LTC nurses - I need a reality check

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I have been an RN for 13+ years, med-surg, tele, ER, ICU, PP, IMC, Home Health, Hospice, stress lab, ambulatory care and now nursing home for past 5 mos. I work weekend doubles. I have to say that it is some of the hardest work I have EVER done. I have a whole new respect for LTC nurses, and I wouldn't trade it for anything.

Staffing has been horrible most of the 5 mos. We have 62 residents. Two nurses, 2 med aides, 6 aides, 1 supervisor for 8 hrs. We have worked with 5, 4, and sometimes 3 aides.

THEN:

This weekend, they cut us to 1 med aide for 62 pts. Have you ever heard of this?

Needless to say, I put in my resignation.

Just curious. Are all or most NH like this.

Please advise. Thank-you for your input.

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Specializes in MICU, SICU, PACU, Travel nursing.

What is a "med aid", I have never heard of that??

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Specializes in Case mgmt., rehab, (CRRN), LTC & psych.
What is a "med aid", I have never heard of that??
Medication aides are used frequently in my state of residence. They are CNAs with an additional 4 to 6 months of training and certification which permits them to administer meds, typically in nursing homes and assisted living facilities.
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Specializes in Case mgmt., rehab, (CRRN), LTC & psych.
Just curious. Are all or most NH like this.
I have spent my entire short career in nursing homes. I currently work at an upscale facility with a great reputation in the medical community, and understaffing is a major issue here. Multiple staff members called in sick today, and nobody wants to fill the empty shift on a beautiful Sunday.

Understaffing has been an issue at every nursing home where I have been employed.

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Specializes in Geriatrics.

I work LTC, my unit has 41 beds, I work the 3 - 11 shift. I have 1 other Nurse working my unit (usually pool) 4 CNA's (if no one calls out) a shift supervisor 4 nights a week (mom - fri). Most weekends I am the only full time Nurse, the others are pool Nurses. On my unit I handle all admitions, discharges, emergencies, Dr order's, contact with families, treatments, questions concerning company policy, finding necessary paperwork, you name it. My question is what does a med aide do?? I'd be happy to have 1 more CNA, but that won't happen. It's a tough job, but it has it's rewards.

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Specializes in Med/Surg.

I work in an eighty five bed facility with two nurses on evenings and maybe five aids. And no supervisor after six

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Specializes in Geriatrics.

I have been in LTC my entire career except for a 6 month stint in Home Health/Hospice. I think in most nursing homes, turnover is really high because of competitive pay, workload, staffing issues like someone who has a high call-in reputation, etc.

Back when I worked full time...for the 3p-11p shift for 60 residents, we had a charge nurse (me), then a certified medication technician and 2-3 hall aides. That was it. I was so used to it I could have done any of their jobs and did indeed sometimes do my job and help the aides out if we were short.

It always seemed like day shift had the most people...it was the other shifts that were hard to cover. There is something out there called a "fire code" that in our state anyway, is so many nurses to patients ratio in case of a fire to help get residents out. Many nursing homes use this code when staffing...it really used to upset me though because you can staff according to code, but not workload. For instance, say half of your residents had to use a lift to get out of bed/total care. Whoever makes these codes up have never considered that when assigning ratios.

I've experienced this in every nursing home I've ever worked at. Burnout and turnover high in every single one...and I've worked in many.

Good luck to you...

Blessings, Michelle

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TheCommuter

I have noticed that you post to a lot of discussions and seem very knowledgeable. I almost feel like I know you from reading so many of your posts. Do you know where I can find any data for required staff in NH?

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Has anyone ever heard of 1 med aide for 62 patients?

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Specializes in Case mgmt., rehab, (CRRN), LTC & psych.
thecommuter

i have noticed that you post to a lot of discussions and seem very knowledgeable. i almost feel like i know you from reading so many of your posts. do you know where i can find any data for required staff in nh?

the nhra requires medicare and medicaid certified nursing homes to have: an rn director of nursing (don); an rn on duty at least 8 hours a day, 7 days a week; a licensed nurse (rn or lpn) on duty the rest of the time; and a minimum of 75 hours of training for nurse's aides. the law allows the dons to also serve in the capacity as the rn on duty in facilities with less than 60 residents. in addition, the law re quires nursing homes "to provide sufficient staff and services to attain or maintain the highest possible level of physical, mental, and psychosocial well-being of each resident" (harrington, 2001; obra, 1987). total licensed nursing requirements converted to hours per resident day (hprd) in a facility with 100 residents are around 0.30 hprd (harrington & mill man, 2001), or 30 hours per day.

despite setting a precedent, this requirement does not provide specific nurse-to-resident staffing ratios for rns, lpns, or nas, and does not require any minimum level of staffing at all for nas. other than the instructions to provide "sufficient" staff, the fact that a facility of 50 residents has basically the same staffing requirements as a facility of 200 indicates the lack of specificity and adequacy of these federal requirements.

http://www.medscape.com/viewarticle/531036

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Specializes in Geriatrics.
Has anyone ever heard of 1 med aide for 62 patients?

Yeppers...we did it all the time. As long as your CMT feels comfortable with passing pills and has a set routine, he/she should be fine...ours always were anyway.

Blessings, Michelle

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Yeppers...we did it all the time. As long as your CMT feels comfortable with passing pills and has a set routine, he/she should be fine...ours always were anyway.

Blessings, Michelle

Unbelievable!! I guess I've been SPOILED to hospital nursing. I can not believe this type of staffing is LEGAL. I will forever defend nursing home nurses any time I hear someone put one down. I am still astonished that this seems to be common in LTC. I had no idea. Totally Blown Away!!!

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