Long term care SNF staffing

hope3456, ASN, RN · Sep 9, 2007

What you describe is the never ending problem in LTC's.....same thing happened in the one I worked at except I worked the night shift. The 8-5 mgmt thought that i just sat on my behind all the time. That is what I was accused of. In reality, I answered call lights constantly b/c there weren't enough CNA's, helped the eve shift RN finish up admission work b/c yes, she did get all the admits, plus the meds, hang IV's, ect.

I used to wonder what the DON did all day.

Nascar nurse, ASN, RN · Sep 10, 2007

The 8-5 mgmt thought that i just sat on my behind all the time. I used to wonder what the DON did all day.

Just as you see the unfairness of mgmt thinking you're sitting on your behind all the time, it is just as unfair to "assume" that the DON is sitting on her behind all the time.

Staffing issues (which at times can take the whole darn day!!!), staff complaint resolution, family complaint resolutions, following up to ensure state requirements are being met (ultimately DON is responsible for nursing care and while most nurses are accountable, there are always a few in each facility that need a "babysitter" to watch over every thing they do - someone's got to go behind and clean up all the little things), all the coorporate complaince reports, etc just to name a few. Believe me, its a hell job and no one is ever happy with the results!

Trust me, I have spent lots of time on both sides of the fence - neither job is a cakewalk

djewel · Sep 10, 2007

So what is customary for staffing for a SNF in Mng? I have too, been on both sides of the fence. I am not saying that any one job is easy. I am just wanting to know what to expect from Mng.? Should the Don have an MDS plus 2 nurses on her shift? This seems alittle unrealistic to me unless this was a very large faciltiy. This is a very small facility, so I am just wanting to know again, what is customary in staffing? I was once a DON, plus did all the on call, MDS's, Care plans, med orders, had a charge nurse only and that was it. This was not a SNF, so I am not clear what is expected from a SNF? I took care of upper mng, plus dealth with families and residents on a daily 24/7 basis. I felt very overwelmed, but it was all done. I did not have nurses on the other shifts most of the time, this was very rare. The ADM and myself took care of everything. It is very hard as an eve. night nurse in a SNF to feel as I am doing it all, when I am not. I relize the day shift had their stuff to deal with also, but in reality it just does'nt seem quite fair to me that the day shift has all the help when the eve. and night nurse has little. ADM will cut the direct care and keep adding to every dept. for the day shift. It just does'nt add up to me. If anyone can assist me , please do, I am desperate. Thank-you so much!

djewel · Sep 10, 2007

Thank-you. So how big is your facility and what is the day staffing for a SNF? I am curious on how other homes are ran. Does your DON delegate any of her responsibilites to other staff, like her MDS, or a charge nurse? I know for a fact that a nurse does'nt sit on her bottom at night, there is always plenty to do and more. Even in a small home I run all night doing Skilled assessments and meds ect. ect. I like working nights as it is better than the eve. shift, as I can't keep up when I do the eve. shifts. I have to do what does'nt get done on the eve. shift, but in all, it is better besides having to change my sleep schedule around, this is probably the most wearing on my body. Thank-you for you help.

hope3456, ASN, RN · Sep 12, 2007

Just as you see the unfairness of mgmt thinking you're sitting on your behind all the time, it is just as unfair to "assume" that the DON is sitting on her behind all the time.
Staffing issues (which at times can take the whole darn day!!!), staff complaint resolution, family complaint resolutions, following up to ensure state requirements are being met (ultimately DON is responsible for nursing care and while most nurses are accountable, there are always a few in each facility that need a "babysitter" to watch over every thing they do - someone's got to go behind and clean up all the little things), all the coorporate complaince reports, etc just to name a few. Believe me, its a hell job and no one is ever happy with the results!
Trust me, I have spent lots of time on both sides of the fence - neither job is a cakewalk

I didn't "assume" that the DON did nothing, I just wondered what she did. I've known others who were great....this one I am referring to, however, got fired not long after I quit so it doesn't really matter anyway. Long story short, I found her practices questionable....apparently I wasn't the only one.

Anyway, this 65 bed SNF had on mgmt staff a DON, ADON, MDS coordinator. Not to mention the administrator, an admitting social worker and a regular social worker. Other facilities I have known of have a similar pattern and I am in Colorado. Maybe things are different elsewhere.

