I give 2,640 meds to 35-40 residents by noon

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Hi.  I am a nurse who recently retired,but I got bored. A friend told me about an assisted living facility 2 mins from my new home that was desperately searching for someone to pass meds. So,I decided to help them out until they found someone else. And,to be honest,I am overwhelmed. I give over 2,640 meds to 35-40 residents by noon. I have over a dozen diabetics who need their blood sugar checked before meals,& insulin given. It's my responsibility to call & order all meds from the pharmacy as well. It's TOO MUCH for one person! Has this become the norm? For the ratio to be 1:40 on med passes? This is insane,& dangerous!! What can I do about this?!

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15 Answers

Specializes in Tele, ICU, Staff Development.

That workload sounds incredibly overwhelming and unsafe. Unfortunately, staffing ratios in long-term care and assisted living facilities are a concern, with many facilities operating with minimal staff to reduce costs.

It is unacceptable to be assigned 40 patients. It is not safe, and there is not enough time to think. A 1:40 ratio, especially with complex tasks such as medication passes, blood sugar checks, and insulin administration, is far from ideal and could be dangerous.

Why is this allowed? The value is not in the residents who are subjected to inadequate nursing care; it's in the bottom line. I don't see this changing because no strong political advocate exists for this population.

However, here are some steps you could try:

  • Document your concerns. You could start by documenting your daily workload, including the number of residents, medications, and tasks you are responsible for. This will provide concrete evidence of the challenges you're facing.
  • Communicate with management. Share your concerns with the facility's management or administration. Highlight the risks associated with the current staffing levels and suggest solutions, such as hiring additional staff or redistributing tasks.
  • Check state regulations. Each state has different regulations regarding staffing ratios in assisted living facilities. Research your state's requirements to see if the facility is in compliance. If not, you may have grounds to file a complaint.
  • Consider reporting. If management is unresponsive and you believe resident safety is at risk, consider reporting the situation to your state's health department or regulatory agency.

If the situation doesn't improve and continues to be unsafe, you may need to reconsider whether it's worth staying in this temporary role. Your well-being and the safety of the residents should be a priority.

Addressing this issue before it leads to potential harm is important. Your experience and intuition as a nurse are valuable in recognizing when a situation is untenable.

Best wishes,

Nurse Beth

Specializes in ICU/ER/Med-Surg/Case Management/Manageme.

I usually agree with Nurse Beth but not on this comment.  😧

 I would not stay around long enough to document concerns, communicate with management, or check state regs.  The only thing I would document is my notice to resign ASAP and I would then follow that with a report to the state health department, etc.  

There are easier ways to eliminate your boredom.  Good luck!!

Specializes in ICU/ER/Med-Surg/Case Management/Manageme.
nightwingcreations said:

Assisted living residents are considered mainly independent for cares so staff is very limited in that situation. I would say this is not an uncommon ratio for med passing.

I'm not in a position to argue since I don't work in an assisted living facility.  However, as part of my PT job, I'm in and out of facilities on a fairly regular basis and I've never seen a situation like the one being discussed.  I'll be asking staff on my next rounds.  But anyway, I was thinking...she said before noon so assuming a 7AM shift start, that would be about 528 meds/hour with about 13 to 15 meds per patient.  Meds coupled with blood sugar checks, (and we all know the minute we walk into a room someone wants to go to the bathroom, wants water, wants something!)and many older people are extremely slow...this situation is a disaster for both the nurse and the patient just waiting to happen.  I absolutely could not do it.  Even when I was young I couldn't do it.  I'm really interested in what others will say.

Edit:  I keep thinking about that nurse from Vanderbilt who went through a nightmare experience after she administered the wrong med on a busy day and the patient died. Nightmare legally, nightmare because her error killed someone.  And she wasn't giving that many meds. 

Specializes in Community and Public Health, Addictions Nursing.

The math is not mathing here....each resident is prescribed 66 different meds? No wonder they need help taking them all instead of being able to take them on their own!

On a more serious note, being responsible for 40 elderly adults' medication on your own each day does not sound like a safe or enjoyable nursing job to have. I hope the facility can work something out. I would definitely NOT be taking it on myself to talk to management and try to fix this issue. They know what they're doing, they need to take accountability and fix it.

Specializes in Geriatrics.

