LTC nurses - I need a reality check

Valerie Salva, BSN, RN · Sep 22, 2008

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

Years ago, I worked nocs as the only nurse for 65 pts. I did all meds,tx, tube feedings,charting, and so on. I worked with three aides. No med aide. House super was in another building. I did all the finger sticks and insulins in the morning. Even on nocs, the med pass was huge.That job wore me down, and I stayed away from LTC for years. I recently tried it again thinking maybe things had improved. They haven't, and I quit. No more LTC for me.

mondkmondk · Sep 22, 2008

I remember back when I was pg with my older son...7 mos. pg and they put me on meds...day shift! My pg belly pushed the cart! The 8 am meds were the worst to pass. Then after the pills, came the eye drops and inhalers and nebulizer treatments. It took me from 7 am to 10 am to do all that...then I had to get all the vitals for the charge nurse and weigh the residents with weekly or daily weights. Then a quick lunch break, then noon meds...then 2pm meds...then hopefully I could sit down and chart out all my narcotics. Then I also had to fill out the behavior psychotropic med sheets too. Oh, and then I had to empty all the Foleys and reset all the G tube pumps and fill out the I&O book.

I was so used to it and had a set routine down.

On the night shift there was one nurse (me), no med nurse, and 2 aides for 60 residents. I had to pass my own meds, plus all the other charge nurse duties.

Oh yes, I remember so much....welcome to LTC!

Blessings, Michelle

SunnyAndrsn · Sep 22, 2008

While understaffing is an issue in our facility, it's not like what others here are describing.

-72 beds: 48 LTC, 24 subacute.

-Subacute is staffed with two nurses (or one + med. aide), plus 1-2 CNA's.

I say "1-2 CNA's" because we frequently have call ins, can't find anyone to fill in, and this is the easiest hall to pull from.

-LTC wings each have a nurse, one has 3 CNAs (32 residents down that hall) and the other hall has 2 CNAs

If we are short staffed on nurses, then we can end up having two nurses + two med. aides. However, that is what we try to avoid.

So our ideal staffing is 4 nurses for AMs and PMs, and 7 CNAs. From 2-5 we usually have 5-6 CNAs.

M-F we also have two in the office, and our supervisory staff made up of our MDS coordinator, the RN who does clinical education, our DON, her boss (also a nurse) our clinical nurse who does all the skin treatment/monitoring on AMs, an LPN who coordinates all of resident's out of building medical apts, plus two office staff. Finally, we have on-site PT/OT/Speech therapy.

I'm starting to see that I have a pretty good working environment.

NOC has one nurse and three CNAs.

Find another facility!

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.

soulofme · Sep 22, 2008

I've worked in LTC and I feel that LTC pts. deserve better care. What these facilities get away with...ought to be a crime. Lock up their sorry orifices...it's all about $$$...nothing to do with care. :crying2:

husker_rn, RN · Sep 22, 2008

I just left a place that had 1 med aide for 53 residents. At the start was the only weekend day [ Fri-Sat-Sun ] nurse. Finally did get a second nurse but frequently was alone..and as the only RN and no day supervisor wore that hat at times too; had assisted living and a memory center in the building as well. And the staffing was a mess. Never knew what kind of mess I was walking into. So although I loved my residents, after high blood pressure, sleeplessness, etc, I went back to the hospital setting. It has it's own stressers as well but I won't have to deal with staffing or get the a** chewings when things don't get done on time. And I'm sure many others have had similar experiences.

nsgnva · Sep 22, 2008

I wish I had that kind of staffing! I work in LTC. I have 40 residents. Mon-Fri we have a unit manager there, but she spends all her time on paperwork and meetings. I am responsible for ALL charge nurse duties, "desk" duties, meds, tx's, etc. I am lucky to have 3 cna's. There are no med techs/med aides allowed in Va. except in an Assisted Living environment. And on the weekends, I usually have only 2 cna's. And this is on 7-3 shift, the busiest, with these poor, overworked girls trying to get everyone bathed, feed, turned, dried, out of bed, back to bed........And all of our beds are certified snf/icf,,,so we can have any proportion of skilled to intermediate care at any given time. Currently I have 6 skilled/34 icf. but staffing stays the same. One nurse, 2-3 cna's. So wherever you are, consider yourself lucky.

