nursing ratio's

sharann, BSN, RN · Jan 18, 2004

What are your ratios now? I may have misread this I HOPE, but I read 93 patients and you want to have 3 or 4 nurses during the day, and 2 or 3 at nocs? I may just be tired. Can you clarify this?

pickledpepperRN · Jan 18, 2004

Originally posted by kathi yudin
i am all for the ratio's.. having enough nurses should always be a priority to ensure safe care.. i currently work at a skilled nursing facility in newport beach.. we have 96 beds and have 93 residents in house at this time.. we run with 12 cna's on during the day ... 8 on 3-11 and 5 or 6 on 11-7.. nurses i generally work with 3 during the day 2.5 on 3-11 and 2 on 11-7.. i have been trying to hire nurses for 4 yrs.. rn's don't want to work unless they can be supervisors and do no patient care.. no meds.. or charting.. just admissions.. and orders.. and telling the lvn's what to do.. i won't use rn's that way.. it is a waste of a nurse.. in addition.. we are in a terrible nursing shortage.. there just are not enough nurses.. so.. the question is.. how do you meet your ratio's when there aren't enough nurses with which to do so???.. i ran an add last week.. got one resume!!!!.. this is the usual.. we bring students in to see what long term is like and to possibly have nurses to hire when they are done... we attempt to be competetive.. the nurses that are out there are ones that go from job to job for the money.. and don't care.. soooo again.. how does one meet the ratio????.. any suggestions/?? my ideal is 3-4 nurses on days.. 3 on 3-11 and 2 on 11-7... every time i get close... some one leaves for better pay elsewhere... kathi

Gosh I wish I knew the answer to this question!

It is embarrasing to read about registered nurses who do not want to care for patients, just supervise.

Many years ago as a CNA in a nursing home I experienced a nurse like that.

I don't know your LVN to patient ratio and am not current on conditions in free standing snfs but your certified nursing assistants are probably caring for too many patients unless licensed nurses are able to help.

7-8 on days, 11-12 evenings, and 18-19 on nights is not conducive to quality care.

Where i worked the linens were rationed and locked up. It was impossible to keep patients clean even if I had time.

Do you know what the ratios making their way through the legislature are?

Now I know it is just HPPD and the (OK I'll say it) lazy "supervisory RN" counts as though he or she is actually providing care.

One point is that we need to respect the work of skilled nursing workers and home health aides. They need to be paid fairly. That may require government action which needs at minimum educating legislators. Probably workers and families of patients need to lobby the staff of the elected officials in their area and write those far away.

I hope you don't mind being included in my prayers.

Hellllllo Nurse, BSN, RN · Jan 18, 2004

I worked in a LTC facility as an LPN and remained in my job as an RN until I left the state. I did all meds, tx, etc., all nursing care for 65 pts. I worked w/ 3 CNAs. I did turning, peri care, etc every shift. I did not get a lunch break for two years. The CNAs however, always got to take their lunch breaks. they always left on time, too. Often, I had to stay over.

I busted my butt doing hands on, direct pt care at that facility as an RN.

I now bust my butt doing direct, hands on care in a dialysis unit.

I am disheartened by your generalization of RNs as not wanting to do real hands on care, being uncaring and just wanting to do paperwork. I've worked w/ CNAs and LPNs that do not want to take care of pts, and doctors who do not care about their pts. There are caring and uncaring people in every level of health-care.

I recently asked to fill out an application at a LTC facility and was told "we don't hire RNs". I told them I would work for LPN pay- I just wanted to work LTC again. They were not interested.

Working conditions are far more important to me, and to many RNs than is money. You say RNs go from job to job just for the money- I have turned down and returned sign-on bonuses when working conditions were poor.

In my experience, any place that tries hard to be a great work-place for nurses has no problem attracting and retaining nurses.

How awful for you to make such generalizations about RNs. Maybe your facility has a bad reputation in your area and that's why RNs don't apply for jobs there.

