Nurse to patient ratio with acuity

[judyparham]

Hello, I have much to say. Many patients are coming into Assisted Living Facilities, Long Term Care Facilities and Rehabilitation Facilities. Much sicker than previously.

When a nurse receives a patient there is a 3-4 page admission packet, then medication verification, skin assessment and 4-5 more forms and assessments. Admission charting, problem charting and eventful charting.

Now we have the patient who are many who feel you are their maid and whatever they say you must do. If it is not medical and something ie. Clean my butt, and the person(s) are capable of cleaning themselves and you do not. You are told, why don't you clean them. Where are the professional ethics and boundaries.

How about passing medication for 4 hours and not allowed to drink water and no time to go to the bathroom. You are expected to pass medications, discharge patients, put them on toilets, give them whatever they want and not make any medication errors. In the middle of pulling medication. Family and staff come and have a conversation not about the person you are about to medicate and you are expected to medicate them appropriately while having a conversation about something else.

Don't make an error you will loose your license. Don't say no you are abusing the patient.

We need clear cut rules and laws which protect the patient and nurses in the real world. The time it takes to give care and the time it takes to give medication. How many things can one person focus on at a time and do it well. If I am taking care of John and you want answers about Sue. Can it wait is it life or death or just because you can. How many nursing errors are made because too much is expected at one time. Here is one I started work at 7am and at 10am still giving medications and scheduling and doing treatments and no break. How many times did you hold your bathroom duties, because someone wanted something. No water on the cart so when is the last time you had a drink. Your break and lunch time is in the vicinity of patients and family no place to wind down for at least 15 minutes. Break room your supervisors and bosses want to come in and talk work. Mental Health, Physical health. Take a walk where, and if the weather is bad then what? There is much to be done. Needs to start soon. Not many people want to go into bedside nursing. With no changes in sight.

It would be nice to get responses from nurses on some of these issues.

How many nurses will comment on some of these issues for improvement.

[ltcnurse4u, CNA, LPN]

Sounds like you could use a moment to take a deep breath.

Most LTC's or Short stay rehabs are filling up with sicker and younger residents. I have a few residents who are in their 20's, 30's and 40's with very different diagnosis than a typical nursing home resident. The facility and staff must learn to adapt to their new and different kinds of residents. Are these residents long term? Some are, most are not and a few are there for end of life care.

It is very important to have a good routine . During your med pass, it is okay to have not disturb you unless its an emergency. Make your to-do list. I always carry a yellow legal pad with me and make my notes as I pass meds. If a staff member needs me to f/u with something, I have them write me a note on my pad. I high light important things as I go.

Take your breaks!! You will burn yourself out very fast unless you make time for yourself!! You are allowed water breaks and 15 min breaks.

[mrsboots87]

If you overwork yourself and allow constant interruptions, you will end up working slower and become more frustrated. When I work LTC I have 31 residents. When I work Rehabi have 15. The acuity is getting a little higher in each of those areas and more is demanded of me.

I do similar to the above with a paper to write things down. My CNAs know not to interrupt my med pass to tell me things unless it is emergent or someone is in pain. Everything else has to wait. If I get a phone call, I politely tell them they will be placed on hold while I finish passing the med I'm pulling for safety. I then pick up the phone when I'm done and explain I am very busy but can spend a minute talking if it's important. When patient family and/or friends interrupt while I am actively pulling a med, I stop and ask if it is an emergency. If not, I tell them they are going to have to wait a minute. Med safety is more important then whatever they need to tell me barring an emergency. If they continue to rudely talk anyway, I literally ignore them until I am done and walk away to my patients room. When I come back I explain they wouldn't want me distracted while passing their loved ones meds and make an error so they need to respect the safety of the other patients in my care. I then address their questions and let them know I will get to whatever they need as soon as possible. If it's something I need to look up, I explain it will have to wait until after med pass.

I akways smile mile and am very polite when telling someone they have to wait. Some get irritated and others are understanding. In either case, I don't care because my priority is to my patients first and their family second.

i take my breaks. Even if in the middle of a med pass. Even if it's just 5-10 minutes to sit and blow off some steam, it is vital. That break is refreshing and I come back and can work faster. If I am thirsty I drink water. If I need to use the restroom, I do. I do not let my needs to go to the wayside. I am not good as a nurse if I am not hydrated and taking care of myself. You should practice similarly or you will fizzle out early in the shift.

My philosophy is that I can only work as fast as I can work and get done what can be done. I will do my best to get things done timely and prioritize well, but I don't overwork myself to do it. One thing at a time and just make a list when multiple things are demanded. Check things off as completed. I sometimes eat at the desk if it's really busy, I sometimes eat in the break room if it's less busy. But either way, I take a lunch break to eat refuel and rest.

I completely understand the unrealistic demands of LTC and SNF. And I feel your pain in everything being demanded at the same time and some patients families and upper management don't care. They just expect it all to get done. But at the end of the day, you can't make everyone happy no matter how hard you try, so don't break yourself trying anyway.