LTC Patient Ratio Unsafe

[Parri11]

Hello everyone. I'm new to this forum, have been an LPN for a year and a half, Work PT for OBGYN doing phone triage and PT at SNF.

3-11 shift: 1 LPN (myself) 4 CNAs, no other staff on unit, just us with 40 residents, many have acute respiratory failure, at least 20 have BP checks twice on my shift at 6 and 9, O2 sats for 15 pts, BIPAPs at 10 for two residents, then half the floor is assist x2 so if I need an aides help to turn a resident for assesment or such it would be a twenty minute wait at least,

There are 12 with GT's currently, but have had 15 a few weeks ago, 10 or more residents with NEB TX some 6 and 9, and some 4, 2 at 6 and one at 9. Currently 2 residents on 2 different IV ABTs at 6 and 10, one resident on IVF, constant transfers to hospital for anything and everything, constant admissions and readmissions (we never have an empty bed for more then a few hours).

Oh, and calling MDs for X-ray and sono reviews, calling to review labs, putting in new orders and d/c'ing old ones, ordering meds from pharmacy many of which need to be faxed over, labs calling me constantly to make sure I got the labs and to re-review them, running to other floors because we never have anything (neb machines break down constantly peg pumps constantly in error, never any IV lines, flushes,), always something not quite right with at least one resident who needs vitals to be monitored constantly, residents with supposed very abnormal baselines as told by Hospital Mds upon transfer, therefore we can't refuse them our care which also means constant monitoring of vitals, and then there's running to the bsement to put endless amounts of stool, sputum, and urine samples for pickup.

And of course nurses notes and report, paper filing constantly, consults, psych ortho and podiatry coming in at end of shift to assess residents and then dumping orders on me, dealing with issues of alert residents who just want attention and to be heard, and dealing with family members who have concerns. And the occasional half hour in service.... And I'm sureI'm forgetting something..oh, BS checks and insulin for 7 residents, bs check only for 3 separate....

I don't feel safe for my residents. I've noticed how over the past year the admins have allowed the admittance of very ill patients who are on loads of meds that change constantly, with, at times, daily lab monitorings (I generally get at least four labs every shift and on PT/INR days I get up to 15.

The floor is anything but stable.

My CNAs are miserable and so am I. I've complained to the supervisor about the working conditions and even he hasn't gotten a response from administration. I've just recently joined 1199, what should I and can I do? I want to protect the residents that have lived there for years and are generally stable but are being neglected care just so the facility can make more money by having "sicker" patients who need much more attention and even skill, then what I alone have.

I want to protect the new residents who are almost in a vegetative state from deteriorating even further, I want to protect my aides from physical and mental stress, and I want the same for myself. I also want to make it known that it is unreasonable and unsafe in the given time slot to perform all tasks responsibly with just one LPN and 4 CNAs.

(I live in NY)

[malenurse69, MSN, NP]

Doesn't sound safe. You can always get another job but you only have one license. Also, life is just too short to put up with unnecessarily stressful jobs. If you're in a pinch then look for another job and quit as soon as you have secured another position. If your financial status is comfortable then hand in that 2 week notice yesterday. Perhaps pick up more hours in your other job in the mean time?

That's what I would do anyway.

[Katillac, RN]

Outside the impossible and unsafe volume of work required of you, your facility has put you in the position of working dangerously far outside the LPN scope of practice. An LPN is permitted to gather data and report it but not triage nor plan patient care. Though it seems you are very competent, you should not be the one reviewing your residents' labs to determine what needs to be done other than monitoring these critically ill residents and reporting your findings. Legally you can't even independently admit residents because that means you are assessing and developing a care plan, even though it may be reviewed by an RN the next day. Additionally, in New York, an LPN can only implement patient specific standing orders. So unless you are pretty much in constant contact with an RN in person or by phone, a large part of the work you are doing is outside your scope.

Unfortunately, you have limited ways to address this. Your manager hasn't heard back from administration because they want to provide care as cheaply as possible and don't care that it's not safe. There's little incentive for the facility to change because the consequences if they are found operating this way are minimal to them. On the other hand, the consequences for you - both to your license from the BON and in a suit brought against you - can be huge if something goes bad and you have assumed the care of these folks.

I'm not sure what 1199 can do for you, but you might want to be in touch with your delegate and ask. But this situation is tragedy, lawsuit and license censure waiting to happen.

[ponymom]

1199 cannot do anything for you, nor could any other union. Nursing unions are historically weak and ineffective in regards to understaffing and that is because they are made up of ....nurses... Who are historically weak and ineffective about advocating for themselves as a whole. Part of the whole "calling" complex. Just the way it is...

Your best bet is to leave, and on your way out the door, inform the families, the media, etc.

Good luck to you.

[Parri11]

Thank you, all of you. I don't know of any other nurses who work in LTC other then my complacent coworkers, who could have given me advice on standard practices at these facilities. I have sadly noticed over this year and a half that LTC workers, from nurses to supervisors to the DONs the aides and recreation departments, are very afraid to say anything about the working conditions. To be honest, LTC pays very well compared to hospital and clinical jobs (non specialty i.e.l&d plastic surgery icu neuro) as I know from experience and speaking with the BSNs NPs and PAs that work with us, so I can understand why they are complacent.

My sanity and health have been slowly deteriorating. I am constantly angry and stressed since working here. I am a very calm and composed person, but I find myself becoming more and more bitter as the days pass, and it terrifies me. I am physically exhausted all the time, my calves and back are in constant pain, losing lots of weight but I have no energy to actually workout and stay fit.

I need to go to work tomorrow, I have responsibilities that require money, but I will be searching for a new position elsewhere right after the New Year (there are limited options for LPNs in nyc other then LTC, Urgent Care, and Dialysis) and in the meantime I will make it a point to complain to OSHA and NYC healthcare about this, to save my residents and myself, and any future young nurses who do not know any better.

Happy new year and blessings to all good nurses everywhere. May the new year bring great good change for all of us in the healthcare industry.

[quiltynurse56, LPN, LVN]

I just left a LTC/Rehab facility for much of the same reasons though I was night shift with 2 nurses and 4 CNAs for about 80 people. Not only were we to do our work, but to finish up what previous shifts did not complete. All this was on paper. Then there was the redundancy in the paperwork. There were issues I won't go into on here, but it wasn't a good fit for me and I felt like I was putting my license on the line here. I am doing PRN right now until I obtain another position. Makes money tight for us, but the anxiety and stress reduction on me is worth it.

[Daisy Joyce]

And in other news, water is wet!

The vast majority of LTC is this way. The facility is there to make money.

I happen to work for that rarest of entities, the well-staffed LTC facility. Our staff turnover is nonexistent.

But sometimes I take a shift from my agency for a "regular" LTC, and all I can say is hats off to you, ladies and gentlemen, who do that very important work under crapsack conditions day in and day out.