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

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.

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.

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 malpractice insurance 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.

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.

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.

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.

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

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

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.

I don't get the people here who are acting like the OP is some kind of a wimp for not wanting to cover 49 patients for a 7p-7a shift and why they are not reading what she clearly stated. She did not say 11p-7a shift, she clearly stated that it was the 7p-7a shift, meaning that she would have to do the HS med pass on 49 residents (which in my experience with LTC is a very big med pass) while being the only nurse in the building, along with having at least one potentially dangerous patient to deal with. Can someone tell me what part of that sounds fair or safe?

One of the reasons why I had to get out of LTC was because I got tired of seeing how much people were paying for "excellent" care in these facilities, only to see bare bones, unsafe staffing behind closed doors. I used to just about gag when I would be working and the management would bring a group of family members of potential residents through on a tour and brag loudly about how much better the staffing was than anywhere else in town and what a great star rating the place had, then we would be told that three people called off for our shift and we were just going to have to suck it up and do the work of 2-3 nurses, only to find at the end of that shift our staffing personnel calling us on the unit and nagging/begging/threatening us to stay for another shift because three more people had called off for that shift.

The entire LTC industry in this country is so shameful, IMHO. It's all about the bottom line, and animals seem to get more respect and better care than our elderly population.