Nurse patient ratio, legally speaking...

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Specializes in Main O.R. and CVOR.

hello everyone!

I am new to the LTC/SUB-ACUTE world. I noticed the nurses on the med carts have 20+ patients to pass meds to and do treatments. I have been orienting on the sub acute unit. there is no way one nurse can adequately take care of 20+ patients with only 2 CNA's....

is there a law (florida) that states that this is too many pt's for a nurse?

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Specializes in Complex pedi to LTC/SA & now a manager.

No. The only state with mandated patient to nurse ratios is CA and that may only apply to acute care hospitals

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Specializes in Main O.R. and CVOR.

WOW.... that's so sad. no one seems to give a crap about the residents/pt's. they get such poor care in these places....

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Specializes in Gerontology, Med surg, Home Health.

If you have 20 patients, I don't think you're in an LTAC. Sounds more like a SNF.

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Specializes in Complex pedi to LTC/SA & now a manager.

Agreed 20-30 patients is skilled nursing and a typical nurse to patient ratio especially for a med pass/treatments. Often ADLs are delegated to CNA staff. If everyone works as a team then safety is not a major concern

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Specializes in Main O.R. and CVOR.

they call this unit "the sub acute unit"..... is that the same as a SNF? This facility has 2 units the other they call the GNR unit (LTC pts)

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Specializes in Complex pedi to LTC/SA & now a manager.

Around here sub-acute/post rehab is 20-25 patients per nurse with 1-2 CNAs. Goal is return to baseline independent living. Acute rehab (Health South) is 10-20 per nurse as rehab not total care is the goal. Long term skilled nursing is ~30/nurse with 1-3 CNAs for support depending on shift. Ratio is 40:1 with 1 CNA overnight

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Specializes in Main O.R. and CVOR.

wow! thanks justbeachynurse for the explanations on differences... I am a 30 year exp O.R. nurse, and I am just overwhelmed at this point in my month long stint in sub-acute care... so many patients and not enough time. plus, the CNA's they have here are always disappearing..... I have to get out of this job somehow. my hat is off to you nurses in this profession.... do you ever leave work feeling like you gave every patient your all?

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Specializes in ER, Med/Surg, LTC, Nursing Informatics.

I've worked as an LPN in a SNF, RN in Med/Surg and now ER (and observed in a couple of ORs). Most of our SNFs (AZ/NV) have LPNs working the floor with the ratios you listed as normal. Usually there is an RN charge nurse. Here RNs rarely work the floor. #1 it is to costly for the facility to employ too many RNs because they get paid much more than LPNs. #2 There is a stigma working in a SNF. The nurses in SNF do work very hard. Frankly, as far as I know, all nurses work very hard, just in different ways and require different levels of skills. In a SNF you have more pts because the pt are more independent (aka less acute), but that can be harder too. I used to have a nightmare that all of my w/c bound SNF pts swarmed me at my cart, all angry, slamming into my cart, asking for Tylenol, colace, aspirin, etc, etc. It was a scary dream for me, but I can't handle high numbers of patients, regardless of "acuity". 4-5 ER pt is much better for me. I can juggle that amount in head. We have "higher acuity" pts, but we have more options (i.e. soft and leather restraints), quick access to meds, (we don't have to go to a back room, in a locked cabinet, to get a tackle box with a lock and get have 2 nurses sign to pull out 1 pain pill), and I get to see positive change in my patients in one shift or less. But I rarely get a break or time to sit down, SNF nurses get some time to take a breath, because, after all the pain and abx meds are given, very, very little requires immediate care. OR nurses can have loooong breaks that they get paid for, but they are involved in the most invasive and potentially critical patients there are. They can work very long hours, with stacked up cases, one after another, after another, etc. But they don't tend to have stable schedules, consistent hours, which is another kind of stressful to deal with. So all nurses need to understand that we all work hard and none of us have enough resources to do the job at the level we want to do it (especially SNFs). It seems we are all trying to search for that "Sweet Spot" where we are paid well, not too much stress, and truly helping others improve in their health/life. Bottom line: that "Sweet Spot" doesn't exist, but you can get close to it if you know what type of pt care fulfills you and what type of stress you handle best. If you can't be positive at your job, your in the wrong job, look somewhere else. And stop tearing down other nurses in other departments and other facilities. We ALL Work Hard!

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

thread moved to LTC nursing

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Specializes in psych,mental health.

I currently work in skilled nursing sub acute care where I have 22:1 ratio and it kicks my tail! ! I've been a nurse there for 6 months. . I've been a nurse for 6 months! It's rough, but this is normal. I'm in Maryland . I needed a start and I got one! Keep your head get all you can until you can get somewhere else

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