How many residents do you care for Per Shift?

Plagueis · Dec 31, 2009

I'm a 3 to 11 LPN who has 30 residents to care for. (7 fingersticks and 3 G-tubes, included.) And yes, on top of passing meds and charting, I also do treatments, take off orders, fax labs, answer the phone, etc. Plus, if there's an admission, I'm expected to do that, on top of the other duties. I also just completed my recaps/changeovers for the next month, which takes me beyond the end of my regular shift to finish. We don't have a supervisor or charge nurse on that shift to help out.

Based on the numerous posts here on this site, plus what other nurses have told me, having 34 residents is not unusual. I've heard of a high of 50 residents on the 3 to 11 shift! :eek: I'm overwhelmed with 30! It's hard and exhausting, and I always feel like I forgot to do something when I get home.

NCIANurse · Dec 31, 2009

Exactly! That's what got me so stinkin' frustrated tonight at work! I had a re-admit (a resident of ours went to hosp for 3 days and came back), and the paperwork that I as her nurse, am expected to do takes ATLEAST 3 hours, just for paperwork! Let alone the time it takes to gather info for paperwork, such as full skin assessment, vitals, weight, filling out med orders, getting signatures/orders for PT/OT/ST, ect.

I think part of what frustrates me is that the nurses (not CNA's, OMT's, ect) at my facility must do all vitals, weights, BS, ect.

Even hearing that I MIGHT get an admit/re-admit makes my night go down the tubes.... filling out admit orders, pain assessments, MME, falls/braden risks, skilled assessments, skin sheets for every bump/bruise, dietary orders, resident data sheets, depression scales, giving immunizations (TB, flu, Pneumonia), filling out calander with dates to check/rescore all of the above... HOLY SMOKES!!!!!!!

I've worked in geriatrics for ages, as a CNA for 4 years, home health aid, ect. I just feel so overwhelmed and underappreciated. I suppose it doesn't help that we had a meeting today that listed everything us nurses do wrong each day, how we don't pay enough attention, we *must* stop taking shortcuts (ie: pulling meds early) ect, or that we will get suspended for 3 days if we leave our med cart unlocked, even if it's to step 5 feet away to keep a resident from falling! yet I leave each day completely exhausted and feeling like I forgot to do 1,000,000 things!

Thanks for listening to the rant!:)

Midwest4me · Dec 31, 2009

i work 1400-2230 as an lpn (soon to be rn as soon as i take boards). i work in a ltc facility that has 68 beds that are always full. so, each night, on second shift there is always myself and 1 other nurse. we are constantly promised that we will "soon" get an omt to help with med pass, but this never occurs. i am curious what other ltc 2nd shift (evening) nurses have to deal with?
my duties: i have 34 residents a night... all get pills at 1700, about 50% of these get pills again at 2000, and about 25% get pills at 2200. i have approximately 10 diabetics that need blood sugars/insulin at least once per shift, 3 wound dressings that take atleast 10 minutes each, i have 2 residents with g-tubes. almost all my residents get atleast 5-10 different meds during our 1700 med pass. i have 10 residents with eye drops, 4 with weekly procrit injections, 1 with a colostomy that gets completely changed q3 days. this is in addition to the fact that our secretary leaves at 1500, so we answer phones, respond to faxes, get doctor orders, sign out meds from pharmacy, call family with labs/med change/condition changes, ect.
and then comes charting.... on average, of my 34 residents, at least 6-10 are skilled, so they require mandatory in-depth charting, usually 4-10 residents are "flagged" (i.e. monitor for mood changes d/t decreased antidepressant), and then any charting that comes from lab results, med changes, ect.
i'm just very interested in what other nurses responsibilities are, such as how many residents they are responsible for, ect. even our first shift nurses (0600-1430) often get stuck with just 2 nurses and 1 omt for all 68 residents. i'm very interested in what everyone else has to deal with!

wow, i sooooo hear where you're coming from! spent many years working ltc and experienced exactly what you describe; had 30-40 pts i was responsible for. unlike you, i had cnas to get my vs for me. to require you nurses to do the vs is asinine!!!!

i wanted to cry because to expect all of that is totally unrealistic. those demands would be enough to **** off the pope!!!!! really!! i always put in 1-2 hours of overtime as there was no way to get it all done. i spent too many years enduring what you are enduring and called it quits several years ago; changed specialties because of the fear my liecense was in jeopardy every time i went to work. get out of there!

Barbara Hessinger · Dec 31, 2009

Does anyone ever consider how the CEOs of these companies sit in their million $ mansions and enjoy the holidays while the worker bees provide for their rich filthy lifestyle. It is a disgusting system. And like it was mentioned before, if you guys quit, there are dozens behind you to take your job.It is a corrupt system...

DeeAngel · Dec 31, 2009

I work med/surg 12 hour night shift and we never have more than 7 patients per nurse.

