Nursing Home, chronic understaffing, and dealing with profit driven business owners?

[AnOldsterRN]

I don't care what anyone says, a I think a 1:30 or a 1:60 Nurse to patient ratio is outrageous, unsafe, and not sane. You very well could be putting your license in jeopardy. If something happens to one of the patients under your care, try using the excuse of "we were understaffed, boss did not want to hire and staff more help." You'll be asked why you took on the assignments if you believed that to be the case.

I was hired on as an "RN Supervisor" and quickly became their kill 2 birds with one stone Nurse. They had their mandated RN hours required plus I took floor shift normally done by LVN.

I found myself in an 11p to 7am 1:57 Nurse to patient ratio and only nurse in the building.

I was told to start the morning med pass and glucose checks and 3am!

Thanks to one of the 3 CNA's on shift I was alerted to a patient c/o chest pain and numbness. 911 was called. What if the CNA (who is too busy with own unreasonable workload) hadn't gotten around to that resident? What if the resident died? What if more than one of those 57 had an emergency? You cannot be at the med cart, on the phone, checking glucose, admin. insulin, breathing treatments, charting, and assisting emergency personnel all at once. CNAs are expected to be our "eyes and ears" but they are not trained at an LVN or RN level to assess for significant changes!

Needless to say, this incident put everything else behind. By the time 7am nurses arrived, I was still occupying a med cart. Not only that, breakfast trays do not arrive until about 7:30am. I'm not counting on a glucose read from 4am or giving insulin too early before breakfast for obvious reasons.

Who gets frowned upon in these instances? We do.. because "other nurses can get everything done by themselves with about 30 patients or about 60 on night shift" OR "911 emergency rarely happens on night shift."

I don't see how any nurse can logistically do all... Med passes, all treatments and wound care, all the different S/E monitoring for meds documented to be signed in MAR, "target behaviors" O2 sat monitoring with and without O2, BP and pulse monitoring for ranges, I&O, meal percentages, admin. Nutren and other various supplements for various patients, and all the other entries in addition to meds in the MAR in 8 hours.. plus sign the MAR and TAR books for about 30 residents (about 60 if night shift), complete all the COC, Medicare, weekly charting, etc. in 8 hours unless they cut corners. It is logistically impossible.

For nurses who manage to supposedly get everything done, I say again that it is logistically impossible without cutting corners (and I've seen cutting corners). I've seen boxes of albuterol for nebulizers with vials when they should have been done. Vitamins and other OTCs (not kept with regular med cards.. and used as "house supply") in the cart that should have been finished by now. Signing the thick TAR and MAR books to get signing out of the way, and I've suspected some 3-11pm of combining both the evening and bedtime meds (no significant drug interactions, but still). I complained about the latter because if you give Seroquel or Ativan for instance at 5pm but mark 10pm, guess who's up for the day and trying to get out of bed at 2am for the night shift nurse? Can't give them anything because they last received supposedly at 10pm.

The shortcuts may not be dangerous per se, but shortcuts nonetheless. These are overworked and exhausted nurses expected to do impossible workloads. They are dedicated nurses who are forced to spread themselves thin and prioritize. In addition to the impossible workloads, a "change of condition" (new rash, a cough, wound or what not) can put a nurse an hour or more behind having to call doctor, chart, wait for doctor to call back, chart, get order, fax pharmacy, update care plan, notify family, update MAR or TAR.

Nurses who are skipping lunch and breaks, clocking out at end of shift and continuing to work, coming in hours early to start treatments, etc then clocking in on time to help reduce cutting corners.. it's admirable, but it is behavior that enables the administrators who refuse to hire, staff and retain anything more than the bare bones minimum required by law. It is also used to as an example to other nurses that "see? Other nurses can get everything done!"

Understand that behind many privately owned for-profit nursing homes are owners who have no clinical background and see a big chunk of profit when they can manage to stay at the bare minimum required by law in their state.Staff is the most costly expense for a nursing home. Every state has a bare minimum for nurses and CNA's (which is still an unreasonable workload). Each one also says that the facility shall staff enough employees to meet the needs of the facility's residents which is open to interpretation. A facility that maintains only the bare minimum "one size fits all" is not considering the individual needs of the residents.

I dont suppose pose I'll be lasting too long at this job. I take my time and to make sure that each entry I signed is what I did, even if that means staying hours over.

