Colima

What type of facility do you work at? How many beds? How many nurses per bed? How many nurses per patient/resident? How many aides per bed? How many aides per patient/resident? Are you satisfied with staffing levels at your facility? If not, do you think this impacts patient/resident health? How much time do you estimate you actually spend directly with each of your patients/residents per shift? Thanks! ELM

Just to clarify, I never suggested that administrators assist direct care nurses with patient care - I suggested that administrators do direct patient care for a week - or one day a month - or one day a year - just to experience the situation for themselves - and either prove that it's doable or admit that it's undoable. It's the administrator's job to secure appropriate staffing, whether it is MDS nurses or direct care nurses. There is no excuse for the situation as it stands. No offense to administrator, who I know also have their hands full - but who also have the power and obligation to do something about it. Also, I understand that extra effort before an audit is normal, and akin to cleaning the house especially well prior to a party or other event. But falsifying records, providing patient care and activities on audit day that are otherwise not provided, and misleading regulators and the public about appopriate staffing levels is NOT akin to cleaning the house - it's simply wrong. I'm not saying all adminstrators do this, but I've seen it myself in several facilities.

http://www.boston.com/news/local/rhode_island/articles/2006/05/02/testimony_begins_in_nursing_home_neglect_trial/ A nurse caring for 60 patients faces criminal neglect charges with a potential for up to three years in prison, based on the undocumented claims of a CNA also caring for 60 patients! The administrator and nursing directors, who controlled the staffing levels that ultimately led to the tragedy? They face lesser charges! I know with 30+ residents I can't assess all of them thoroughly in any one shift, much less multiple times. How many times have you had a resident developing symptoms of URI, diminished lung sounds, etc? In CHF, a death can occur in hours. Do you listen to all of your patient's lung sounds regularly? With so many patients, you simply can't! In all likelihood this nurse may not even have known about the resident's respiratory distress until too late - or may have been busy with the multitude of other tasks she no doubt had - many of them urgent as well. When push comes to shove, everyone is going to cover their own ass - including aides, nurses, and administrators. If it's not documented it didn't happen! But many times you can't complete thorough documentation until the very end or even AFTER your shift! Vital signs at our facility were turned in by CNA's at 10pm on the 3-11 shift. If an abnormality is not called to our attention by the aide or patient ... NURSES,it's OUR licenses on the line and our very freedom on the line should something happen on our watch. I urge everyone to file written complaints/notices with their employers, ombudsman, and to contact local media to let them know the situations at their own workplaces.

Great response, and I completely agree. We are enabling this system by not demanding adequate staffing and by not taking strong actions against the current and unacceptable situation. I wrote to my state and national ombudsman, and am now going to write an article for the local newspapers (one of which did a glowing article about this same facility, all based on bs provided by the administrators). Nobody knows what goes on on the front lines but the patients and the nurses. It's our job to make what goes on public. No matter how much we care or struggle, the best thing we can do for our patients is to help change the system, not wear ourselves thin within in. If there any nurses in NH or elsewhere who would like to contribute their stories (anonomously or not), please e-mail me!

Exactly. When regulators/auditors are expected, administration goes into overdrive, making it appear that they are meeting or exceeding recommendations/requirements. Suddenly there are continual activities for residents to participate in, whereas on "normal" days they sit in their rooms or in the halls with nothing to do. Aides are instructed to place water pitchers specifically reserved for "audits" in each room. Nurses are instructed to fabricate nursing notes missing in charts, including fabricating vital signs. Staffing is twice what it is on "normal" days. Auditors are carefully routed through the day and the facility, introduced to residents in private rooms and residents most likely to report positive things. It's completely dishonest. And then, when the audit is over, the administrators breathe a sigh of relief and the nurses and residents are left once again holding the bag. I not only quit, but I reported the situation to the Ombudsman and to local lawmakers. It was crazy. If one patient fell, suffered a stroke or other emergency, the other 29 - 59 residents were without medications and without nursing assistance for up to 3 hours at a time. And administrators would admonish nurses for not getting everything done, instead of realizing that it is their own policy and staffing levels, and ultimately the money issue, that results in things not getting done. I wonder if every nurse who works at an understaffed facility reported these conditions ... would something actually be done? I feel as if we are almost condoning things by not speaking out - or at least enabling it to continue.

