Is this supposed to be "quality care"??

[WannaBeNrse]

Hi,

I am just curious if what I am experiencing is common in nursing homes all over the country, or if I just work at a "bad" one..... my problem is, basically, the care I am able to provide with the work load I have is not the care I wish to provide. On most days, I feel like I don't have a snowball's chance in hell to get everything done.

Here's the situation: Our LTC has 3 wings, two with 18-20 residents each, and these wings have two aides on, and one wing with 13 residents, and I have to work this wing by myself. Two of my residents are 2:1 assists, 5 are on tabs alarms and should technically not be left alone in the bathroom (but i don't have a choice), and in the morning I have 2.5 hours to get them all ready for breakfast, this includes one bath (which takes at least half an hour). The problem is, when the first few residents are done with breakfast, they need to be toileted, but the rest of my residents isn't even out of bed yet. I don't have any help with answering lights etc. (since i am by myself on this wing), so i get further and further behind, and all along my charge nurse keeps reminding me of things she wants done an hour ago. Needless to say, i get completely stressed out, i am constantly watching the clock, and the slightest deviation from the normal routine makes things even worse. I don't have more than 10 minutes to spend with each resident- some of them take almost this long to get out of bed. I don't have time to let them decide what to wear. Sometimes I am not able to answer the call light until it is already too late, meaning the resident couldn't "hold it" any longer....The night shift "gets some people up for me" usually, but that alone doesn't help. Also, I don't think it's okay that residents - and mostly the ones who are too sick/too weak/too confused to object- have to get up and dressed at 5am or even sooner, just because our facility is not adequately staffed in the am shift. Quite honestly, if my grandparents had to live in a place like this, it would give me a stomach ache.

I have worked at this place for about 4 months now, and I am really ready to quit. I like the residents and I actually like my job itself, but the working conditions just do not agree with my ideals. Is it like this everywhere? Because if it is, the nursing crisis in this country is even bigger than i thought :-(

[SuesquatchRN, BSN, RN]

This is short staffing even for LTC. In NY it is more usual to have 1 aide to 10 people, with enough aides that they can work in pairs.

I would find another job and go.

[Heidi W]

Unfortuneatly, that is how it was at the LTC I began working at. I started working day shift and everyone said "you're crazy!!!" because that was my first job after CNA training....they were right. I know exactly what you are talking about, we had 4 wings, it's been a while but I think about 18-24 residents each, and we typically had about 6-8 aides (depending on how many called in) I was so stressed, I went home crying every day. I eventually had to switch to night shift. there we had 4-5 aides for the whole building. I loved working nights though, it was so much more relaxed, and some of the residents like to get the chance to actually talk to someone for a while.

I ended up moving and now I work in Home health. I absolutely love it! I recommend it if you are concerned about the quality of care you can provide. I love taking care of one person at a time, you go at their pace, and you actually get to know them. And most importantly I know they are receiving the care they need/deserve.

[TheCommuter, BSN, RN]

I work at a very upscale facility located in a wealthy part of the city. However, the facility is so understaffed at times that we occasionally have 1 aide caring for 28 residents by herself, since we could not find another aide who was willing to work that day. With 28 residents, we know that some showers are being skipped, some patients are not being fed, and some time-consuming ADLs aren't getting done.

LTC is in shambles in America.

[Valerie Salva, BSN, RN]

.... my problem is, basically, the care I am able to provide with the work load I have is not the care I wish to provide. On most days, I feel like I don't have a snowball's chance in hell to get everything done.

This is precisely the reason for the nursing shortage, and yes, this is typical.

"...we do not really have a shortage of qualified nurses. What we have is an insufficient numbeof nurses willing to work under the very difficult working conditions they face in hospitals. In 2000, for example, there were almost 500,000 nurses not working in health care -- many more than would be needed to fill every position in every health-care facility in this country. While some nurses choose to stay at home and raise families, others work in fields ranging from real estate to education to retail sales. In a great many cases, they do so because they believe that current conditions in hospitals prevent them from providing optimal -- or even adequate -- care to their patients."

http://www.post-gazette.com/pg/06241/716999-28.stm

[Cls62011]

Unfortunately, both nursing homes I've worked at are like this- short staffed all the time!

[bethin]

Needless to say, i get completely stressed out, i am constantly watching the clock, and the slightest deviation from the normal routine makes things even worse.

It's been awhile since I've done LTC, but on days we had 2 aides for 30 residents and on nights, the few times I worked, I had 25 residents by myself, NO NURSE in a lockdown unit.

Something I've learned when the work piles up and the stressometer is off the chart: take a breath, remind yourself that you're working as hard and as fast as you can. What you get done gets done. I know that probably sounds bad, but when I was dizzy because my HR was so high, I had to do something!

I quit LTC because of this. Med surg is still crazy, but not everyone is a total care and there's more nurses so more people to help out.

[pagandeva2000, LPN]

Yes, this is the basic state of long term care. I really hope that either myself or anyone I love has to ever be admitted to one, because the staffing is horrible and it reduces patient dignity.

[megykilo]

yup, it sounds just like the LTC where i work. so sad. what a system.

[scarlet]

ditto.

[DreamyEyes]

..... my problem is, basically, the care I am able to provide with the work load I have is not the care I wish to provide. On most days, I feel like I don't have a snowball's chance in hell to get everything done.

Exactly how I feel. (On most days, unless we have an extra aide on)

The sad part is, the place I work at is "assisted living", so all administration cares about is money- so they don't care if the aides are running around like crazy with no help and that the residents are suffering because of it. Don't get me wrong, I love all of our residents, but I don't think total COMPLETE care on residents (with hoyer lifts) is what I would call "assisted living"....not to mention that you can't give them the care that they deserve because you're too busy running around like a chicken trying to get everyone to breakfast in time. Can you tell I work mornings?!?!

[pumpkin92356]

Well sounds to me that this facility is out for the buck and not concerned with level of care. I dont know what your nurse to patient ratio is in your state but this is clearly not quality care nor is it safe for you or your residents. And believe me if one of them falls and breaks a hip or starts to have skin breakdown you are going to be the one they are going to want to point the finger at. I have said this over and over nursing care hours required by the state need to be figured per shift not on a 24 hour clock. A licensed nurse is considered to be two staff in the figuring of these hours. These hours are most important to the LTC facility because this is their payment from the government medicare program. If they had to figure it our per shift there would have to be so many nursing staff on duty per 8 hour shift. As it stands in most states running short on swing shift for example wouldnt have much effect on the 24 hour clock because maybe they were fully staffed on the other two shifts. Long as they come up with the right numbers per 24 hours they keep getting paid and you keep getting overworked and understaffed.