LTC facility trying to fire me over refusing to take on 50 residents

Specialties Geriatric

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I have to get opinions, i cannot find much about the GA law against LTC facilities and nurse to resident ratios. So, my situation was basically an employee called out for the unit that is on the same floor as my unit. I get to work and they tell me that I have to take on both units all night! Both units contain 49 residents and one of the residents is very violent and has attacked many nurses. Management even threatened that if I did not take the keys to other hall that they would report me to state for abandonment, yet I was NOT scheduled to work that unit, and there and the day Nurse was still there. Also, I work 12 hr shifts, I had gotten called in on my day off just the day before this mess happened. This happened on a Thurs. I had already worked Mon, Tues, off wed, Supposed to work Thurs, Friday, Sat, and Sun. and they wanted me to take on 2 units by myself. Is this NOT crazy!!!

Specializes in LTC,Hospice/palliative care,acute care.

That's not safe. What happened that shift? Who covered the other unit? We have had so many calls off int eh past 6 weeks we have mandated a number of staff members.That stinks for everyone involved.

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Specializes in Pediatrics, Emergency, Trauma.

Maybe it's me, but the norm on night shift is 1:60 ratio with three CNAs at my facility; and the max norm going for my area; 45 is WAYY better than the ratio at my facility.

My only concern is not enough staff, especially for a resident with documented violence; THAT does need to be addressed. :yes:

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Specializes in Case mgmt., rehab, (CRRN), LTC & psych.
I have to get opinions, i cannot find much about the GA law against LTC facilities and nurse to resident ratios.
49 nursing home residents is a legally acceptable nurse/patient ratio for night shift.

I've had up to 68 residents on night shift. It is not as if you are doing time-consuming head-to-toe assessments on every resident. Since you work 7pm to 7am, you have the 8:00pm med pass. A small handful of residents receive some midnight meds, then there's typically a larger med pass at 6:00am. Between the med pass, you are charting and making occasional rounds.

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Specializes in LTC,Hospice/palliative care,acute care.
49 nursing home residents is a legally acceptable nurse/patient ratio for night shift.

I've had up to 68 residents on night shift. It is not as if you are doing time-consuming head-to-toe assessments on every resident. Since you work 7pm to 7am, you have the 8:00pm med pass. A small handful of residents receive some midnight meds, then there's typically a larger med pass at 6:00am. Between the med pass, you are charting and making occasional rounds.

Ever have 98? seems a bit much to me.

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Specializes in Case mgmt., rehab, (CRRN), LTC & psych.
Ever have 98? seems a bit much to me.
The OP is stating she had a total of 49 residents between the two units. Not 98. The OP clarified that she had a total of 49 on post number 5.
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Specializes in retired LTC.

Accdg to OP's post, it DOES sound like they wanted her to cover 2 separate units, equaling 98 pts. That's NOT appropriate. TOO UNSAFE.

Maybe in a governmental declared state of emergency, like a hurricane/blizzard/tornado/earthquake etc it could be required.

We don't know her pt case mix/acuities, so there could be some highly skilled pt care needed. Most LTC units' standard census is 60 with a few extra (I've seen 70). But not for one nurse to take on 98 pts!!!!

Just curious - what was the ACTUAL census? Not just the capacity. And why wasn't the other unit's prior nurse staying? She'd be the 'abandoning' nurse IMO. Was there a prior shift supervisor?

Regardless, OP shouldn't be running from unit to unit. My first suggestion would be to contact your and request some advice.

My next suggestion is to contact your State Ombudsman Office and your State Dept of Health with the details if you actually were the only one there. The BON will just be talking about 'practicing safely' and they'll refer to DOH for staffing numbers. To my knowledge, only California has any true legislation re staffing numbers and then it only covers hospitals, I believe. I could be wrong about that.

OP - what was the final outcome. Did you get stuck? Did anyone else stay or come in? And be aware, if you do contact any gov't agency, and they investigate, you'll be considered stirring up dust. So be prepared for any negative fallout. But then if there's any retaliation, you'd be covered by 'whistle blower' regs. It might be time to start looking elsewhere as your current employer doesn't seem to regard pt safety or staff.

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Specializes in Pediatrics, Emergency, Trauma.
Accdg to OP's post, it DOES sound like they wanted her to cover 2 separate units, equaling 98 pts. That's NOT appropriate. TOO UNSAFE.

Maybe in a governmental declared state of emergency, like a hurricane/blizzard/tornado/earthquake etc it could be required.

We don't know her pt case mix/acuities, so there could be some highly skilled pt care needed. Most LTC units' standard census is 60 with a few extra (I've seen 70). But not for one nurse to take on 98 pts!!!!

The OP has already clarified:

No both units total of 49 residents with 3 CNAs and all night, 7p to 7a one nurse

Even in a complex skilled unit, 45 is actually do able.

Just curious - what was the ACTUAL census? Not just the capacity. And why wasn't the other unit's prior nurse staying? She'd be the 'abandoning' nurse IMO. Was there a prior shift supervisor?

Regardless, OP shouldn't be running from unit to unit. My first suggestion would be to contact your malpractice insurance and request some advice.

EVEN on separate units; not ideal, but it's not against the law, unfortunately.

My next suggestion is to contact your State Ombudsman Office and your State Dept of Health with the details if you actually were the only one there. The BON will just be talking about 'practicing safely' and they'll refer to DOH for staffing numbers. To my knowledge, only California has any true legislation re staffing numbers and then it only covers hospitals, I believe. I could be wrong about that.

The OP would be alone; or at least didn't indicate she would be the "only one"; if there is a supervisor, there would be someone else in the building for support.

As Commuter explained well, most med passes and treatments in LTC overnight are not heavy. :no:

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Specializes in retired LTC.

I'm sorry! Maybe I'm just not seeing it, but I still don't see TOTAL of 49 pts combined on the two units. What's that - 25 pts per unit?

That's manageable.

As many said, most single units are 60 pts. and meds aren't usually terrible for 11-7. So I retract much of my previous post.

But it would be difficult going back & forth unit to unit.

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Specializes in retired LTC.

OP has posted a similar entry under the LTAC forum. Not sure which one she is working. Her biography page identifies her as an LPN.

And wile she/s NOT a new newbie, she doesn't have the years that many of us do.

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if there are medicare patients on both units, it may not meet medicare guidelines.

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Update your resume. Go elsewhere. I don't waste my time trying to change others. I just leave.

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I work in LTC skilled 45 bed high acuity unit 2-3 cnas 7p-7a and I have been only nurse but have kma , occasionaly which is doable but far from piece of cake..2 nurses is busy. I think 45 is too much reliability for one nurse and try to avoid if all possible.

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