LTC Nurse: Patient Ratios

[ringaring]

I have not found any state (OR) requirements for nurse:patient ratios in LTC facilities. By 'nurse' I am referring to RNs and LPNs. From what I have read, it seems one nurse for up to 30 patients is generally accepted by the industry. Acuity is not taken into account - it's simply a numbers game for the accountants. I work in a facility that accepts such an unreasonable and unsafe workload which in turn prohibits patient from receiving the competent and thorough care they are entitled to and paying for. What to do . . .?

I could report this to some agency however, this corporation and most like it have been dancing around the regulations for years and can far outwit any inspectors.

I have addressed the issue with administration only to be told the facility is 'in compliance with nursing:patient ratios', and, we are 'not budgeted for more staff'.

I can bring the problem to a forum such as this and ask for input - which is why I'm here.

Any suggestions to facilitate changes in LTC nursing policy are welcome.

. . . and please, no 'suck it up and deal with it' attitudes! That kind of tolerance to an abusive industry is unacceptable and shameful in professional nursing.

[HippyDippyLPN]

Honestly? There is nothing you can do, many good nurses before have fought that battle before and lost. The thing is, depending on your state, they most likely are in compliance with ratios. But I might venture a guess that these ratios were created before LTC became what it is now, a place with g tube, IV drips, wound vacs, drains, etc.

It just is what it is and unless LTC nurses as a whole start picketing, creating unions or some other extreme nothing is going to change it. My fear is it will only get worse with the aging population who needs a facility increasing.

1:30 is what I had on a good day and that was taking no breaks and staying over 2 hours unpaid to finish charting. You get good experience though and learn to prioritize and multi task safely very well. I know you don't want to hear " suck it up" but unless you can change an entire industry, you kinda have to : /

[Esme12, ASN, BSN, RN]

YOU will have a long fight....and it is because there is not always family to fight for this group of patients. A Google search on State LTC staffing found this...Critical Issues in Long Term Care

A national organization, the National Citizens Coalition for Nursing Home Reform (NCCNHR), has identified staffing one of the most critical issues facing the Long-Term Care System. It has called for federal laws to mandate specific staffing ratios in nursing homes. Their recommendations are a ratio of 1:5 during the day shift, 1:8 during the afternoon shift, and 1:15 at night.

This issue is sure to cause debate. The industry feels this will be too expensive to implement and will drive the cost of long-term care higher.

To take action

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To learn more about the issue of staffing, contact NCCNHR at 202-332-2275 and visit their website at:

The National Consumer Voice for Quality Long-Term Care

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To help support legislation in Washington State that may be proposed in the future contact: Louise Ryan, Washington State Long-Term Care (LTC) Ombudsman at [email protected] or by phone at: 253-838-6810.

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Review and Respond to Louise Ryan's

Long-Term Care Legislative Issues

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[HippyDippyLPN]

Ah how I would have loved a 1:5 ratio! Heck with 1:5 I could do all their ADL's and my nursing duties. Heck I would have settled for 1:15.

[herring_RN, ASN, BSN]

The acuity of many patients in nursing homes is the same as hospitalized medical-surgical patients.

I think 1:4 or 1:5 with sufficient certified nursing assistants would be appropriate.

I know nurses working at a hospital based SNF who achieved staffing on 1 RN, 1 LVN, and 1 CNA for every 10 patients if the patient has any IV medications, a trach, or tube feedings.

For other patients it is 20 patients for 1 RN, 1 Lvn, and 3 CNAs.

They know how fortunate they and their patients are. They could lose it if their manager leaves.

[nurse_girl_LPN]

I have been concerned with this as well, in regards to nurse patient ratios. I have worked in the medical field for 10 years, but only as a nurse for 1 year. I currently work in a skilled rehab facility with a high acuity. We take patient's from hospitals typically 2-3 day post-op. On a typical day I will have 1-3 admits, 1-2 discharges, on top of all my other nursing responsibilities. Most days I feel very overwhelmed. We conduct a full head-to-toe assessment on each patient in narrative charting. My patient ratio is 1:17. I feel it's too much. My DON is sympathetic to a point but her hands are tied as management says "we don't have the budget for another nurse". It's tough.

[milkers]

I am an LPN in LTC with a day shift pt ratio of 1nurse to 38 residents. It is the most BS thing I have ever seen. I've worked in LTC for a while and usual the nurse to pt ratio is about 1:20 which is still keeping you on your toes. 1:38 is impossible on days and PM's. I'm sure many treatments and assessments are being charted though not necessarily done.

[trinitymaster2]

I have been concerned with this as well, in regards to nurse:patient ratios. I have worked in the medical field for 10 years, but only as a nurse for 1 year. I currently work in a skilled rehab facility with a high acuity. We take patient's from hospitals typically 2-3 day post-op. On a typical day I will have 1-3 admits, 1-2 discharges, on top of all my other nursing responsibilities. Most days I feel very overwhelmed. We conduct a full head-to-toe assessment on each patient in narrative charting. My patient ratio is 1:17. I feel it's too much. My DON is sympathetic to a point but her hands are tied as management says "we don't have the budget for another nurse". It's tough.

Pick up a sign and walk the line. That is what hospital nurses had to do 30+ years ago. Do not fall into the trap of feeling obligated to take care of your patients. All you have to do is give your organization 30 days notice that you (ALL of the STAFF) are going to picket.

Of course, that would take courage which most of us (myself included) would never have without union representation.

[TheCommuter, BSN, RN]

As long as Medicaid is the main payor source for residents in LTC facilities and nursing homes, the extremely high nurse/patient ratios will persist well into the future.

In most states Medicaid only reimburses LTC facilities at the paltry rate of $100 per day per resident. With pitifully low reimbursement rates like that, the nurse/patient ratios are not decreasing to safe levels anytime soon.

Money talks and bullcrap walks, and until more money is infused into the Medicaid system to provide for the care of elders, expect to continue caring for plenty of residents.

[nurse_girl_LPN]

Very good point, TheCommuter, and that validates my concerns. I worked for one month at an LTC where I had 38 patients!! I couldn't believe it. I left after 30 days. I didn't care what they were paying me, that was AWFUL working conditions.

[DoGoodThenGo]

As alluded to upthread LTCs for the post part still fall under state regulations for when they were mainly nursing homes, and served a vastly different population. Anytime noise is made about staffing or other issues thems that run such places will say reimbursement rates are too low and so forth.

[VickyRN, MSN, DNP, RN]

The only way I see to effectively change these horrendous and scandalous ratios would require 'whistleblower' status on your part, which could effectively end your nursing career (i.e., your getting blacklisted from all facilities in your area, or losing your license over BS charges).

#1. You could contact local, state, and national media to highlight the unsafe conditions and how our elderly residents are being neglected and mistreated (institutional elder abuse).

#2 You could contact your state representatives in your state General Assembly in an attempt to get sane nurse: resident ratio laws passed for all nursing facilities in your state. This would in effect call for highter Medicaid reimbursements for institutional long-term care (money that your state is likely not to have), so you would face an uphill battle on this one.

Thank you for caring.