How scary does this sound to you? Or am I the only one -


I'm a new grad (RN) and just had an interview at an LTC/SNF.

It is a corporate/for profit facility that apparently doesn't want to have too many RNs on staff. There are 120 beds (2 wings of 60). For the 3-11 shift there is 1 RN on the skilled care floor (60 residents) who has the help of LPNs for med pass and CNAs for ADLs. On the other wing ---- NO RN. There is a highly competent, very experienced LPN who is handling the dementia/Alzheimer patients. the RN I would be legally responsible for 120 residents! I don't think so....I just about RAN out of that place! Even the person interviewing me said it was a lot of responsibility and no nurse wants to find themselves sitting in front of the BON if there's an incident.

I did some research before the interview and noticed that Medicare only gave them 1 star for nursing. So, I figured their RN to patient ratio was probably high - but I NEVER imagined it was that high.


Anne36, LPN

1,360 Posts

Hi, Im brand new (LPN) and looking for my first job. I have an offer pending now, just waiting for a phone call. That does sound questionable. Why is extended care so short staffed? In my area, all of my friends who are new Grad LPN are telling me that orientation is basically non-existant. We just got out of school and have not had the opportunity to do tube feedings, trach care, IV, except for a few isolated cases in clinical if at all. Im terrified about my first job. It would be hard enough being an experienced nurse at a new facility.


51 Posts

To be fair - I'm not sure how many LPNs they have for all those residents. My concern as the RN being legally responsible for any incidents since the LPNs and CNAs would be under my supervision. I think 120 residents from 3-11 with only 1 RN is dangerous.

Anne36, LPN

1,360 Posts

I agree, it does sound dangerous. Is this going to be your first job? How many patients did you get up to in clinical? The most I ever had was 4 and that only happened twice. I told the DON that tidbit when she asked in the interview. I want a job, but I also want an orientation as a new grad. Im not sure Im ever going to get one in my area.

Right now Im writing myself a list of Assessments and procedures to review along with a list of what ifs situations and how I would handle them. I have been out of school for almost 5 months and took my NCLEX at the end of July.


51 Posts

Yes - this would have been my first job (that's even crazier).

The most I had during clinical was 4 except for when we played "charge nurse". We were assigned 10 patients and had to delegate to a team of (3) fellow students. Each student had a different role (med nurse, PCA, LPN, etc) But I was responsible for all 10 patients.

Maybe a more experienced nurse would be fine with these numbers - but I'm not willing to sit in front of the BON and explain someone else's actions if there is an incident. Since the interviewer basically said - I'm supervising and if there's an incident, I'm the one that people are going to come to.

Oh was my first interview since receiving my license last week. I took my NCLEX the end of July too! So, I'm not feeling desperate yet - I'll just keep looking!

loriangel14, RN

6,931 Posts

Specializes in Acute Care, Rehab, Palliative.

That sounds typical for LTC. Quite often one RN in the building for a shift.

Specializes in LTC, Hospice, Case Management. Has 37 years experience.

LTC facilities are not staffed the same as you probably learned in a hospital setting. Many, if not most, times you will find only one RN present for any shift. There is just as likely not to be an RN on the shift at all.


215 Posts

sounds like every ltc I have ever worked at or considered working at.


139 Posts

Has 1 years experience.

The assisted living facility I worked at was about the same size, and had one RN on the payroll, and that was the DON. So some shifts didn't have an RN at all. There were two seperate units with a locked door between them. Night shift there would sometimes only be one LPN for the entire building with a few aids (not CNA's, its cheaper to hire someone with out certification).

It wasn't SNF so I guess it isn't as bad? I always worried about the residents on night shift. I meen the door in between the units could be a pain in the butt, and what if something happened and the nurse was on the other side? Not to mention how over worked the nurse was, trying to taake care of so many residents and not allowed to go outside for a smoke break or anything.

I liked LTC as an aid but I would be afraid to work with those ratios as a nurse.

Specializes in Med/Surg,Cardiac. Has 1 years experience.

I'd be afraid to supervise. Especially since early on (and probably still) I don't have the knowledge base to be fully in charge. School doesn't teach you everything. I wouldn't take this job.

CapeCodMermaid, RN

6,089 Posts

Specializes in Gerontology, Med surg, Home Health. Has 30 years experience.

Each nurse is responsible for his or her own practice. Why do you think you would go in front of the board if someone else screwed up?


16 Posts

i've worked as an LPN on 3-11 shift where there was only one RN for about that many residents