caandt · Sep 22, 2008

I am currently the charge nurse for a LTC, 3-11 shift. We are suppose to have 5-6 CNA's for 65 heavy, demanding residents, but usually have 3-4 if we are lucky. I end up doing more CNA work than my own some nights just to help the girls out. It is a very emotinal, stressful, demanding job also. Sometimes the families are worse than the Residents!! The turn over rate is unbelievable and we seem to get the same staff that quit months ago back. Burn out rate is high, and the attiftudes suck. I have always said, and will always say that the CNA's have the hardest job and don't get the apprietation they deserve. LTC can be very rewarding, but you need to deal with very stressful sitiuations too. I also feel that the nursing staff has to work together as a team, help each other out otherwise it makes it hellish. I don't have a RN at my beck and call, and envy those of you that do. The RN we have is "old school" and is very resistive to up to date medical practices and treatments. Don't get me wrong, I love my job, but some days asking "Do you want fries with that" sounds very tempting.........

CoffeeRTC, BSN, RN · Sep 22, 2008

I'm just wondering...you said you have 2 nurses and 2 med aids now one med aid...what do the two nurses do?

In PA we don't have med aids, so it would be common for the 2 nurses for the 62 pts and then the cnas would varry...more on 7-3 than 3-11 and even less on 11-7. If would be common to have one nurse on 11-7.

Me...I found that I really cant to over 25-30 pts. I normally have 26 and do charge nurse/ supervisor for the building. Thats me, tho.

When I've worked other buildings and have the 25 and have to pic up another assignment..I've found that is too many.

LakesideRN · Sep 22, 2008

I'm just wondering...you said you have 2 nurses and 2 med aids now one med aid...what do the two nurses do?
In PA we don't have med aids, so it would be common for the 2 nurses for the 62 pts and then the cnas would varry...more on 7-3 than 3-11 and even less on 11-7. If would be common to have one nurse on 11-7.
Me...I found that I really cant to over 25-30 pts. I normally have 26 and do charge nurse/ supervisor for the building. Thats me, tho.
When I've worked other buildings and have the 25 and have to pic up another assignment..I've found that is too many.

The two nurses do the charting, treatments, glucometers, resp tx, tons of paperwork for skin tears and falls (which happen EVERY weekend), assist with all 3 meals, and as much aide work as possible - showers, lifting, cleaning, etc.

nsgnva · Sep 22, 2008

you are so right! our elderly in this country get the worst care at the hands of Medicare/Medicaid. The only ones that get good care are at private paid facilities, but then for nurses, those are usually the worst paying facilities

cmyersRN · Sep 22, 2008

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.

I work as an LPN in a 100 bed facility. We have four wings with 25 residents to a wing. For Day and PM shift there will be four wing nurses and a charge nurse and usually (hopefully) three aides to each wing, if no one has called out. On nights, there is two nurses, and one has to be an RN (charge has to be an RN) and three aides per two halls. However, we don't have med aides, so each wing nurse is responsible for the med passes, admissions to that wing, wound treatments or temporary problems, charting, etc, etc. There's not enough hours in a shift and right now our DON is making us leave right at the end of shift because we had too much overtime last quarter, so lately, a lot of weekly charting hasn't been getting done on time. It's been a mess. But our staffing issues seem puny compared to yours. :eek:

CoffeeRTC, BSN, RN · Sep 22, 2008

I think your work load might be doable. That is 31 pts each? With the med aids even if it is 1-2. Might just be me.

It depends on your pt acuity. Ours fluctuates. Even tho I might have 26 on my hall, I still need to float over to the other side to do the IV pushes etc that the LPN cant do.