Nurse to client ratios

[cd1229]

I am the sole nurse for an agency that provides supported living (6 homes) and dayhab as well. I love the work! We have 24 clients and I work 25 hours/week. DSP give the meds. The agency's Executive Director wants me to cut back to 20 hours a week. I feel overwhelmed already and can't see how I'm going to keep up or meet the state and agency's expectations. (I've already discussed this with her and she won't budge). So I'm curious about what your agency's nurse to client ratio might be, and whether you're full-time or part-time. Is it just me or is this unrealistic?

[Judy_CMHN]

I work for a state agency that provides residential and program services to individuals with DD. Our IRA's (residences) have 6 to 8 individuals each and our programs vary in size. Our 80 person program has an RN providing oversight but employs 2 LPNs full time to ensure regs are met. Our other programs have about 15-20 individuals with LPNs from the IRAs assisting the RN. Again the RN is mostly for oversight. This RN II has 3 IRAs and 2 small programs. So you could say he has 22 individuals in IRAs and 35 individuals in programs. His responsibility is mostly to make sure regs are met and to do all the required paperwork (LPNs do most of the direct support and AMAPs give all meds.) I am a CMHN and have 8 Family Care Homes with 22 indviduals on my caseload. I do not have IRAs or programs, I work in the community. Our state licensing agency recommends we have 20 people on a caseload, we are allowed up to 50. Does this help?

[limonada]

Seems unrealistic to me. At my facility, each residence has anywhere from eight to fifteen residents, and 24 hour nursing. There is always a staff nurse (RN or LPN) in the residence to give meds, coordinate appointments, do all the paperwork, etc etc. Then there are nurse directors who are RNs who each oversee about 30 clients each. Most of the residents are pretty medically involved at my facility.

[marsy]

I work at a residential facility that has over 80 clients but I am the nurse for only 24 people working 40 hours per week. I worked previously at a day hab and was responsible for over 160 people working 35 hours per week.

[LVN_it1995, BSN, RN]

working for an agency I work 1:1 nurse:client ration with opportunities to teach family. Can get boring(boring is good sometime though) but many opportunities to be involved in patient care and observation/monitoring documentation.

at the skilled/sub-acute facilities I have worked with/for the ratio average was 1:30. It can get fast paced at times, especially around routine meds times and emergency situations in the hospital. Most nurses believe that a good load would be somewhere near 1:20 for nurses in sub acute/skilled. Gives time to make sure work is accomplished by patient, unlicensed personnel, nurse, allied professionals, and less carried over to next shift due to not having time, already overtime.

[LGD2011]

I work at a much larger agency (not as a nurse) which has over 30 group homes and a day program. The day program has two part time nurses who split the 5 day work week. There is one RN and one LPN to oversee the residences and teach trainings, but they are rarely actually in the homes. I'm quite jealous of the poster who always has a nurse in house.

OP, perhaps you could talk to the Executive Director about being solely responsible for day program if you are cut to 20 hours a week. I think it depends on the medical complexity of your clients whether the work load is reasonable.

Just realized this is an old post. Cd1229, what happened in your situation?

[cd1229]

(a few months later)... My hours did get cut... for awhile. But the Director finally listened, and I now work 28 hours a week. Could still use more hours, but we're heading in the right direction.