Before re applying at a LTC facility, I would urge you to check the facility's staffing on a site like Healthgrove dot com. A facility that staffs above the bare minimum is likely to treat their employees better too.

Thats all for my ranting. Thanks for listening and I'd love to hear input.

[amoLucia]

I did a BIG sigh when I finished your post. Shook my head too.

Oh, so true! Sad, but true.

I didn't see where you included refrigerator temps, changing piston syringes, changing O2 equip, glucometer calibrations, and crash cart checks. And the monthly roll-overs (or whatever you call them).

I'm guessing that this is your first job post-school or your first LTC position. Nothing is likely to change where you are.

And no, you're not really ranting. Just venting. There's a difference. I understand - been there, done that.

Am still sighing.

(((AnOldsterRN)))

[AnOldsterRN]

Thank you amoLucia.

Yes, you are correct. First LTC position. In all my years of nursing how come I hadn't heard about LTC facilities and what their really about? After many years in the home health, clinic, wound care consultant sectors, inthought it would be nice to sign up to work at one of the many nursing homes and stay put until I retire. No homework, no driving, work with the geriatric population that I love. Boy oh boy.. LTC is insanity. It's also extremely frustrating given impossible workloads. I feel for the staff and for the patients.

Gosh, we get off easy.. CNA's change O2 concentrator bottles and piston syringes. Ah yes.. the calibration book for glucometers. Don't forget E-kits! And yes.. the monthly cycles and restocking meds.

Insanity!

I can't wait to get the heck out!

[amoLucia]

I guess I was lucky in that I began in LTC around 1990ish. LTC wasn't so crazy back then. The changes in LTC that caused it to evolve into today's monster developed along the way. So in a way, I just adapted along with it all. Made all the insanity easier.

Just to say, that I worked several different facilities. Some facilities were good with caring Admin & other staff. Even with all the silliness of regulations, cost containment, customer service, etc. And then there were the others ...

I am out of the game now.

[AnOldsterRN]

Why oh WHY do nurses take shortcuts or come in super early to start care care then clock in on time, clock out but never leave for lunch then clock back in, lock out and continue working? I absolutely won't do that. I suspect I'll be let go due to that.

If more nurses stuck together with regards to the impossible workload, perhaps things might change.i don't see that happening though. It's going to take the law and their are bones minimum staffing.

[TheCommuter, BSN, RN]

I worked as a floor nurse in LTC/nursing homes for six years. LTC was the first gig I worked after graduating from nursing school.

Only the threat of impending homelessness would prompt me to return to the LTC industry. I salute those who still fight the good battle in today's nursing facilities, but I checked out of that sector five years ago and have not looked back.

[Natasha A., CNA, LVN]

Hi , thank you for sharing your story and honestly a lot of nurses can relate to what you are going through. You are not ranting at all and we appreciate your concern for the nurses and pts. you have an active conscious telling you this is not right and that is okay. You have ethics which may not be praised in the world but do not let it go. I would highly suggest if you do not have support with management to look for another job asap. please keep us posted :)

[Purple_Clover]

Perhaps it would be better at a non-profit facility?

[3319684]

I've worked in both LTC and hospital and LTCs are a joke.

[bryanleo9]

They are all driven by the "bottom line". Saving money at the workers and residents expense. Administrators and owners see numbers, they could care less about patient care.

[Guest757854]

6 hours ago, bryanleo9 said:

Administrators and owners see numbers, they could care less about patient care. 

100% Bryanleo9! Changes need to be made in LTC like yesterday. And i am a strong believer with "you get what you pay for" sometimes. These huge corporation are not paying staff what they are worth, or paying them for the amount of work they put in, amd lets not even speak about the staff already working 2-3 people less then what is needed. So nursing responsibilities are divided up to the staff who are actually there, driving up their duties and responsibilities for the shift.

I would not mind working LTC, heck thats where i started my nursing career. But to witness and go thru the "post-war" type changes (and by post-war, i mean big corporation buy-out) i just had to get out of that field of nursing. I just could no longer do it anymore.

People who continue to put themselves on the front line & in the line of fire...i.e. LTC nurses.....will ALWAYS be viewed, thru my eyes of course, as people who soooo much better than me!

[bryanleo9]

And like you I would go back if LTC was changed dramatically.