High nurse to pt ratios SNF

Golden_RN, MSN · Apr 16, 2020

1:20 for day/PM shift is reasonable, especially if you have good CNAs. I have worked facilities that have 1:40 and that is tough! You really have to know the residents well, have good CNAs, and manage your time extremely well. One fall or change of condition and the whole shift is screwed.

As long as Medicaid reimbursement remains low, SNF staff are not unionized and your state representatives don't know/care about the issue, it will never change.

Spooky, RN · Apr 30, 2020

When I started in 2011, my max was 23 residents for the hall with an average of 18-20 most of the time. Changes happened around 2015. Nurses and CNAs fired purposely (nit-picking paper trails), they refused to hire anymore staff and state "low census" was the reason. Gave me the keys and now I had 28 residents. The other hall had maybe 32. We didn't adjust well since we hardly ever cared for more than 20 residents at a time. Next SNF, I was given 26 (still not easy for me). The last straw was 31. I pledged to not ever go back to LTC even though I miss it. I felt the same way about their care. There was never enough time to care for all of them properly. Sometimes (probably more than sometimes) a CNA didn't show up. Either I had to help on top of my work or luckily they would find help from other halls. The thing is, I know we're not supposed to complain about "CNA work" and there's "no such thing as CNA work" in the nursing world, but what is the reality of that? The CNAs would clock-out right on time and just head home. I was stuck finishing up paperwork that I didn't get to do. My shift would end by 10pm and I didn't finish up till midnight most rotations. And there goes management... "What were you doing?! Why are you staying so late?! That's a write-up if you keep doing this." Blah, blah, blah... Enough was enough.

Good experience, but not worth it in my opinion. I never found the "golden egg" of a nursing home where staff ratios are beautifully 1:15-20. Don't stress yourself out. Make sure to find out about ratios and staff availability before hiring on.

liznrs30, LVN · May 15, 2020

OMG SpookyLVN,

After 2 years of being an LVN, I, too am sick and tired of LTC/SNF cuz where I work they don't want me to stay overtime, I get 32-38 residents during day shift, 45 during NOCs(during my first job), I always seem paranoid each time I get off work cuz I fear that I made a mistake or forgot to chart my weekly's which add more paperwork to my next shifts which is ridiculous, I can totally relate with everything you mentioned on your post and I do wish they turn it down a notch for these nurse to patient ratios, its seems dangerous and nobody cares until we actually did something wrong ? and get family complaints etc.

I'm glad to have read your post because I am currently applying to other jobs d/t commute, since lockdown I almost got a new position as school nurse but obviously not gona happened. So I'm trying out homecare, LVN for the first time, nervous? but excited, and was about to apply for another agency called Carelinx and undecided because they happened to be looking for nurses to go to SNFs. I'm debating on going back in that department, I'm aware it'll be a challenge to be on the floor not knowing how patients are etc but are they still letting families visit in facilities during the pandemic? I also noticed they are paying LVNs more ? like $30/hr assuming they might end up with a covid patient I dont know I been noticing it on every job site like Indeed or Glassdoor. If you have any advice I would like to hear them. Thanx and be safe.

Mintezia · May 17, 2020

I'm in home health for this reason. Sure you don't use all your skills (unless you're a visiting nurse with patients of differing acuity levels) but there's no way I want to kill myself for a paycheck. The last facility I was at was 1:40 in an affluent area. Horrifying experience. Immigrant cliques (nothing against them. These are bad because thet exclude you if you aren't the same as them and speak their language). One of the supervisors tried to have me work 6 days straight as a new grad with 40 patients. I honestly think that is corrupt. At orientation there were 2 other nurses and a ton of CNAs for a facility of 500 something residents. So I don't understand why they make it so hard for the new hires regardless of experience.

I don't like the mandated overtime or having to chart after shift. I've been hearing of sick Covid patients being returned or brought to the nursing homes which only adds to the load. Nursing homes aren't equipped to effectively dealing with such patients.

I don't see how they can continue this model indefinitely especially with the nursing shortage as it is.

Spooky, RN · May 19, 2020

On 5/15/2020 at 5:09 PM, liznrs30 said:
OMG SpookyLVN,
After 2 years of being an LVN, I, too am sick and tired of LTC/SNF cuz where I work they don't want me to stay overtime, I get 32-38 residents during day shift, 45 during NOCs(during my first job), I always seem paranoid each time I get off work cuz I fear that I made a mistake or forgot to chart my weekly's which add more paperwork to my next shifts which is ridiculous, I can totally relate with everything you mentioned on your post and I do wish they turn it down a notch for these nurse to patient ratios, its seems dangerous and nobody cares until we actually did something wrong ? and get family complaints etc.
I'm glad to have read your post because I am currently applying to other jobs d/t commute, since lockdown I almost got a new position as school nurse but obviously not gona happened. So I'm trying out homecare, LVN for the first time, nervous? but excited, and was about to apply for another agency called Carelinx and undecided because they happened to be looking for nurses to go to SNFs. I'm debating on going back in that department, I'm aware it'll be a challenge to be on the floor not knowing how patients are etc but are they still letting families visit in facilities during the pandemic? I also noticed they are paying LVNs more ? like $30/hr assuming they might end up with a covid patient I dont know I been noticing it on every job site like Indeed or Glassdoor. If you have any advice I would like to hear them. Thanx and be safe.

Hey, there. ? Thank you for your reply. That's exciting (and scary) to start something new, but it's a change! Change is good! I would definitely take the home health gig to try. I have personally never worked HH, but it was a interest of mine after dealing with my first SNF experience. I had moved to a different state/bigger city (an additional 65,000 estimated population from my small town!) from home and I was nervous to do HH. Driving around in a bigger area scared me and I wasn't adjusting well being away from home, so starting something completely new wrecked my nerves. I just started my second (maybe last) SNF there. Well, obviously it wasn't any better in most cases... Also, I have no idea if they're allowing family members in the SNFs now. Last I heard from a nurse buddy (beginning of April) in my area near DFW Texas, they're not allowing visitors. Temp checks of all employees clocking-in/out, locked doors, no dining room services (all room trays). I can't remember what else, but I feel so bad for the residents and their families. We've had cases in our local SNFs where I stay. ☹️ Anyway, I wish you lots of luck on a new job of your choosing and hope the change is better for you! ? Stay safe!

Oh! By the way, I have never tried agency/staff nursing, but just because they pay significantly higher than regular hourly pay, I would be cautious about it, especially during this time. You never know what you'll sign-up for just for higher pay. I'd rather not completely stress myself out for high pay. Quality of life comes first. If I can help it, I just "do" without all the money and stress!