Is every LTC nursing home understaffed? just wondering

Nursing Students CNA/MA

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OK here is a quick synopsis. Started "training" (loosely put). It was my second day today. Yesterday I worked the Alzheimer's unit. It had let's say 25-30 people. There were just 2 aides. They called another PRN who was not much help, he took about 15 breaks. The other aids worked hard, I mean constantly. They were stlll cool with me and I worked hard too. It's sort of difficult when the patients don;t know you and you are only going to be there one day.

Today I show up at the short term rehab. area and let's say there were 30 (?) residents. It was just ONE CNA until we got another PRN from the LTC hall to help. She was not familiar with the area. There should have been minimum 4-5 people to get the job done half way right. Plus there was a family insisting on a shower, and stayed until 3 when we said the next shift would give him one. Several other visiting families with many requests and some complaints about the facility right to me and this other CNA, comparing it to another. I got peed on several times (8) and pooped on twice, several residents with c-diff, hep , etc.

Anyways I am due to work nights so The meals won't be a worry and neither will the showers. But I have already been warned about the hall I am assigned to and basically it's a place where no one co-operates and helps. No I will tell you this, we had 3 women (2 pregnant) lift a 400 lb woman today. Even the nurse helped. i am NOT about to lift a 400 lb man by myself. I mean I know there are lifts right and I have to be trained on them.

Basically are all facilities like this? It is clean, nice, pretty but just today only I have had several complaints on the food (I could not cut the ham slice (Turkey?) for several residents it was so hard. The residents will compare this place to another just a mile away if they have stayed there.

Help with advice. I mean I KNOW this is not a productive environment and I am just staying there for my resume and the cash, yes the cash LOL

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Unfortunately understaffing is a problem just about everywhere...but some places to a far lesser degree. I'd say give it a chance for at least a little bit, finish your training and give it a few weeks. Sometimes places have bad phases, but once the new hires are trained, it's much better.

Like right now at my facility - there used to be 7 second shift aides on my weekend, which left us with 12-13 residents apiece. In the last month, one went to days, and two quit. SO now we are down to 4 aides per weekend until we get those spots filled. That leaves us with approximately 21 residents each. We have to train like that. It's not always like that, but will be until we get them trained and they're out on their own, you know?

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Specializes in geriatrics, dementia, ortho.

It may just be a bad phase, or it maybe chronic. In general, understaffing is a problem everywhere especially when someone calls off & it's really hard to get anyone to come in on their day off and cover. But if it's crazy for weeks on end, you can always try other facilities. I worked nocs at one place where I literally would never know if ANYONE would show up for dayshift to relieve me, and I only worked there one week before putting in my notice.

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Specializes in Mostly geri :).

In a word, yes.

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thank you for all the responses. They have given me insight. I was told there are 3 CNA's on the night shift. Yes people did call in sick and the PRN's did show up when called. THe training nurse made a huge deal of calling in 4 hours or at best 8 hours before you know you can't come in.

I will get a better feel for how things run at night. Also charting is done by hand not on a computer screen mounted to the wall like at other places so for a while after you finish your shift you chart. I mean Do people chart along as they go? I guess I will have to jot down in a notepad what i do cause I sure won't remember 7 hours later who did what. The other CNA's just told me to put what the other one did the day before in the charts, one CNA PRN just got tired of charting and after 45 minutes went home without charting the rest of her patients.

I will stay at this facility and learn everything I can and do the best I can that's what I know

Thanks again for all the responses

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The LTC facility I work in has a very good reputation and it's really not a terrible place to work (depending on who you ask)....but this very issue is the reason I will never work in such a facility ever again. There's no way an aide can give good quality care to as many residents as each one is assigned to on any given shift. Because you can't be there for everyone, we use alarms to 'babysit' the residents who are fall risks, hoping that the alarms will help you get to the resident in time to prevent a fall. Fine.....so what can you do when you hear an alarm going off and you are with someone you just put on the toilet who can't be left alone? You hope another aide will jump in and help. Many times that doesn't happen and the person still falls. A couple of months ago, we had a lady take her alarm off and get herself out of bed alone -- she fell and re-broke her hip, then died a few days later. It was during a busy morning while every aide was busy getting everyone else up, this lady got tired of waiting for help and tried to do it herself. These LTC facilities get away with this kind of horrendous **** because they try and staff as few people as they can possibly get away with.

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Specializes in LTC.
Also charting is done by hand not on a computer screen mounted to the wall like at other places so for a while after you finish your shift you chart. I mean Do people chart along as they go? I guess I will have to jot down in a notepad what i do cause I sure won't remember 7 hours later who did what. The other CNA's just told me to put what the other one did the day before in the charts

OMG, pet peeve! I hate it when people just copy down the ADL codes from the day before on rehab patients. It takes 2 seconds to actually THINK about how much help the person needed with each ADL and put down the right code! Same goes for charting off the care plans- people just write their initials without even reading what they're signing off on and then 2 weeks later I'll have that person on my assignment and see that for 2 solid weeks people were signing something that was dc'd a long time ago!

After a while you will not need to write everything on a notepad once you get used to the residents, routine, etc. I got out of work 2 hours ago and I could probably tell you from memory at what times each resident peed in the toilet or was incontinent today and what everybody ate and drank for both meals. Sometimes I remember what the vitals were too, but I do still write those down.

