In your opinion, how many pts is too many in SNF/rehab?

CapeCodMermaid, RN · May 9, 2011

If someone's heart rate is 130 because her meds were late, she belongs in the hospital not in a snf.

20-25 is not an unusual work load. I've been doing this for years and only in one facility did we have 3 med nurses and a nurse manager for a short term unit...and we had sick people straight from the ER and 3 days post op quadruple bypass.

ComeClarity · May 9, 2011

So you're saying that I'm concerned for nothing? I became a nurse to take care of people - and I am not sure if I will be able to properly take care of these patients being a new nurse responsible for so many.

LissaLynn · May 9, 2011

I don't think anyone is saying to be concerned for nothing, but this is the life of long term care facilities. I have only worked LTC since graduating nursing school and I love it. There is no gray area...you are either going to love it or hate it. It's extremely fast paced due to the enormous work load.

It's totally normal to be nervous. It's a scary thing to be responsible for that many people! But it sounds like you have your heart in the right place, which is extremely important in LTC and I am sure you are an awesome nurse. Talk with your ADON or your DON and perhaps they can give you some more orientation until you feel comfortable. Trust me, once you learn the residents (which will happen faster than you realize) the rest will fall into place.

okchug · May 10, 2011

Ok....what's wrong here. The OP has had 1 WEEK of orientation!! is expected to care for 25 patients!! and this is not regular LTC but SNF/rehab.....if nurses keep "just getting used to it" nothing will change. I'd talk to your DON and ask about the promise of 3 nurses, and extending your orientation- 1 week is insane!

wish you luck.

ComeClarity · May 10, 2011

I don't think anyone is saying to be concerned for nothing, but this is the life of long term care facilities. I have only worked LTC since graduating nursing school and I love it. There is no gray area...you are either going to love it or hate it. It's extremely fast paced due to the enormous work load.
It's totally normal to be nervous. It's a scary thing to be responsible for that many people! But it sounds like you have your heart in the right place, which is extremely important in LTC and I am sure you are an awesome nurse. Talk with your ADON or your DON and perhaps they can give you some more orientation until you feel comfortable. Trust me, once you learn the residents (which will happen faster than you realize) the rest will fall into place.

Uh, this is not just a regular LTC unit.. there are a few long-term residents but most are short-term rehabbers or just released from the hospital & too sick to go home yet, still on IV abx or whatever. It kind of reminds me of a med-surg floor in a way.

I guess they figure after a week we should have it down-pat..

LissaLynn · May 10, 2011

okchug - 1 week of orientation is actually a lot more than a lot of people get in LTC facilities.

And OP, most LTC facilities have short term rehab patients and very sick people on IVs, etc. Most facilities are used just for their rehab programs alone, so a lot of post-op short term patients.

And no, they don't expect you to have everything down pat in a week, which is why if you don't feel comfortable, just talk to your DON.

LaneRN · May 10, 2011

I went into a LTC/SNF right out of LPN school. I also felt the same way you do, but my DON told me in the beginning that if i did not feel ready to be on my own to just let her know and I am pretty sure yours feels the same way she would rather you tell her you need more orienting than for you to just take over and not feel comfortable. Good Luck I love Long term care and will graduate on Friday from an RN program and plan to stay where I am. Like someone posted earlier either you love LTC or you hate it. Just talk to your DON and I am sure everything will work out fine.

AhenRN1784 · May 10, 2011

I graduated from RN schoollast may and started my first job in a SNF. I had up to 25 patients at a time, on IV's, tube feeds, with external fixators, wound vacs... you name it. I was thrown onto the med cart after less than a week because the place was so poorly staffed. It was very scary and intimidating, I also started supervising 3-11 shift within a month. I felt like I had no clue what I was doing. but all I could do was do the best I could with tools and knowledge I had. The place was an absolute nightmare, although I loved my patients after 7 months I quit without finding another job. When I look back on that experience I am very thankful i got out when I did becuase I felt like my license was at risk. My advice would be to see how you do, but If you don't feel like your practicing safe nursing care, put your license first and don't risk it.

I have since found a new job in a SNF where I only have upt o 12 patients at a time. So it's not required that you have that many patients. Good luck and hope this helped.

CapeCodMermaid, RN · May 10, 2011

Wow...I didn't say you shouldn't be concerned...I said this is what most SNFs are like. Patients are getting sicker and we need to be able to keep up. Since reimbursement hasn't caught up with this, staffing most likely won't increase in the near future.

N.U.R.S.E. · May 10, 2011

Okay people let's stopmaking excuses for the powers that be their is no w2ay that you can safely. Take care of your pts and do everything according to the bon board of nursing I just took the same concerns to my nurse manager adon and the don to no avail I am upset that many of you seem to see nothing wrong with this in my facility we have 30to32 pts you might have 7 accuck 5tubefeeders I with a colostomy bag. Sceduled insulin for 4,6,8 some meds where contingencies are required pulse. Bp monitor the dining room answer the door chart do body audits 4 per shift supervise cnas talk with family members doctors. And that only if nothing. Happens like a fall or no goes into shock from hypo/hyperglycemia no seizuresor anything else let's not foret adding new meds that come in treatment and charting on atleast 15 of the 30 you have now remember to do every thing azccording to the stat board of nursing oh yeah we have med call at 4,6 8 and may two or three people have meds at 10 and remember to flush those tf and hang new nutritional supplements if you all that say no problem are you doing everything according to the bon if so send me how you manage your time so well remember to take your 2 fifteen min breaks and your 30 min lunch break and be ready to go by the end of your shif please. Help me bcz I am unable to despite my best laid plans

Mudder · May 10, 2011

Count yourself lucky, where I work, we have 40 pt's, most with IV's, tube feedings, wound vac's etc. with 2 nurses and a unit manager on 7-3 shift, but come 3-11, they drop it down to 1 nurse (and she's usually a new grad that doesn't know any better). Since I'm the day unit manager, if someone calls off on 3-11, I have to work that shift. It's not safe........I've told management repeatedly, they just don't get it. They even keep a nurse for that shift because no one else will do it and I've given them documentation she doesn't pass all her meds.......that's why I have put in my notice......I'm getting out of there before someone dies because it's too much and the administrator just wants to make sure he gets his bonuses and doesn't really care about the patients or the nurses

RUN.........RUN AS FAST AS YOU CAN!