In my last job (which I quit due to inadequate staffing), I had 30 patients to take care of, 60 while the other nurse was at lunch. Our CNAs had 10 residents each, sometimes up to 20. The facility was a combination rehab/long-term-care facility. Approximately 1/3 of my residents were also Alzheimers and/or psychiatric residents. These residents required almost continual supervision. Even if I wanted to, there was no way I could do bedmaking, bedpans, etc. :uhoh21: Still, I did do these things when I had to - but that time cut into my required tasks as a nurse. The third floor of this facility has 60 beds, usually full. Evening shift (3-11) has only TWO nurses - that means each nurse must care for THIRTY residents all by herself. At night there is only ONE nurse caring for all SIXTY residents. The facility meets the hour/ratio requirements by hiring nurses in administrative positions - and counting any moving body with any type of direct care license (even if they aren't taking care of patients), making it seem like there are more nurses than there actually are. They count anyone licensed to do any type of direct care and who is in the building - regardless of the fact that some of those people are administrators, OT/PT/RT, or other staff that are not providing daily direct patient care. It is logistically IMPOSSIBLE for one nurse to provide competent, adequate, thorough, and truly compassionate nursing care to 30 residents. You can come in early, leave late, skip all meals and breaks, and still not do the things you should be doing, still not give the care the residents deserve. The formula used for nurse/patient ratios presents skewed results. Regulatory agencies should look directly at how many nurses are taking care of how many patients at any one time, not including staff that are not providing direct care at that time. I think New Hampshire's ratio is 3.7 hours, and HCFA says that a number below 3.5 hours is insufficient to provide adequate care. Cutting it close, aren't we? Recent recommondations are 4.1-4.6, I believe. Nurses on that floor, with 30 residents each: pass medications, do wound assessment and care, do treatments, catheters, resident assessments, incoming lab/radiology/consult results, call physicians to relay information and request orders, take new orders, enact those orders, stock, receive pharmacy deliveries, assist residents with ADLs, pass meal trays, feed residents, deal with resident family needs, requests for various assistance by residents and/or other staff, and deal with physicians. They answer the phones, monitor, assist, and supervise CNAs, and do a myriad of other tasks and miscellaneous resident care including but not limited to assessment, monitoring meeting social needs, performing treatments, and providing emergency care. There is no secretary, unit clerk, charge nurse, or other person to take care of phone calls/faxes/family/orders or the multitude of other tasks necessary behind the scenes (at the nurse's station). A nurse cannot be in the nurse's station, on the telephone, at a med cart, and in a resident room all at the same time! And of course this doesn't include all of the paperwork and documentation due at the end of the shift. No wonder staff turn over is high and residents receive inadequate care (carefully covered up by administrators and statistics). At the end of the day, it's the patient that receives inadequate care, it's the nurses that are exhausted, and it's the nurses license on the line should any legal liability result from the care she is unable to give due to inadequate staffing. Let's see any of the "adminstrators" who are also nurses work the floor for a week and do everything that they continually remind us to do. They can't. Because it's impossible. I know this for a fact. And I know for a fact that nurses and aides at that facility are signing off on care that they don't actually provide and tasks that they don't actually perform. 30 patients to one nurse is WAY TOO MANY. 20 patients to one nurse is still too many. Hear it from the front lines - in LTC facilities, nurses should have no more than 15 residents - and in hospitals, no more than 5. Anyone who states otherwise has 1) never worked as a nurse or aide, 2) never been a resident or patient in an understaffed facility, and 3) is not living in reality. Oh - one final thought. The third floor of that facility, with 60 beds, has only ONE complete set of vital sign equipment! That is ONE tympanogram, ONE oximeter, ONE working BP cuff, NO large or small cuffs, and few if any functioning stethoscopes. No pen lights for neuro checks. No sharps containers in rooms. Only one hand sanitizer dispenser on each hall. In other words, it's BYOE (bring your own equipment). A long list of problems that made it difficult if not impossible to provide good care...

