the room and just gives meds, then comes back to assess something else. So many things can be lumped together in one trip.