PMHNP10 · Jan 18, 2004

Originally posted by kathi yudin
i am all for the ratio's.. having enough nurses should always be a priority to ensure safe care.. i currently work at a skilled nursing facility in newport beach.. we have 96 beds and have 93 residents in house at this time.. we run with 12 cna's on during the day ... 8 on 3-11 and 5 or 6 on 11-7.. nurses i generally work with 3 during the day 2.5 on 3-11 and 2 on 11-7.. i have been trying to hire nurses for 4 yrs.. rn's don't want to work unless they can be supervisors and do no patient care.. no meds.. or charting.. just admissions.. and orders.. and telling the lvn's what to do.. i won't use rn's that way.. it is a waste of a nurse.. in addition.. we are in a terrible nursing shortage.. there just are not enough nurses.. so.. the question is.. how do you meet your ratio's when there aren't enough nurses with which to do so???.. i ran an add last week.. got one resume!!!!.. this is the usual.. we bring students in to see what long term is like and to possibly have nurses to hire when they are done... we attempt to be competetive.. the nurses that are out there are ones that go from job to job for the money.. and don't care.. soooo again.. how does one meet the ratio????.. any suggestions/?? my ideal is 3-4 nurses on days.. 3 on 3-11 and 2 on 11-7... every time i get close... some one leaves for better pay elsewhere... kathi

Wow!!! If I am understanding this correctly, you are going to have to have 15 nurses/ shift to become compliant with the 6:1 ratio for med/surg type pts, which means you will have to hire approximately 30 more nurses for the assorted shifts. Also, this means currently each nurse is taking care of approximately 30-48 pts on the various shifts. I hate to be negative, but if I have your original numbers correct, I have to say you are in way too big of a hole to dig out of no matter what you do.

edit...

I read this post a second time and noted you mentioned long term--the shock of the figures running through my head had me too bewildered to notice previously. Is this as in a nursing home type thing...are there established ratios for this type of setting? Regardless, being responsible for 30+ lives is not a good thing, and what I previously stated still goes. Nonetheless, I wish you luck.

kathi yudin · Jan 18, 2004

i also am a very hands on rn.. the generalizations come from the calls i get from rn's who answer my adds.. they don't come in.. after they find out they have to push pills and be with residents..it comes from the few rn's i have hired that didn't want to push pills and do charting and all that was required... we would love to hire rn's.. it is not easy being the only one.. we are a fair.. nice place to work.. but.. they don't want to work... sorry if you feel it is a generalization... all i can say it is from the experiences i have had over the past 4 yrs... we actually are close to meeting our quota of nursing hours... 8 residents per cna is really not alot.. the residents are all taken care of.. clean.. changed... we get good surveys and have a good reputation in the community.. the problem is keeping good nurses.. who leave for no other reason then the money!!.. shows me that there is no loyalty.. or little... we are one of the few facilities that train new nurses... and take as long as they need to feel comfortable with what they are doing... the issue is not working conditions... it is money money money... pure and simple.. do i sound callous??.. i hope not.. it is what i am seeing... last week.. an rn just licensed.. from china... came in for an interview.. BRAND NEW!!.. offered her a position .. she chose a snf down the road for $32/hr!!!... a single owner facility can NO WAY compete with rates like that... especially for someone with Nexperience...

Sheri257 · Jan 18, 2004

Originally posted by kathi yudin
the residents are all taken care of.. clean.. changed... we get good surveys and have a good reputation in the community.. the problem is keeping good nurses.. who leave for no other reason then the money!!.. shows me that there is no loyalty.. or little... we are one of the few facilities that train new nurses... and take as long as they need to feel comfortable with what they are doing... the issue is not working conditions... it is money money money... pure and simple.. do i sound callous??.. i hope not.. it is what i am seeing... last week.. an rn just licensed.. from china... came in for an interview.. BRAND NEW!!.. offered her a position .. she chose a snf down the road for $32/hr!!!... a single owner facility can NO WAY compete with rates like that... especially for someone with Nexperience...

How much do you pay? Just wondering if there is a large difference between the $32 and what your facility pays.

You're right about the money. But I don't blame nurses for wanting more money either. Especially if they're living in Orange County, which is incredibly expensive. Rentals and housing prices are outrageous, so they may need more money just for that.

You usually can't buy a house in Orange County for less than $500,000. Your only alternative is to move to a cheaper area and endure the commute from hell.

