How to handle the impossible assignment..

[NurseQT]

The facility I work at is a 75 bed SNF and LTC nursing home. We have three halls, one of which is the Medicare/Rehab hall, but there are some long term residents residing on this hall. The other two halls are supposed to be long term residents only but will get Medicare/rehab patients as well. The biggest problem is that up until about 3 years ago there was no specific rehab hall, and when the DON at the time decided to designate one hall as the rehab hall she chose the one with the most beds. Unfortunately this hall only has 4 private rooms, 3 of which are filled with LTC residents. Poor planning on her part since one of the halls, that happens to be closest to the therapy room has 12 private rooms! Many of our rehab patients either require a private room due to an infection or they request a private room and are willing to pay for that room. The Medicare hall is staffed with either two nurses and four CNAs or one nurse, one nurse tech/med tech and four cnas. The other two halls are staffed each with one nurse and if they're lucky three CNAs each..

As of yesterday the hall with the 12 private rooms was full. There's currently 5 patients with extensive wounds (one patient has 5 different wounds, and another has a wound vac), a fresh knee post-op, and a very complicated patient with multiple problems and is basically a train wreck. The day shift nurse alone has two med passes to complete and 4 large dressing changes to do on a good day (M-W-F there's now 5 with the wound vac). Plus doctors' rounds, care conferences, ect. There's no way one nurse get it all done in one shift. The Medicare wing currently has at least 5 open beds yet it's staffed with the two nurses or a nurse and a med tech. They're getting everything done by 10 am besides noon meds! The staffing is not right but I don't know how to approach the issue with the DON and ADONs, especially since they are well aware of the patient load on the one hall..

[caliotter3]

Saw the same sort of thing when I started out in LTC, but was informed by the DON that Medicare staffing standards had to be met. I did the best I could with what I had for as long as I could. There is little else you can do without better staffing both in number, and in quality of work. Sometimes it does not help to be fully staffed when half the employees hide out most of the time.