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The LTC facility I work in has a very good reputation and it's really not a terrible place to work (depending on who you ask)....but this very issue is the reason I will never work in such a facility ever again. There's no way an aide can give good quality care to as many residents as each one is assigned to on any given shift. Because you can't be there for everyone, we use alarms to 'babysit' the residents who are fall risks, hoping that the alarms will help you get to the resident in time to prevent a fall. Fine.....so what can you do when you hear an alarm going off and you are with someone you just put on the toilet who can't be left alone? You hope another aide will jump in and help. Many times that doesn't happen and the person still falls. A couple of months ago, we had a lady take her alarm off and get herself out of bed alone -- she fell and re-broke her hip, then died a few days later. It was during a busy morning while every aide was busy getting everyone else up, this lady got tired of waiting for help and tried to do it herself. These LTC facilities get away with this kind of horrendous **** because they try and staff as few people as they can possibly get away with.

I feel as if there is no way I can give quality care to 20 plus residents being new. How can i get all the 5 people up and to the nurse's station and dressed and doing my last round at 4:30 am while changing sheets, briefs etc. Yes they use those wheelchair and bed alarms for the wanderers who have dementia as babysitters there as well. I am having the hardest time realizing I can't waste a second and while I have 2 call lights going and am doing my last rounds the other CNA sitting at the nurse's station or smoking her 15th smoke won't even think of helping the newbie

I guess the facility looks clean and fancy but even the residents in the middle of the night will ask me " have you been very busy, is there just one of you" they know we are way understaffed for that hall. Anyways my plan is to start getting people up earlier than 4:30 am and dressed until I am used to it because I HAVE TO BE OUT the door at 7am sharp to be home for my husband to go to work on time (can't leave the kids alone).

Anyways I guess this is how a lot of these places are run they probably only get so much from the state or insurance and another CNA on the hall giving good care would kill the budget.

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I've found its really hit or miss. I work post-acute/recovery on the weekends and we have a max of 42 beds. There have been days there were just 2 NA's for 36 people, and some days there are 4 NA's for 21 people. They always have 3-4 scheduled but it only takes one person to call in to make a easy day go bad.

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There is hope. When I first started at my facility we were understaffed. We have quite few residents that are 1:1 and on close supervision so they need their own aides. CNAs got extremely angry and complained to the management. When inspection came one day and they saw all the shortcuts we used just to finish everything by the time our shift ended, the bosses finally listened. We are no longer understaffed. We get 10-11 residents maximum during the day but most CNAs get 8 (only on one of the wings we have 2-3 more). But people leave all the time and my nursing home is looking for aides too. Just yesterday I saw their ad on craigslist. I feel lucky that my bosses actually care about their facility's reputation. I just wish we had more CNAs during the night :[

PS- We have a sign up sheet by our punch in clock where people can put their name and they can work overtime. Also, there is usually a spot for a "back up" person. The sheet is always filled to the very last spot. A lot of people need money and it shows.

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There is hope. When I first started at my facility we were understaffed. We have quite few residents that are 1:1 and on close supervision so they need their own aides. CNAs got extremely angry and complained to the management. When inspection came one day and they saw all the shortcuts we used just to finish everything by the time our shift ended, the bosses finally listened. We are no longer understaffed. We get 10-11 residents maximum during the day but most CNAs get 8 (only on one of the wings we have 2-3 more). But people leave all the time and my nursing home is looking for aides too. Just yesterday I saw their ad on craigslist. I feel lucky that my bosses actually care about their facility's reputation. I just wish we had more CNAs during the night :[

PS- We have a sign up sheet by our punch in clock where people can put their name and they can work overtime. Also, there is usually a spot for a "back up" person. The sheet is always filled to the very last spot. A lot of people need money and it shows.

This makes me wonder how the LTC facility that I work at continues to have a 'good' reputation. We have a number of people who really need 1:1 care but rarely get it because it makes the nursing hours look bad and the DON gets her butt chewed out by corporate if she doesn't staff us down to the bare wire. At a recent CNA meeting, the staff coordinator was criticizing the NOC shift for not doing such chores as cleaning all the wheelchairs and seat pads at night. One of the CNA's spoke up and said 'Hey, do you realize that the NOC shift is chronically short right now? That's why it isn't getting done, what about having housekeeping back us up on this and help out when they see we're in trouble?' The staff coordinator got an annoyed look on her face and said that housekeeping was not going to be willing to chip in on this. See, we're supposed to have 4 aides at night and there are times we have only 1 person -- for a 64-bed facility. Usually they manage to get at least one other person to come in, but it's been a long time since they actually had all 4 aides present on a NOC shift. And what's with the housekeeping staff -- buncha 'ole bitties who get really pi**ed off if they have to do any more work than they absolutely have to, never mind the fact of how hard all the CNA's bust their butts to fill in the gaps left by others.

As far as shortcuts, management doesn't even want to hear about that as long as everything looks OK on the outside and they don't get any complaints from family about their loved one getting poor care. Which yes they do at times.

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Specializes in LTC.
When I first started at my facility we were understaffed. We have quite few residents that are 1:1 and on close supervision so they need their own aides. CNAs got extremely angry and complained to the management. When inspection came one day and they saw all the shortcuts we used just to finish everything by the time our shift ended, the bosses finally listened. We are no longer understaffed.

If that was my facility the aides that were "caught" taking necessary shortcuts would have been chewed up and spit out. Everyone would have heard, "You better get it right" and the staffing would have remained the same.

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