Sandcastles, ASN, RN · Dec 31, 2009

This is the norm in LTC sadly.I work 11-7 and I have 30 patients each night with half of them being subacute post op from surgeries so Im popping them painpills all night,along with Gtube boluses,accuchecks,meds,treatments,oh and charting on all the medicare residents which last night was 18 plus anyone on ABT or incident,Day 1,2 and 3 admit.You know the drill.Its alot.I just try and hang tough.Jobs are scare out there.

makes needs known · Dec 31, 2009

Keep smiling at your patient and keep screaming at your management. You know, when 1 nurse does all this and does it well, without a sweat it makes the other nurses look bad. Some nurses get used to this high level of stress and seem to do well. But it is wrong. Do you want to work this way?

Need2Wings · Dec 31, 2009

Thank you for posting this, the song is familiar to me as well... I also work LTC/rehab. I thought of a few extra things we are responsible for but the only thing that now comes to mind is checking O2 tanks q 2 hrs with documentation of such. There are days I go home feeling like I got beat with the ugly stick. Having been in this position for less than 6 months, I don't know how some of my fellow nurses have time to smoke 5 x a shift but I am certain it isnt because they are so efficient or thorough but that they have developed some super short cuts. (not that I want to follow if this is the case) I count down the days of class left for me to finish classes for the RN degree which I hope is my ticket out of here. The sad thing is I really enjoy our residents and will miss them but the stress and feeling of my license being gambled each time I work takes away any satisfaction felt. :angryfire. One of our vocal nurses has talked to administration about this situation and was told that its our job to get over it. I have myself considered talking to the DON about how I feel, there is still a billion things I do not know and feel my orientation was cut short which is something I wanted to address BUT it will all fall on deaf ears. :crying2:

Oh, not trying to avoid the initial question but we have 23-30 residents to care for and like your facility there is no backup all of the nurses on our second shift have about the same number of residents and honestly no time to back each other up. This is the first time I have worked in an environment that does not have the "team concept" (keep in mind also this is my second career and the first time in healthcare facility as a nurse-- this statement itself is SAD)..

PM me if you wish.. I would love to beat this subject further.

oh... I might ask why there are attempts to set patient limits in hospital settings but not LTC? (just curious) :idea:

MaritesaRN · Jan 1, 2010

Thank you for posting this, the song is familiar to me as well... I also work LTC/rehab. I thought of a few extra things we are responsible for but the only thing that now comes to mind is checking O2 tanks q 2 hrs with documentation of such. There are days I go home feeling like I got beat with the ugly stick. Having been in this position for less than 6 months, I don't know how some of my fellow nurses have time to smoke 5 x a shift but I am certain it isnt because they are so efficient or thorough but that they have developed some super short cuts. (not that I want to follow if this is the case) I count down the days of class left for me to finish classes for the RN degree which I hope is my ticket out of here. The sad thing is I really enjoy our residents and will miss them but the stress and feeling of my license being gambled each time I work takes away any satisfaction felt. :angryfire. One of our vocal nurses has talked to administration about this situation and was told that its our job to get over it. I have myself considered talking to the DON about how I feel, there is still a billion things I do not know and feel my orientation was cut short which is something I wanted to address BUT it will all fall on deaf ears.
Oh, not trying to avoid the initial question but we have 23-30 residents to care for and like your facility there is no backup all of the nurses on our second shift have about the same number of residents and honestly no time to back each other up. This is the first time I have worked in an environment that does not have the "team concept" (keep in mind also this is my second career and the first time in healthcare facility as a nurse-- this statement itself is SAD)..
PM me if you wish.. I would love to beat this subject further.
oh... I might ask why there are attempts to set patient limits in hospital settings but not LTC? (just curious)

:bugeyes: good question ! Why is the patient ration not controlled or regulated ????? and to think I am changing gear to go to this specialty ?????tha is whay I am here and listening to you ladies . So far it sounds like taht the LTC is controlled by a small business people , and staffing is done so low for profit??? should we not bring this up for regulatory review so staffing may be also by ratio? It's just not the employees, but also the safety of the residents!!!

SuesquatchRN, BSN, RN · Jan 1, 2010

34 actually isn't too bad.

I would look at the chedule and try to make ONE pass per resident if there are meds that can be combined without complications. Early pass is for those nodding off at dessert and sound asleep by 1900, the later pass for those who can stay awake until 2100. So 17 at 6, 17 at 8. Two hours for each, you should be done with meds by 2100 and you have time left for charting.

It can be done. But you MUST create two passes instead of three, and ONE PASS per resident, again, the only exception for meds that can't be combined.

Good luck.

SuesquatchRN, BSN, RN · Jan 1, 2010

Oh, and it's hard to make money in LTC. Most places operating with these ratios are doing a bit better than breaking even. Some aren't doing that. The reimbursement rates have little reflection in reality, and regulatory compliance is costly.