I have been thinking about this thread since I read it yesterday.
A couple of thoughts come to mind, which may or may not apply to your situation. But I'll throw them out there.
One is that I believe there is a disconnect between the way management perceives a job as a floor nurse to be, and the way it actually is for that floor nurse. What do your nurses tell you when you ask why these things aren't being done?
I know the correct way to do most things at both of the facilities I've worked at. I'm not stupid. But when I've got (what feels like) at least 10 different things simultaneously coming at me all day long, I can't always do things the correct way. Sometimes I forget. Sometimes I have to say screw it, because I am one person, and in my mind at that moment -- A, B, and C are more important than D. It sucks. And it doesn't fit well with my perfectionist personality. But it's the reality of me working in LTC.
I know, your mind may be wanting to go to "but my facility is different". No, it probably isn't. I'm working at a very nice place, relatively low acuity, only private pay and Medicare, staffing ratio about the same as yours most days. We do get more admissions and discharges, but the DON and ADON help out with those quite a bit when they are there.
My days still feel just as busy, and my mind just as full, as when I was working at the Medicaid facility and responsible for 28-35 residents each day. It's just a different busy. I encounter more family members on a daily basis, who are more educated and more involved in the resident's care. They ask a lot of questions. They have higher expectations. We also take WAY more vitals and daily weights, O2 sats etc that have to be put into the computer on a daily basis.
Also, when your residents are functioning at a higher level, they tend to want to converse and ask a lot of questions of their own. They show up at your cart and want their meds right now. Etc.
20:1 doesn't sound like a lot to some people who have worked in much worse conditions. But I'm here to tell you that the days can be just as full. I worked 11.5 hours on what is supposed to be an 8.5 hour job yesterday. No lunch break. Didn't eat all day, in fact. And I left without doing my Medicare charting AT ALL.