Help! Is this nurse/patient ratio the norm?

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Good Morning...

I have a question that has been on my mind ever since I started working at a SNF a few months ago.

I work night shift (11pm-7am) in a SNF and I was wondering if anyone knew the nurses to patient ratio in a SNF. Almost every night there are only 2 nurses working and we will have about 26-27 patients each. We have all types of patients (long-term, same day surgery, rehab) Day shift and evening shift have 4 nurses and on days there are short they have 3 which is probably about 15-17 patients each if there are 3. I just wonder how do they expect for us to fully do our job attending 26-27 patients each night with call bells constantly going off, removing foleys, emptying JP drains, passing meds, measuring wounds, vitals, etc. Not to mention that the CNAs disappear and are most likely sleeping somewhere so you also have to take patients to the bathroom and clean them and get them water in the kitchen and whatever else they need.

I just need to know is this the norm because this is my first time working in this type of facility.

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Specializes in Care Coordination, Care Management.

My first RN job was in a SNF, and that is very much like the ratios where I worked. The shift was 7P-7A. So we had two med passes, residents of various levels of acuity, treatments, etc. If the resident requires a higher, more complex level of care, they belong in an LTAC or sub acute unit somewhere, with a lower patient/nurse ratio.

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The only SNF (and really they should have been called an LTAC) that I'm familiar with is in PA and they have 6 patients on days and 10 on nights. This particular place usually has a lot of very complicated, but stable patients. It's normal to have 8 of your 10 with tube feedings, 6 with wound vacs, salem sumps, JP drains. A lot of the nurses that I had spoken to, had come from SNF where 15 patients was a light day. Not sure if that's helpful...

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I'd find out about your CNAs. They may just be busy elsewhere but if they really are sleeping.

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Specializes in Case mgmt., rehab, (CRRN), LTC & psych.

I had 34 residents when I worked in the SNF setting on nights (10:00pm to 6:00am) several years ago. Therefore, the ratios you have are reasonably normal.

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Specializes in Home Health,Dialysis, MDS, School Nurse.

The SNF I used to work at had 30 beds and was full most days. There was one nurse for nights and one for days ( although days had DON and others around that were very helpful). Days also had more aides. It was doable, but we didn't have the complexity of care some places do. Although many were heavy care, there was not alot of IV's/drains, etc.

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When I first started my current job I was on nights. When I was on the LTC side, I had 50-60 patients per night shift 10p-6a. On the rehab side I had anywhere from 30-45. Those included jp drains, foleys, PICC lines, IV, etc. even now on day shift it is not unheard of for us to have 22 patients to one nurse with several fairly acute IMO, though most days it is 16-18. I would say your ratios sound reasonable, but I only have the one job to compare to.

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Specializes in Geriatrics, Dialysis.

That sounds about right. We have on night shift 2 nurses and 3 CNA's for 70-80 residents depending on current census.

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Thank you all. I wasn't sure if this was a normal ratio at a skilled nursing facility. I feel like I'm drowning. I never get out on time. I usually have to leave after giving report, take my son to school and go back to write my notes. It's so overwhelming.

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Yep, normal ratio. My ratio was 25-30/SNF unit and 55/LTC.

You need to find where the CNAs are though, you're supervising them. They could be in other rooms helping residents but, if they are off sleeping somewhere write them up. Let them know you need to know where they are.

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Specializes in EMS, LTC, Sub-acute Rehab.

Yeah, add it to all the things they don't teach in nursing school right? I felt the same way when I started. It's a lot to process. Take your time and be safe. Speed will come later.

I personally don't think it ever gets easier just slightly above manageable. If you're doing it right, there is always something to do. If you didn't screw something up, you didn't learn anything. Best of Luck!

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Specializes in VA, Ortho, Med/Surg.

Ok well now I'm scared ******** to start my new job in a SNF lol. I picked one that was non-profit and had a great reputation but I have TRIED other places, dumps really, many years ago and always cried then quit. I'd still be passing my 5 o'clocks at 10 pm. That was the very first night alone with 30 patients or more on the Medicare floor. Then a nurse tells me I have 3 transfers LOL. I said "I will finish tonight but you better call in the night nurses early cause I'm quitting, I won't be back tomorrow." I do realize I didn't give it long enuf to get to know the residents and get a routine down but I was so overwhelmed. The place had the highest turnover in my neck of the woods and I should have known better and that was like 10 yrs. ago but I'm hoping this place is semi decent and I can try again. I'm taking this job because despite my bad experiences, my gut still tells me I belong in SNF. And in order to do travel nursing later, I must get the experience and I've only done Pediatric Home Health for the last 10 yrs. and need to brush up on my nursing skills. I'd love to go back to get my RN but my brain doesn't seem to be able to memorize quite like it used to to be able to take and pass A&P. Tried.

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