1 RN to 45 patients-should I leave?

[Nurse Beth, MSN]

Dear Nurse Beth,

I wanted to ask for your opinion. I've been a RN for a little over a year. Currently work in healthcare/assisted living at a nursing home. I love working third shift. I don't work at a bad place and I love the residents. The facility keeps admitting people to assisted living that don't even know how to get back to there own room and 2 weeks ago I caught someone escaping. There are always med errors happening. I'm one nurse over 45 people in assisted living (we call it healthcare overflow.) Now, they keep admitting hospice to assisted living and I don't have enough staff to keep an eye on people trying to escape and those coming to the end of their life.

Some of the staff members don't want to work as a team. But I know that happens. I honestly hate coming into work to the point my stomach is in knots. I feel like I want to experience the hospital nursing. But scared to make the move since I'm comfortable here. When I had clinical, I was not a fan of med-surg, peds, or OB. Just looking for a little guidance. Thank you! Sorry, this is a little mixed around. My thoughts are all over the place right

Dear Has 45 Patients,

It's time to experience a different setting. You sound like a caring, compassionate nurse who is in an overwhelming situation. There is no way you can provide safe care to 45 patients. Often with that kind of workload and expectations, the nurse has to take shortcuts and workarounds just to get through a shift. This causes moral distress.

Hospital nursing can be very stressful as well, but you will gain so many skills, valuable experience, and a broader perspective. If you work a stepdown unit, for example, you may only have 3 patients (depending on where you live).

Go for it.

Best wishes,

Nurse Beth

Author, "Your Last Nursing Class: How to Land Your First Nursing Job"...and your next!

[Dragon Heart]

Sounds like in the interest of resident health and life safety a complaint investigation is in order and can be filed anonymously via state agency website that licenses Assisted Living Programs in your state of practice.

The Assisted Living regulations are on line (so you can crosswalk your concerns with regulatory guidance).

The areas that served as red flags to me in your communication are :

Resident Rights ;

Staffing to meet health and psychosocial needs of the population served

Service Plans ( individualized, realistic, measurable);

Quality Assurance plan and meetings (including incident reporting, pharmacy reviews, interdisciplinary input/notes

Emergency Disaster Planning/Policies and drills (e.g. elopement /wandering behavior)

[Wlaurie, RN]

If I were in your position I would look into hospice nursing if that's what you want to do. There are greener pastures out there so don't be afraid to look. If it doesn't work out I would bet you could get your old ltc job back if you wanted it. I started out in ltc and was not satisfied with it. Handing out pills all day long, no time to spend with residents, huge workload and left defeated and tired at the end of the day. Right now I'm doing private duty nursing making more looking after one patient. Don't be afraid to look for other opportunities out there.