RN:patient ratio in SNF in Ca

[Oranges3420]

I am a new RN just starting my first job at a SNF in Sacramento. The patient load is about 22-27 patients. There's a desk nurse - sometimes - to help w/admissions or new orders but, for the most part, I am on my own w/all of this. The residents are all sub-acute on my wing. It is a MADHOUSE!!!! Is this patient load normal? I was on my own for the first time last week and didnt finish my 21:00 meds til 23:15 at night!!! (my shift is 2pm-11pm) Then I had to chart on 15 of the patients. I left very, very late.

Does anyone have any tips/suggestions as to how to manage my time better? The nurses tell me they double up the meds - giving 1700 and 2100 meds at the same time - but I thought this wasn't kosher. I also don't seem to have time to actually ASSESS my patients! I don't know what' going on w/them or why they are there.

Are there other facilities out there that may be better for a new grad? This seems impossible to do!

[achot chavi]

ratio sound ok, dont double up and give meds at the same time - there is a reason for the different timing- but start earlier if you can.

It gets easier- I promise- do assessments and treatments earlier.

Try to be organized

[CapeCodMermaid, RN]

Talk to the pharmacy consultant to see if some meds can be given safely together instead of two different passes. Sometimes it's easier to do your assessments when you're giving the meds. I used to assess the residents for the MDS during tray pass. You'd be surprised how much you can find out if you just watch them. Giving a pain med? There's an assessment done...giving a coumadin? there's part of your note for medicare charting for anticoagulant therapy. It does get easier. 27 subacute patients is a lot, but it is doable. You'll get quicker and more confident with time, but don't hesitate to ask for help if you feel like you're sinking faster than you can paddle.

[Oranges3420]

Thanks CapeCod.

Do you think it makes a difference if a new grad works for a LTC chain of facilities vs a single, private one? Would they offer more training or support to staff?

[CapeCodMermaid, RN]

I've worked in many places from stand alone single owner buildings to huge corporate places. Most of them had the same orientation...3 days. Pitiful really. I worked in one place that had a 4 week orientation for new grads. It was wonderful. By the end of the second week, most of them were bored and wanted to get going, but it was nice to be able to go slow if they needed to. You'll find a place where you fit in.

[NurseKatie08, MSN]

Yikes...I work subacute (as a new grad) and I guess I feel lucky--my orientation was 6.5, almost 7 weeks. (5 weeks on days, and then two weeks on eves, I am permanent eves). Our ratio on days/eves is 8-9:1, the night nurse has 22.

[Oranges3420]

mama mia! where do you work? are you in Ca?