nursing ratio's

U.S.A. California

Published

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

i am an rn.. been so for close to 30 yrs!!!,,, i am a pt advocate as is my staff developer and administrator!!!.. maybe we are a rarity.. but.. if the pt needs it .. we get it.. we keep our residents at the facility longer then any other facility.. i believe and pass this along to my nurses.. we are nurses just like the nurses in the acute with the same training..!!.. we need to use it.. the only thing that we can not do is put someone on a ventilator.. sooooooooo why not act like nurses!!!.. and they do a good job of it which the drs. appreciate!!!.. it is tooo disruptive to constantly be sending them back and forth.. in addition to this.. the majority of our residents are behavior probs with psych histories.. send them to the acute.. they are taken off of their psych meds.. and.. the behaviors escalate!!..soooo we keep them there and be nurses!!!.. part of the problem i find with the nurses that leave my facility is .. they do not want to work as hard as they have to.. between 34 residents.. charting.. careplans.. treatments ... they are constantly on the go... and they leave for facilities that are less hectic... there are more regs with ltc then hospitals.. dhs can come in under obra or title 22.. we have to comply to both!!!.. i must say we do do a good job at it...!!!.. i am lucky to have the lvn's that i have..

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I find your statement that older nurses are complacent offensive and untrue. I work rings around most of the younger nurses I have come into contact with over the last 3 to 5 years. I work smarter too.

I know ltc is a difficult job and one that takes a certain dedication.

I do agree with the poster who stated facilities love to hear a nurse saying patient care is her #1 issue, but when she has a problem or an issue that requires certain policies or rules be challenged, then she is often called a trouble maker, not a team player, or narrow minded. I find most nurses who have worked in a facility that is truly caring and good to the staff and patients have a great loyalty. Unhappily there are just too few of these.

Lastly, I am not living in California, but have several relatives who do, I find the salary very low for the area. Not to mention the job description.

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Well, let's see...the OP does not like new grads, does not like older nurses, does not like nurses who want to earn the highest salaries they can, does not like RNs in general...

Well, I guess you're just SOL, lady!

Better put on some comfortable shoes and start pushin' that old med cart down the hall!

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for helllllo nurse.. if you are talking about me.. i do like graduates more then anything... they are like sponges.. and are great to teach.. as for the older nurses.. i didn't say i didn't like them.. but.. the ones that i have seen in MY facility.. are more complacent.. they can work rings around the younger ones.. but.. take more for granted and are not quite as questioning as the younger nurses... i have nothing against wanting to make the most that one can.. what i do have against nurses is when they jump from one facility to the next with difficulty staying in one place.. however.. there is more then just money.. i could probably make 15- 20 thousand more then currently making.. and work better hrs.. currently.. i get in between 6 and 6:30 am.. however.. there is something to be said for loyalty.. and don't leave most nites before 6 pm.. i put in time on weekends like this weekend.. hanging iv's because i can't get an rn... yet.. at another facility i would not have an administrator that is willing to teach me and guide me.. and my administrator has done that for me.. she has taught me everything.. including things about mcare and mcal.. admissions.. things i might not have learned or had the ability to learn elsewhere.. that.. is what loyalty is about.. the ability to learn and add to ones bank of knowledge

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Originally posted by kathi yudin

what i do have against nurses is when they jump from one facility to the next with difficulty staying in one place.. however.. there is more then just money.. i could probably make 15- 20 thousand more then currently making.. and work better hrs.. currently.. i get in between 6 and 6:30 am.. however.. there is something to be said for loyalty..

I agree. But I honestly don't think this is just about greed or disloyalty.

If the pay difference between your facility and others is $8 an hour, nurses might really need that extra $1,100 a month just to find a decent place to live.

You haven't addressed this point, but if the owner is really willing to help, I'd work on paying better salaries. I've lived in OC and $24 just isn't a living wage in that area, unless you have a husband who also works or some other major source of income.

Housing is way too expensive there, and I don't think your salary is taking that into account.

