How to get CNA:patient ratios down.

Lulu Belle, RN, EMT-B · Aug 23, 2015

I don't have an answer, but I have been thinking about this a lot because it's such a prevalent issue.

Just out of curiosity, how big are your assignments?

I think I'm very lucky. I work 3-11 and usually have 10-11 residents. I've seen assignments as high as 13 and as low as 6 on 3-11.

Night shift is not so lucky. They usually have closer to 30 because they are never staffed adequately.

Missingyou, CNA · Aug 23, 2015

I work 3p-11p and I have, on average 11 residents. It's not unusual for me to have 13...and that is just my residents, it doesn't count the residents that my hallmate has that are 2 assist which means I leave my residents in order to help transfer her residents....something we all deal with and State forgets.

Lulu Belle, RN, EMT-B · Aug 24, 2015

I work 3p-11p and I have, on average 11 residents. It's not unusual for me to have 13...and that is just my residents, it doesn't count the residents that my hallmate has that are 2 assist which means I leave my residents in order to help transfer her residents....something we all deal with and State forgets.

Exactly. There is one hallway that is basically all hoyers, so the aides on that hallway just work together and it's all hunky dory.

Every other two assist in the facility will never get toileted, repositioned, changed etc. more than twice a shift.

Now that I think about it, when the state came in earlier this summer, a bunch of aides got in big trouble when they saw the above happening. I think if they saw it happening consistently in a facility, they would shut it down rather than reassess what is a safe ratio.

It would take a LOT of commitment and time to bring about any change. And a lot of aides would lose their jobs and certs in the process.

Princess Bubblegum · Aug 24, 2015

We just voted to unionize ancillary staff at the hospital I work at, and will be bargaining for better CNA staffing. But the state doesn't regulate hospital CNA staffing (at least here, they do regulate LTC staffing though), so we've been at the mercy of our hospital administration. It does feel like things get worse before they will get better. Hang in there. :hugs:

Missingyou, CNA · Aug 26, 2015

Exactly.
Every other two assist in the facility will never get toileted, repositioned, changed etc. more than twice a shift.
Now that I think about it, when the state came in earlier this summer, a bunch of aides got in big trouble when they saw the above happening. I think if they saw it happening consistently in a facility, they would shut it down rather than reassess what is a safe ratio.
It would take a LOT of commitment and time to bring about any change. And a lot of aides would lose their jobs and certs in the process.

I absolutely agree. If they shut down a facility because staff cannot toilet, reposition etc as state determines it should be done with the amount of staff ratios given, then there would be no nursing homes. I believe it's the same in every long term care facility and I believe most places and most CNA's/nurses are giving more than 100%....and things are done differently when state walks in. We have to do what needs to be done (short cuts) otherwise, the quality of care would be MUCH worse and the repositioning, toileting would be done more like once a shift.

BBboy · Aug 29, 2015

In this field I definitely believe there's a give and take regarding doing things by the book. For the most part I believe most actions we carry about should be carried out relatively by the book but sometime, aka like 70-90% of the time, it is not practical and as long as we accomplish our tasks with not only relative speed but satisfaction from the resident/client/patient themselves then we've accomplished our goals.

neuron · Aug 31, 2015

If CNA's in TX want to get the CNA to patient ratio down, we would all have to go to Austin and stand in front of their office. Nurses also. I worked in CA as a CNA and at my first facility we had 5 patients each. It was beautiful. It was a licensed hospiced facility. Now that I live in TX, we have sometimes 13 - 15 on day and evening shift. I have read that TX has some of the worst staffing in the country. I just do the medications now, and it is still a lot of patients.

In CNA class, they just don't tell you the real world CNA duties. 5 alarms going off, 3 patients have to be fed, 2 patients have their emergency lights going off, 2 patients are a hoyer lift to get in to bed and the DON is wondering why you aren't answering the call lights. Sometimes you never see CNA's or nurses again here because they don't want to be bothered with the workload. They don't give 2 weeks, no prior notice, they just quit. One would think the facilities or the state would somehow make changes, but their silence probably is speaking to a lot of cna's or nurses that either someone has to die or STAFF has to do something.

Valcorie34, BSN, MSN, RN · Sep 1, 2015

Heck I would love it if we were able to have the ratio the state expects it would be gravy. I am so used to being short staffed, I left early for nursing school. I was just plain burning out. 15 resident sections for days in a LTC unit with lots of hoyers and dementia, high needs people was getting to much. Should be closer to 10 per CNA, that can be doable even if we do everything we should. It is hard but it can be done. The facility is a good facility and we have signing bonuses, but there just are not enough CNA's applying.

I remember about 6 months ago, I had normally 8-10 residents. One day they accidentally assigned me two sections I had 16, and three CNA students doing clinical. It was horrible. I hated it. Now I am so used to it, I don't bat an eye.