And, disloyalty can cut both ways. I'm not saying this is the case with your facility, and I certainly sympathize with your situation, but with all the cutbacks, downsizing, etc. that's happened over the years, there's not too many companies that treat their employees well.

Even if your facility is different, things can change very quickly. So if there's tendency to just grab the best financial deal, I can understand why nurses might go with the bottom line.

kathi yudin · Jan 18, 2004

we are a single owner facility.. last of a breed.. anything i need we get.. the administrator rarely if ever says not now.. including hiring staff... we do lots of things to keep staff including the fact that i honor all requests as long as it is humanly possible to do so... for the holidays we drew names and gave away turkeys, hams, baskets.. we do taquito's for halloween.. will do something for valentines day.. always coming up with new ideas.. staff is happy and well taken care of.. we were offering $24/hr for a brand new grad. rn with NO ltc experience that we were going to have to orient from the ground up.. the facility offering $32/hr.. can't admit patients.. didn't pass survey..is under new ownership.. another corporation.. has an awful reputation.. but.. i did explain all of this to her.. but..money talks..

Hellllllo Nurse, BSN, RN · Jan 18, 2004

Even after your generalization of RNs, your facility sounds good to me. If I lived in the area, I would definitly apply.

BTW- I have been an RN for 4 years, was an LPN for 7 years and a CNA for 3 years. I make $22./hr, no benefits.

As an EXPERIENCED nurse, I know that working conditions are far more important than $$. However, I have been told by other facilities that pts and staff are their priorities. Then see that $$ is the only real priority.

foreign nurses often have incurred a lot of debt to get to The US, and need to send $$$ back home. Besides, isn't their primary motive for coming to The US the opportunity to earn big bucks?

If you are looking for a nurse whose primary motivation is not $$$, new grads and foreign nurses are not a good choice, IMO.

Maybe an older nurse would be better?

I'm thinking of someone who knows how hard nursing can be, someone without young children to support or student loans to pay off. If your staffing is truly good, a nurse with a back injury hx, or someone who finds most nursing to physically demanding might be good.

kathi yudin · Jan 18, 2004

think you can be a good nurse and a good employee... i consider myself both.. the nurses i currently have are.. new grads are good sometimes if the will is there... older nurses sometimes become too complacent.. based on the experience of the few older nurses i currently have.. they don't question.. just take for granted.. new or newer nurses do more questioning... we run the gamut from american to philipine to mexican nurses... interviewed someone the other day from belfast.. it is always nice to have cross representation..again however.. my question is.. how does one comply with the quota in acutes.. and ratios in ltc when there is a huge shortage..??.. he idea behind it is terrific..more nurses.. less stressed.. better pt care.. however.. where do we find these nurses????

Hellllllo Nurse, BSN, RN · Jan 18, 2004

Are their any nurses that you like?

You can find a good racial/ethnic mix of nurses among US citizens! No need to look to foreigners for that!

And again....there is no nursing shortage, everyone KNOWS that. This is fact-

There are 500,000 licensed RNs in The US who are working but not in nursing- Why? Working conditions!

That's the main reason behind the ratios- to lure them back and retain the ones who've stuck it out so far.

In my years as a nurse, I find that it IS very difficult to be both a good nurse and a "good employee". Employers like to hear nurses say they are pt advocates and that their pts are their #1 priority, but when you start actually making waves to try and get your pts' needs met, then managers change their tune. They want only lip-service to pt advocasy, not real action.

Are you an RN?

Sheri257 · Jan 18, 2004

I still think the real problem is cost of living in Orange County.

$24 just doesn't go very far there. Figure a little under $900 for 36 hours a week ... not including taxes which, of course, reduce your take home pay.

Rent for a tiny apartment is at least $1,500 a month I think? Often $2,000. (My friend charges $1,800 for his studio apartment rental.) And mortgages are easily double that.

In OC, it could easily take two paychecks just to pay rent for a box at $24 an hour. Unless, of course, you're willing to live in a really bad neighborhood or fight traffic for at least two hours a day.

I live in the San Bernardino desert where the cost of living is much cheaper (houses are typically $150,000 verus $500,000 in OC)

You may have to drive a half hour, but new nurses can get $24 here with a much lower cost of living. If you don't want to drive, $20 is about the average.

Just some info for comparision purposes.