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Hi,

My name is Candy Goulette. I am the editor for Real Life Healthcare, a monthly healthcare magazine published by The Sacramento Bee. We're mailed to 75,000 nurses and other healthcare folks in a 14-county area from Lake Tahoe through the greater Bay area.

Health care facilities here are also dealing with problems directly related to the ratios that went into effect on Jan. 1. Hospitals here pay from $25 (small, rural hospital) to $33 (Kaiser, Sutter) an hour for NEW grads, which means the old-timers are getting even more. These hospitals must be in compliance to ratios, too, but many aren't, simply because they can't find the nurses to staff their med-surg floors.

Do any of you have any comments that I could use in my next issue of the magazine? I know our readers would be interested in your plight.

Let me know. You can email me at [email protected]. See this month's magazine at http://www.reallifehealthcare.com

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Here is a (famous) great article that explains a lot about the nursing "shortage".

http://www.revolutionmag.com/engineering.html

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thanks for the quick reply -- very interesting to see the shortage from the other side.

It is much as I suspected. I find it very interesting that nurses are leaving California for Arizona in droves and that many midwestern states find themselves with more nurses than they need.

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Kathi,

Sounds like you run an ideal facility. I have just applied to nursing schools and am wondering what your opinion is:

a) How much does it matter where a BSN is from?

b) What's your opinion of these schools- have you worked with any of their graduates (BSN)

1- Mount Saint Mary's College, Los Angeles

2- University of San Francisco

3- Univ. of Arizona, Tucson

4- Johns Hopkins School of Nursing

I've applied to all of them and am awaiting acceptance notice.

I've got a 3.6 GPA and hope to have a 3.8 by the end of this semester (finishing Physiology, English 101-B, Nutrition)

Would you be able to respond to my personal email as I may have a difficult time finding this page again>?

Thanks,

Nancy P.

[email protected] :coollook:

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ok.. not sure where to start.. snf's don't work with ratio's per say.. they go by nursing hours.. included in this are the cna's.. nurses including mds nurse... most facilities can't meet the nursing hrs.. but we do come pretty close.. 8 residents for cna's is actually a very good number.. they give showers twice/wk to each resident.. change diapers.. and give all care with time to spare.. very frequently the cna's are found holding up walls with time on their hands.. we have good surveys and dhs has actually recommended us to families... as for the rn's.. for the one that would like to return to ltc.. please.. by all means contact me and i would love to interview you.. unfortunately.. most rn's in the area just want to supervise.. i will stand behind that emphatically.. i would love to have an rn or two.. yes.. the nurses do the treatments... have 34 residents at maximum... and do usually get out on time.. as well as getting lunch.. ratio's serve their purpose.. but .. again.. it brings me to the original question.. where do we get the nurses???..

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Hi there! I'm just new in here and i wanna ask some questions regarding nursing in california. I am a foreign nurse and would like to know if it is possible for me to get a working visa and eventually work in California without passing the CGFNS Exam? I already have an employer based in Indio and the only thing he made clear of to me is to pass the NCLEX exam right after i arrived there. Is it really possible? I just wanna make sure of it. I will be starting as a nurses aide and it doesn't really matter to me as long as i can go to the states. I know that it would be just a stepping stone for me and eventually can practice as an RN right after the exam. PLeas elet me know if direct hiring is really possible. Thank you so much. :)

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Hi Nancy,

Mount St. Mary's is the Holy Grail of nursing schools. Your credentials are impressive, but be warned that St. Mary's has a waiting list. USF is also wonderful, as is UCSF. I don't think you can go wrong with any of these schools. As for the other two you mention, both have very strong medical schools and great traditions in health care.

As for how much where you earn your BS counts, I believe that only matters if you plan to do advanced training or earn advanced degrees. If you plan to be a floor nurse, or a critical care nurse, or any of a hundred "regular" nursing jobs, where you earned your degree doesn't matter. It's what you learn that really counts.

Candy Goulette

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