In my last job (which I quit due to inadequate staffing), I had 30 patients to take care of, 60 while the other nurse was at lunch. Our CNAs had 10 residents each, sometimes up to 20. The facility was a combination rehab/long-term-care facility. Approximately 1/3 of my residents were also Alzheimers and/or psychiatric residents. These residents required almost continual supervision. Even if I wanted to, there was no way I could do bedmaking, bedpans, etc. :uhoh21: Still, I did do these things when I had to - but that time cut into my required tasks as a nurse. The third floor of this facility has 60 beds, usually full. Evening shift (3-11) has only TWO nurses - that means each nurse must care for THIRTY residents all by herself. At night there is only ONE nurse caring for all SIXTY residents. The facility meets the hour/ratio requirements by hiring nurses in administrative positions - and counting any moving body with any type of direct care license (even if they aren't taking care of patients), making it seem like there are more nurses than there actually are. They count anyone licensed to do any type of direct care and who is in the building - regardless of the fact that some of those people are administrators, OT/PT/RT, or other staff that are not providing daily direct patient care. It is logistically IMPOSSIBLE for one nurse to provide competent, adequate, thorough, and truly compassionate nursing care to 30 residents. You can come in early, leave late, skip all meals and breaks, and still not do the things you should be doing, still not give the care the residents deserve. The formula used for nurse/patient ratios presents skewed results. Regulatory agencies should look directly at how many nurses are taking care of how many patients at any one time, not including staff that are not providing direct care at that time. I think New Hampshire's ratio is 3.7 hours, and HCFA says that a number below 3.5 hours is insufficient to provide adequate care. Cutting it close, aren't we? Recent recommondations are 4.1-4.6, I believe. Nurses on that floor, with 30 residents each: pass medications, do wound assessment and care, do treatments, catheters, resident assessments, incoming lab/radiology/consult results, call physicians to relay information and request orders, take new orders, enact those orders, stock, receive pharmacy deliveries, assist residents with ADLs, pass meal trays, feed residents, deal with resident family needs, requests for various assistance by residents and/or other staff, and deal with physicians. They answer the phones, monitor, assist, and supervise CNAs, and do a myriad of other tasks and miscellaneous resident care including but not limited to assessment, monitoring meeting social needs, performing treatments, and providing emergency care. There is no secretary, unit clerk, charge nurse, or other person to take care of phone calls/faxes/family/orders or the multitude of other tasks necessary behind the scenes (at the nurse's station). A nurse cannot be in the nurse's station, on the telephone, at a med cart, and in a resident room all at the same time! And of course this doesn't include all of the paperwork and documentation due at the end of the shift. No wonder staff turn over is high and residents receive inadequate care (carefully covered up by administrators and statistics). At the end of the day, it's the patient that receives inadequate care, it's the nurses that are exhausted, and it's the nurses license on the line should any legal liability result from the care she is unable to give due to inadequate staffing. Let's see any of the "adminstrators" who are also nurses work the floor for a week and do everything that they continually remind us to do. They can't. Because it's impossible. I know this for a fact. And I know for a fact that nurses and aides at that facility are signing off on care that they don't actually provide and tasks that they don't actually perform. 30 patients to one nurse is WAY TOO MANY. 20 patients to one nurse is still too many. Hear it from the front lines - in LTC facilities, nurses should have no more than 15 residents - and in hospitals, no more than 5. Anyone who states otherwise has 1) never worked as a nurse or aide, 2) never been a resident or patient in an understaffed facility, and 3) is not living in reality. Oh - one final thought. The third floor of that facility, with 60 beds, has only ONE complete set of vital sign equipment! That is ONE tympanogram, ONE oximeter, ONE working BP cuff, NO large or small cuffs, and few if any functioning stethoscopes. No pen lights for neuro checks. No sharps containers in rooms. Only one hand sanitizer dispenser on each hall. In other words, it's BYOE (bring your own equipment). A long list of problems that made it difficult if not impossible to provide good care...

New Hampshire has no laws, rules, or regulations mandating nurse/patient ratios. In my last job, I had 30 patients to take care of, 60 while the other nurse was at lunch. Our CNAs had 10 residents each, sometimes up to 20. The facility was a combination rehab/long-term-care facility. Approximately 1/3 of my residents were also Alzheimers and/or psychiatric residents. These residents required almost continual supervision. Even if I wanted to, there was no way I could do bedmaking, bedpans, etc. It was logistically impossible to do two med passes, assess residents, assist residents and family, monitor lab/radiology/consult results, talk to doctors, take new orders, do treatments/woundcare/cath care and deal with emergencies or admissions/discharges. I'm posting this as a new thread wondering about nurse/patient ratios in other New Hampshire facilities, in other states, and what NURSES think nurse/patient ratios should be. :uhoh21: