LTC nurse to patient ratio

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So I have been working in family practice since I became an LPN 3 years ago. I love it, but I hate the pay. Since my husband recently became unemployed, we have been struggling, and I started looking for a 2nd job.. I was offered a job at a local LTC facility yesterday for much better pay than I am making now ($3.50/hr more).. I didn't know what to ask for when they asked what kind of pay I was looking for so I said $18/hr (that's what I hear is average for LPNs in my community in LTC) and they offered me the job for that much. Hopefully that's good. Anyway, she said that when they are fully staffed you will have 25 patients, and that there is usually 11-12 CNAs working my shift (3-11) with me. I have never worked LTC before so I am kind of nervous. Is that patient to nurse ratio too high or average? I am so afraid that I will hate LTC, mainly because it is a big change. But I surely hate struggling with bills more. Who knows.. I may end up loving it. I am going to be on the waiting list to switch to days or night shift when it comes available because with this shift I wont see my little ones much during the week. Any tips for a first timer in LTC?? How can I make this transition easier?

I am working towards my RN now, so hopefully this change will give me more experience that will help when I become a RN..

Specializes in Allergy/ENT, Occ Health, LTC/Skilled.

I have been in LTC and doctor's offices. I spent most of my career in clinics but recently return to LTC PRN because I too am finishing up my RN and need a flexible schedule. I have 25 patients on my shift, max of 8 that are skilled. I have 6 aides on my side. IMO, the pay you requested is too low, but you already accepted. I wouldn't do it for less than $20 PRN, a little less for part/full time. it's just a different ball game than a doctor's office. My center is low acuity so it's a bit easier than some LTC, the most skilled thing we take is a PICC line or g-tube. Rare we have a trach, never take lung drains or vents. So, it's doable for me and I have been out of LTC since 2010. Of course, being PRN, it's taking me longer to get in the groove because i am only in 4-5 x/month. LTC is definitely something I wouldn't do part or full time unless I had too because its exceedingly overwhelming but for PRN it works out well and I am keeping up my critical thinking skills while in school. I do a lot of second shift, I go in at 3 and do not sit down once until 11 pm when I get to my charting and I will eat my dinner then as well lol. Most of time is sucked up by my rehab patients and families, my long term care patients are easier.

A few big things for me when it comes to LTC was

1) making sure i got the appropriate amount of floor training. Even though I have 5 years of nursing experience, I still requested 6-7 shifts of training and was told by my DON that if it wasn't enough to tell her and she would give more because she wanted me to comfortable. That was my first sign it was a better LTC than most

2) that the ratio wasn't over 25 in a LTC/skilled setting (more for AL though)

3) that the nurses worked together

4) I never had to work off the clock. Meaning when I was new nurse and took more **** than I should have, I would be there for hours after my shift finishing up things UNPAID. I will not do that now, if i am there, I am getting paid. If you want me to work off the clock then we will have a professional separation of employment. In my area, they are desperate for LTC nurses right now so if needed I could find another job.

Sorry this was a bit longer than I meant, bottom line for me is LTC is great PRN while your in school. In the facility I work at, PRN nurses are expected to do normal nursing duties but as far as monthly assessments, in depth paper work, etc, we do not do it, the regularly staffed nurses do.

Good luck!

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Specializes in Allergy/ENT, Occ Health, LTC/Skilled.

Wanted to add in a suggestion for you...have you looked into Occ health? LPN's are generally paid more. I made $18.05 at my first occ health job, i worked 9-5, M-F, no weekends or holidays, ever. I would not have left, except that they need full time LPNs because its a RN dependent contract.

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Specializes in LTC and Pediatrics.

Pay is going to depend on the area of the country in which you work.

Also, while it sounds like a high ration, once you get trained and a few months behind you, you are going to think it isn't bad. I don't think I would be saying that with 50 residents though. At first, I felt like I was never going to learn everyone and their meds, tx's, etc. I felt like I was so slow. Now, I know who my residents are, their med and tx routines (I do check these though each time I work) and I have time to spend with each resident when I take them their meds.

I work 2-10, and I feel like getting out at 10:30 is on time, what with report and narc count.

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I have been in LTC and doctor's offices. I spent most of my career in clinics but recently return to LTC PRN because I too am finishing up my RN and need a flexible schedule. I have 25 patients on my shift, max of 8 that are skilled. I have 6 aides on my side. IMO, the pay you requested is too low, but you already accepted. I wouldn't do it for less than $20 PRN, a little less for part/full time. it's just a different ball game than a doctor's office. My center is low acuity so it's a bit easier than some LTC, the most skilled thing we take is a PICC line or g-tube. Rare we have a trach, never take lung drains or vents. So, it's doable for me and I have been out of LTC since 2010. Of course, being PRN, it's taking me longer to get in the groove because i am only in 4-5 x/month. LTC is definitely something I wouldn't do part or full time unless I had too because its exceedingly overwhelming but for PRN it works out well and I am keeping up my critical thinking skills while in school. I do a lot of second shift, I go in at 3 and do not sit down once until 11 pm when I get to my charting and I will eat my dinner then as well lol. Most of time is sucked up by my rehab patients and families, my long term care patients are easier.

A few big things for me when it comes to LTC was

1) making sure i got the appropriate amount of floor training. Even though I have 5 years of nursing experience, I still requested 6-7 shifts of training and was told by my DON that if it wasn't enough to tell her and she would give more because she wanted me to comfortable. That was my first sign it was a better LTC than most

2) that the ratio wasn't over 25 in a LTC/skilled setting (more for AL though)

3) that the nurses worked together

4) I never had to work off the clock. Meaning when I was new nurse and took more **** than I should have, I would be there for hours after my shift finishing up things UNPAID. I will not do that now, if i am there, I am getting paid. If you want me to work off the clock then we will have a professional separation of employment. In my area, they are desperate for LTC nurses right now so if needed I could find another job.

Sorry this was a bit longer than I meant, bottom line for me is LTC is great PRN while your in school. In the facility I work at, PRN nurses are expected to do normal nursing duties but as far as monthly assessments, in depth paper work, etc, we do not do it, the regularly staffed nurses do.

Good luck!

Thanks!

She did state specifically that max patient to nurse ratio is 1:25 when fully staffed, and that they are not at fully capacity at the moment so it would be around 20.. I even commented on the amount of CNAs that they had working at once and she said they like to have 11-12 on to ensure that there was no under staffing and that the nurse could focus on her patients. I am going in this Friday for paperwork and a few other things and they said that I would be paid for the time I was there. I asked a few other nurses in the area around here and they said $18/hr was pretty much the starting rate (small town in AR).. I have noticed that the pay in my area is way lower than other areas. I am very excited and nervous about this transition. This facility has skilled, non-skilled, and rehab patients.

It will definitely be while I am in school. I want to work in the hospital once I have my RN

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Wanted to add in a suggestion for you...have you looked into Occ health? LPN's are generally paid more. I made $18.05 at my first occ health job, i worked 9-5, M-F, no weekends or holidays, ever. I would not have left, except that they need full time LPNs because its a RN dependent contract.

I havne't looked into it, only because I haven't heard of any listings. I occupational health but I am not sure where to look for these positions. There aren't many listings in our papers or online here.

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The number of CNAs doesn't sound right. In fact, that sounds VERY not right. It needs clarification.

Having adequate number of ancillary CNA staff is crucial to meeting staffing needs for adequate care. I would be skeptical of such a high number. Likewise, you used the phrase "when fully staffed" - does that mean you're not up to full staff yet? That leaves a LOT of wiggle-room for your nurse/pt ratio until you get there. Like your number for nurse to pt ratio may be higher than the 1:25 as discussed.

In as much as you're not LTC saavy, I would be cautious. Otherwise, you may be in for a surprise.

She did state specifically that max patient to nurse ratio is 1:25 when fully staffed, and that they are not at fully capacity at the moment so it would be around 20.. I even commented on the amount of CNAs that they had working at once and she said they like to have 11-12 on to ensure that there was no under staffing and that the nurse could focus on her patients. I am going in this Friday for paperwork and a few other things and they said that I would be paid for the time I was there. I expect a few small surprises, but I am hoping for nothing serious and to make this a smooth transition. I really hope that I end up loving this until I am able to work in the hospital as a RN

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Update** I have worked at this facility since October of last year. I do like it, but there are things that could have been worded differently during the interview. Our facility is split between sides, or halls, (East and West) and then each side is split (front hall and back hall). Usually on my side, East, there are 4-5 CNAs on each side (2-3 on front hall and 2 on back hall). East Front hall can house 27 residents and East back hall can house up to 22. During meal time, all except 2 CNAs help feed residents who require assistance. The 2 CNAs left on the hall are the meal aides. They hold down the fort while everyone is eating by answering call lights and taking care of the residents on both front and back hall on their side. So for 2-3 hours during a shift there is really only 2 CNAs on the floor.

I do like my job and have learned a lot in this short time working their. There aren't enough CNAs and sometimes our residents suffer because of it. I don't know how those nurses who have 36-40 residents under them at one time get their 2 hour med pass complete on time. I struggle to finish mine on time and the max I have is 27. I stop to help my CNAs and try my best not to rush in and out of room as to not make my residents feel as though they are "just another pill' to me.

A nurse that trained me told me once that this job will help when I go to work at a hospital. Those nurses don't have as many patients under them. I hope he was right. I do like my job, despite it's stressors.

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