And I worked nights, so I was somewhat out of the loop.

djewel · Sep 13, 2007

Hello, did your DON have also a charge nurse along with the ADON and MDS Cordinator? I know my DON is very busy, never said she sat on her behind??? I have been a DON and never had the privledge of having a ADON or MDS, I did it all, but it was not a SNF, it was a reg. LTC. I had no Professional lic. nurses on every shift, so I had to take call 24/7. My question is still this, was is normal in a small SNF, are they all different? Is it common to have 4 nurses on a day shift, while the other shifts suffer? I know everyone is very busy, no one just sits all day at this home, just curious to find out from others what thier homes have as far as staffing/Nurses, DON, ect. in a small SNF???? If anyone could comment, thank-you.

nrse77 · Jan 20, 2008

I'm a LPN in LTC and the DON, ADON ,receptionist, MDS cordinator,social worker, therapy, med.records, and all of the other office people leave at aproximately 4PM. I am the charge nurse on one of the largest halls, there are three. My hall has 47 residents right now. Some evenings that I have worked 3-11PM, I have had to work with 2 aides and myself. That includes doing my own meds, charging,taking orders,dealing with pharmacy,admits,answering the phone, and the million other things that there are to do. On a regular staffed day on my hall I am staffed with a Med Tech.(CMT), at least 3 aides and my self. I just don't understand how the ADON and the DON can just walk out the door at 4PM on days where we are this short and not stay to help out. I was always under the impression that was the ADON and the DON's position to work the floor if there was nobody else to do it. There is always a person "on-call" where I work in case of a call in. This is always the DON or ADON. When 2 or more people call in to where we are just to short to function we call the on-call we are always told to do our best and do what we can. The on-call has never once come in to help or has called people in to help out. I don't inderstand the "on-call" persons position.

Does anyone know the aide per rsident ratio and/or nurse ratio by state law? Or is there even one these days?

Simplepleasures · Jan 20, 2008

I'm a LPN in LTC and the DON, ADON ,receptionist, MDS cordinator,social worker, therapy, med.records, and all of the other office people leave at aproximately 4PM. I am the charge nurse on one of the largest halls, there are three. My hall has 47 residents right now. Some evenings that I have worked 3-11PM, I have had to work with 2 aides and myself. That includes doing my own meds, charging,taking orders,dealing with pharmacy,admits,answering the phone, and the million other things that there are to do. On a regular staffed day on my hall I am staffed with a Med Tech.(CMT), at least 3 aides and my self. I just don't understand how the ADON and the DON can just walk out the door at 4PM on days where we are this short and not stay to help out. I was always under the impression that was the ADON and the DON's position to work the floor if there was nobody else to do it. There is always a person "on-call" where I work in case of a call in. This is always the DON or ADON. When 2 or more people call in to where we are just to short to function we call the on-call we are always told to do our best and do what we can. The on-call has never once come in to help or has called people in to help out. I don't inderstand the "on-call" persons position.
Does anyone know the aide per rsident ratio and/or nurse ratio by state law? Or is there even one these days?

The ratios that are in place are antiquated, they were from the days that nursing home patients were low acuity, things have changed drastically in the last 15 years or so.

nrse77 · Jan 20, 2008

I just wrote about being the only nurse on 3-11pm and passing my own meds, having 3 aids, and having 47 residents. I charge on one hall of LTC and the other hall in our building is also LTC and they have two less residents. They were staffed with 2 nurses a CMT and 3 aides. They have the same type of residents. We both have several g-t's. I actually have more, and more difficult people. The aides in the buiding were asking why this ADON was doing this to me d/t it has never been done to another nurse. It's always done to me. When I quetioned it I was basically told if I didn't like it I could go find another job. I love the people I work with. This ADON is new this this company. She came in and completely took over and the DON allows her to do so. The DON has only been in her position a very short 6 weeks. Everyone sees her pushing me, and only me. My question is to you, is it time to go elsewhere? I think I'm a very good nurse I never qustion my assignments. They always change everyones schedule without notice and I go with the flow never c/o these little things that bothers everyone else so much. Still, it seems she tries to see how much she can do until I speak up. The previous DON was very tough but great, and she never treated her nurses this way. Should I leave? Has anyone encounted a problem like this?

CapeCodMermaid, RN · Jan 20, 2008

The regulations, in Massachusetts at least, says staffing must be 'adequate.' We could all argue all day about what is adequate and what is not. I've never worked in a building where is was part of the ADON or DON duties to pass meds. I've done it , of course, but it was never part of the job description.

The number of management type nurses depends on the size of the building and whether the residents are skilled or not.

My building has 135 beds, we have a DNS, ADNS, 2 MDS nurses, a Staff Development Coordinator and 3 nurse managers on the day shift. On the evening shift we usually have a free floating supervisor. The last building I was in had 120 beds with the same number of management types but fewer nurses on the floor. Every company is different...mostly it depends on your Medicare census

pumpkin92356 · Jan 27, 2008

Where I work at you have DON, MDS, staff developer etc all on the day shift and we have one extra CNA total of 4 aides and LVN for 50 patients. What gripes me is that the swing shift does everything we do on day shift but we serve one extra meal that is lunch. The PM shift does just as many baths and during the dinner time one of them has to go to the main cafeteria because some of the residents about 5 prefer to dine independently and an aide has to be observing for choking assisting with serving food etc. This leaves 2 aides and one lVN to tackle the rest of the facility during dinner. We have 11 residents on bedalarms and 2 that yell out for the commode at least every hour. The staffing for pm shift needs at least one more aide like we have on dayshift.