Leaving LTC for hospital

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:( I'm sad because I feel like I have been forced into a decision to leave the LTC facility and the residents that I love because of poor staffing. I work nights 11-7 and we have 2 LPN's and 6 CNA's (on a good night) with 120 residents including 42 on a locked dementia unit. On the other two units we have 12 tube feeders (3 continuous and 9 bolus,all nine of which are fed at midnight and 5 a.m.) 2 trach patients (one who is in a persistant vegitative state and currently as MRSA in her sputum). There are a total of 22 insulin dependent diabetics in the facility, several of whom are unstable. We give all the a.m. dilantins, place all the nitroglycerine patches, do all those feedings, suction the trach patients, give all the a.m. doses of lasix, give all the a.m. doeses of reglan, do all the finger sticks, plus give the a.m. doses of scheduled insulin at 6:30 a.m. in addition to any sliding scale that is necessary. We change out all tubing, clean all the equipment, order all supplies, do chart checks, MAR verification. In addition to this, we are currently charting on 26 residents between the two of us nurses, and obviously, if we are charting on them, then we are expected to assess and get vital signs on all 26 residents. Add to this, all the confusion of the residents on the locked unit. Fights break out nightly. Last night, I had a fall that resulted in a hip fx and wrist fx. In fact, in the last three weeks, there have been three fractures. Two hip and one wrist. I have also had a full code who died on me in the last few weeks. The other night shift nurse is going on medical leave for her second knee surgery in the last year. the facility (read DON) has known that this day was coming for three months now. She has done nothing to replace the other nurse, and now tells me that 'legally, one nurse can do it on nights'. Because, apparently due to the fact that there are 15 licensed nurses on days and 6 on 3-11, the facility falls well within the legal number of required nursing hours needed to satisfy state requirements. so, therefore, it is expected that i will accept a ratio of 120/1. Needless to say, I am exhausted, frustrated and feel like I put my license on the line every night I go into that place, and i refuse to do it alone. So, I have decided to accept a job on a post surgical unit at a hospital 20 minutes away. Does anyone here have a similar situation with such an outrageous resident nurse ratio, and if so, how do you handle it
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OMGoodness. I can't imagine them thinking that 120 to one is acceptable! Just because the other shifts meet or go over the staffing numbers, nights still needs the staff. That is sooo much work to be doing. Why do you have to give so many meds at night if they have 15! licensed nurses on days? Obviously it is unsafe.....look at all the falls/ fx. I'm a fighter and normally would stick around if I loved the place, but with all the stuff you explained.....run. Even though the ratio might be okay on paper, I'm sure the state would love to investigate the high rates of accidents ( no fault of the nurses....you just can't do all of that work)

A pat on the back and hug for all the work you have done!

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Specializes in cardiology, LTC.

Are you sure we don't work in the same facility? :eek: I refuse to work nights for the same reason. On nights we usually have 1 nurse per 60 skilled residents. All these pt are supposed to be charted on every shift. At night there is only 1 nurse so guess how many are supposed to be done on nights? Night shift gives all the insulins, scheduled and coverage for sliding scales, thyroid meds, all before breakfast meds, and changes out tubings for O2 and tube feedings. On 3-11 it usually isn't much better. Lately we have been running on two nurses and three CNAs. Pts are late getting meds, gettings trays passed, treatments are going undone. There are not enough hours in the shift to do correctly everything that needs doing for these patients. They deserve a lot better than bare minimum staffing. Who cares if it is legal to staff those numbers. That is why when I finish my RN in two months -HOORAY!! -I am going back to a job in a hospital. Love my patients- hate the consistent short staffing in LTC.

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Specializes in Case mgmt., rehab, (CRRN), LTC & psych.

I would leave this LTC facility if I had to do all the work you've been doing.

Good luck with your job change. I hope it works out for the best. ;)

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Specializes in MS Home Health.

AHHHHHHHHHHHHHHH I just posted why I am afraid of working in long term care on another thread even though I am drawn to it!!

renerian :eek: :chair: :sofahider

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OMG, it is getting worse! My DON has now decided that in addition to a resident to nurse ratio of 120:1, that on Feb. 28, I will be able to do MAR/TAR change over ALONE!. Monthly change over for 120 residents is a 5 hour job for two nurses because the RN's who are suppose to be verifying the new MAR's/TAR's do a lousy job at bringing forward any new orders and making sure all recent D/C's are taken off, so we have to go over each sheet and basically do what they are suppose to be doing. So, it isn't a matter of just taking off this month's MAR/TAR and replacing it with the new one. We wind up working overtime on the first of every month just to get all the new physician's orders on the charts! We still have to pass our meds on change over night. My DON has taken leave of her senses or else she's just trying to take advantage of me because I put in my notice.

