Management forcing 63 residents on medication aides

[Nurse Beth, MSN]

Hi there! It sounds like you're in a challenging situation. 

In this kind of workplace situation, employees like yourself, a Level 1 medication aide/certified medication technician, are forced to cut corners or worse. Not only do the residents suffer due to shortcuts, but good workers become discouraged, and morale plunges. You can no longer feel good about doing your job.

It's really helpful you told me which state you're in, thank you.

Licensing: Assisted living facilities in Missouri are licensed by the Department of Health and Senior Services (DHSS). They need to meet specific standards regarding health, safety, and staffing.

Staffing Requirements: Facilities must have a sufficient number of trained staff available to meet residents' needs. Staff should receive training in areas like first aid, CPR, and resident care.

Staffing ratio: According to the  Title 19—DEPARTMENT OF HEALTH AND SENIOR SERVICES Division 30—Division of Regulation and Licensure Chapter 86—Residential Care Facilities and Assisted Living Facilities 19 CSR 30-86.047 Administrative, Personnel and Resident Care Requirements for Assisted Living Facilities,

Missouri code requires:

• One staff per 15 residents during the day shift,
• One staff per 20 residents during the evening shift, and 
• One staff per 25 residents during the night. 

However, the staff ratio on medication carts is not specific. 

Here are some steps you could consider:

• Document everything. Record your daily tasks, including how long each takes and the challenges you face due to the workload. This documentation can help when discussing the situation with management. Which activities take up the most time?
• Read your facility's policies to be informed.
• Gather support. If you have colleagues who share your concerns, consider discussing them as a group. A united front carries more weight in discussions with management.
• Communicate with management. Schedule a meeting with your supervisor or management to express your concerns. Ask to see the staffing plan and if the above ratio is correct for the facility. Aim for a cooperative discussion where you bring forth concerns. Present concerns from a patient care point of view, as in "patients have to delay lunch while waiting for insulin injections" rather than "the workload is too much for any one person."
• Use your documentation to highlight the impact of the increased workload on resident care and staff well-being. Give examples of how challenging or impossible it is to meet the administration windows and to ensure medication safety due to interruptions, locating residents, slow swallowers, vision impairment, cognitive difficulties, lack of supplies, complex medication regimes, crushing pills, dropped medications, time constraints, and more. 
• Be professional and courteous. Suggest solutions. Come prepared with potential solutions, such as hiring additional staff, adjusting the schedule, or reallocating duties to improve workflow. Do nursing assistants make less than medication aides, and would hiring a nursing assistant, even part-time, help you pass meds more timely by locating residents, providing care, and dealing with family interruptions? Could supplies be better managed to improve workflow? 
• Make sure your pay is not incorrectly docked. Missouri labor laws state that employers aren't obligated to provide breaks, but if they deduct pay for a break, the break must be over 20 minutes, and you must be relieved of all duties.  

Consider Reporting

If you believe the situation is unsafe or detrimental to resident care, you might report it to a higher authority or an oversight organization. You can file a report in Missouri using the state's Adult Abuse and Neglect Hotline  by calling [phone]. 

Prioritize your own well-being. Stress management techniques, like mindfulness or deep breathing, can be helpful during busy shifts.

It's important to advocate for yourself and your residents. You're doing important work, and your concerns are valid.

Best wishes,

Nurse Beth