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?!

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

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

Dear Nurse Beth Advice Column - The following letter submitted anonymously in search for answers. Join the conversation!

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nightwingcreations, CNA, LPN

28 Posts

Specializes in Geriatrics.

Aug 15, 2024

DallasRN said:

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.

LOL, no your math was not wrong but you were basing it on giving meds every hour, that isn't happening in ASL,(or anywhere else really). Also all that is required to administer own meds is an assessment that they are able to do so and are aware of what they are taking. Even in Long term care there are a few who can do this. They are basically independent and many still own their cars and drive them, so yes they can take their meds. ASL has rules for being a resident there and they do have to be able to take themselves to the bathroom and do most cares themselves. They get assist with bathing and household stuff. (The rules might be different in some states I suppose, but not too much or it wouldn't be assisted living...) But my main idea was, I doubt that she has 40 res. receiving approx. 66 meds each before noon.

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sleepwalker, MSN, NP

450 Posts

Specializes in Occupational Health.

Oct 15, 2024

nightwingcreations said:

But my main idea was, I doubt that she has 40 res. receiving approx. 66 meds each before noon.

Exactly

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delrionurse

248 Posts

Oct 31, 2024

Nurse Beth said:

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?!

That is quite normal and even 1:60 in some states. I read Nurse Beth's comments about reporting, and when I passed meds, you can bet I reported, I called state, I did everything and nothing was done. I believe that state is immune to it, heard everything and know they can't do anything about it. I've watched state come, investigate, walk out the door and say no deficiencies were found. What a slap in the face. I continue to report and document regardless. I still advocate for the patient until something is done.

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