Assisted living residents are considered mainly independent for cares so staff is very limited in that situation. I would say this is not an uncommon ratio for med passing. As a matter of fact our ASL only has a med aide on for med pass in the evening and night, no nurse on except in the day shift. They call the LTC nurse for an emergency, like a fall.  The problem is in most states there is very little regulation on safe staffing ratios for ASL or LTC.  But with that said, if you are coming from a hospital background it will be totally overwhelming for you just based on the number of patients, it's a totally different situation than the hospital.

Specializes in ICU/ER/Med-Surg/Case Management/Manageme.
nightwingcreations said:

I have my doubts about the numbers of meds the OP is claiming to be giving. That's 66 meds per person. Anyway, in ASL they take themselves to the bathroom and other stuff independently, many would also be allowed to take meds independently, just hand to them and leave.  It's not the same as a nursing home.

Was my math totally wrong?  That wouldn't be surprising!  🤣  I'm familiar with some ASL's in my area and in those the med aide has to stay with the patient until they take the med.  Leaving them on a bedside table is an absolute no-no.  And it makes sense.  How would you know the patient was taking the med?  And yes, most do take themselves to the bathroom independently but like all (most) patients, always want a bit of help.  And they are slow.  Maybe things are different in your area altho' I hope not. 

Specializes in Geriatrics.

This is normal Numbers of residents for Assisted Living and often a job for medaides....maybe not giving insulin but the meds for sure. You are not doing basically anything but passing pills, not assessments, etc.  I'm not trying to be rude but besides the number of meds she claims not making sense, this is a nurse who always worked in a hospital and thought she would get an "easy job".... Guess what ? It's not! Nursing homes and Assisted livings are not staffed anything like a hospital.  

Specializes in LTC, assisted living, med-surg, psych.
DallasRN said:

I usually agree with Nurse Beth but not on this comment.  😧

 I would not stay around long enough to document concerns, communicate with management, or check state regs.  The only thing I would document is my notice to resign ASAP and I would then follow that with a report to the state health department, etc.  

There are easier ways to eliminate your boredom.  Good luck!!

This! ^^

Specializes in Telemetry, DD, Ortho, CCU, BHU.

Unsafe ratios is a problem these days and young people see this and they decide they don't want to go into nursing.

My friend was in a Nursing home for wound care.  She had the call bell on for 45 minutes.  I went to the Nursing desk and asked for assistance for her (she did not want me to help her) and was told they would be there soon.  30 minutes went by and no one came.  My friend called the Main # of the Nursing home and asked for assist.  Someone was there in 5 minutes.  They were so apologetic, but they all looked so exhausted already.  Just not enough staff.  I felt so bad for them.

Specializes in Med nurse in med-surg., float, HH, and PDN.

Had an LTC job passing meds, and all the other related jobs (lots of etc, etc, etc) for nearly that many patients. My problem was trying to stick it out and trying to improve my ability to deal with it all. I should have quit. I was fired, instead and it was the best thing that ever happened, although I had to go through all kinds of BON requirements. If I knew how horribly staffed the place was, maybe I wouldn't have taken the job in the first place. But as the country song went: "They say hindsight's 20-20, but I'm nearly going blind..." 

I say, if you find yourself in an untenable situation....GET OUT!

Specializes in Geriatrics.
DallasRN said:

I'm not in a position to argue since I don't work in an assisted living facility.  However, as part of my PT job, I'm in and out of facilities on a fairly regular basis and I've never seen a situation like the one being discussed.  I'll be asking staff on my next rounds.  But anyway, I was thinking...she said before noon so assuming a 7AM shift start, that would be about 528 meds/hour with about 13 to 15 meds per patient.  Meds coupled with blood sugar checks, (and we all know the minute we walk into a room someone wants to go to the bathroom, wants water, wants something!)and many older people are extremely slow...

I have my doubts about the numbers of meds the OP is claiming to be giving. That's 66 meds per person. Anyway, in ASL they take themselves to the bathroom and other stuff independently, many would also be allowed to take meds independently, just hand to them and leave.  It's not the same as a nursing home.

Unfortunately unsafe ratios like that are becoming a common thing. I'm not saying this is right. It's awful and unsafe for both you and the residents/patients. But you need to think about you and your lisence first. 

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