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Ummmm Is this a corporate facility? Anyone you can call about this? What about the Administrator? This is total BS. I still can't get over a 1:120 being legal. Just because the numbers tell you how many nurses you need in a 24 hr day Im still guessing you need at the minimium 2 nurses? Your state should have some type of regs for this.

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She has done nothing to replace the other nurse, and now tells me that 'legally, one nurse can do it on nights'. Because, apparently due to the fact that there are 15 licensed nurses on days and 6 on 3-11, the facility falls well within the legal number of required nursing hours needed to satisfy state requirements. so, therefore, it is expected that i will accept a ratio of 120/1.

This is what burns me. State requirements that do not look at the whole picture, and facilities that use them to put residents in danger and a nurse's license on the line.

Why would it make sense, to a reasonable individual, to have 15 licensed nurses on day, less than half of that on evenings (6), and a mere fraction on nights (1-2) for 120 residents? :angryfire :angryfire

My DON has taken leave of her senses or else she's just trying to take advantage of me because I put in my notice.

Your assuming she had sense to start with, obviously not. If she is an RN, you may want to consider reporting HER to the SBON for patient neglect and endangerment. DO NOT agree to work these shifts alone.

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Specializes in Geriatrics, Cardiac, ICU.
This is what burns me. State requirements that do not look at the whole picture, and facilities that use them to put residents in danger and a nurse's license on the line.

Why would it make sense, to a reasonable individual, to have 15 licensed nurses on day, less than half of that on evenings (6), and a mere fraction on nights (1-2) for 120 residents? :angryfire :angryfire

Your assuming she had sense to start with, obviously not. If she is an RN, you may want to consider reporting HER to the SBON for patient neglect and endangerment. DO NOT agree to work these shifts alone.

I'm thinking about doing some LTC.

Let's say I report to work and find out I will be working alone with 120 residents--if I don't take the assignment (flat out refuse to take over this amount of people) would I be considered to have neglected my patients or is that only if I accept the assignment?

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My DON has taken leave of her senses or else she's just trying to take advantage of me because I put in my notice.

I would send her a certified letter or something akin to it, with the reasons why you gave notice clearly specified....AND I would also inform her - IN WRITING - that I would NOT be doing any more additional chores than I am currently doing.

That way, if they accuse you of anything, it won't hold up.

Not to mention: if they are going to start this sort of thing, I would consider forgoing the two weeks' notice. If they start playing these sort of games when they're already endangering your license, I would simply call in and tell them I'm not honoring my notice because of what THEY are doing.

I mean, it's not like you're going to be eligible for rehire.

Let's say I report to work and find out I will be working alone with 120 residents--if I don't take the assignment (flat out refuse to take over this amount of people) would I be considered to have neglected my patients or is that only if I accept the assignment?

If you don't take report, they can't say you abandoned anyone. JMO.

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If you don't take report or the keys, than no...its not abandonment. I'd always look around for the other staff before getting started. Hard sometimes where I work, someone might be running a few minutes late and I normally want to get started with report, etc. Thank goodness we don't have that problem.

I just looked at PAs staffing regs....yep 1Rn on 11-7 for 120 is okay. but it also added this

" The Department may require an increase in the number of nursing personnel from the minimum requirements if specific situations in the facility—including, but not limited to, the physical or mental condition of residents, quality of nursing care administered, the location of residents, the location of the nursing station and location of the facility—indicate the departures as necessary for the welfare, health and safety of the residents."

Authority

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Why would it make sense, to a reasonable individual, to have 15 licensed nurses on day, less than half of that on evenings (6), and a mere fraction on nights (1-2) for 120 residents? :angryfire :angryfire

All the "important people" who hold a license work on days, which is why they have so freaking many licensed people on days. All the nurses on evenings are on the floor with a med cart. Same as with us on nights. We don't have any "important people" on our shifts. Unfortunately, those "important people" do very little direct resident care, yet they are counted into the total number of required nursing hours. Burns me up, too. I think the formula for required nursing hours should be on a shift by shift basis. We have an "on-call nurse", but that's just on paper too. On call nurses are all day shift "important people" and they never come in. In fact, since I've been working at this facility only one on call nurse has come in to work, and that was on a holiday when there was alot of nurse and CNA call outs throughout the day, but she just sat in her little office doing her own MDS work. She didn't push a cart or give direct resident care. She was just a warm body with a license in the building. It's all a farce. My attitude has gotten bad and it really is time for me to move on. I'm looking forward to two weeks vacation between the end of this job and the start of my new one. Hopefully, there will never come a day when I'm expected to work the whole freaking hospital alone. If there does, I think I'll have to leave nursing.

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