Doesn’t seem to be your medication aides are the problem but the expectations of the facility on the RN. To have one RN cover both a skilled unit of 20 and be responsible for assessments, treatments, orders and insulin on 3 other units - for a grand a total of 80 is asking for things to be missed. She’s juggling too many balls, it’s that simple. Follow her for a day, look at her acuity on the unit she’s on, the acuity and behaviors overall, what tasks she’s responsible for (treatments, IVs, wound vac, nebulizers, bladder scanner, EKG, admissions/discharges, teaching, Medicare charting, Care planning, mds, - all the paper/computer work she’s required to do) do a time study of how long it takes for her to do her tasks, paperwork. Remember that tasks change often and remember that even a simple pulse oximeter check can take time if it’s with and without O2, with exertion, or the patient has a low reading. Or the patient is slow and uncooperative. Allow for unexpected emergencies, Falls, skin tears and families needing reassurance,Education etc. Be sure to include how long it takes simply getting from unit to unit seeing patients (remember if there are patients requiring insulin or prns at the same time on different units that is going to add to the inevitable inefficiency and length of time to get things done.) How accessible and stocked are supplies? If you have a computer system, allow for time to log in, freezing, total clicks to get from page to page and other frustrating system hiccups. Look at how things are communicated to the nurse - how is she notified of new orders? Does she have to do rounds with the MDs? If so, how generally time consuming are rounds and how disruptive to her responsibilities? Does she get behind? If she doesn’t do rounds, do they simply leave orders on the units she is not physically on? If so, who notifies her the doctor was here. How many staff are assigned to her on her unit and on the other units? Are they reliable, caring, kind, well trained, efficient and can recognize when they need to speak to the RN? Or do they actually add to her workload? And finally, what do you as a charge nurse do to support her, the caregivers and the facility? Do some investigation and you might find out why.