Published Jul 12, 2013
So we all live with the same CMS 5 star rating system. Part of the rating is the # of RNs on staff. I've put an ad in the paper and on craiglist for RNs. The LPNs I have working for me on a per diem basis give me the evil eye every time I walk down the hall because I won't hire them for the open slots.
Ladies, I don't make the rules. I have to live with them. We are getting more and more clinically complex residents and I need RNs to care for them.
It is not my fault you chose the path you did.
Quit glaring at me.
PS. These are all fine nurses. But, in this business those initials after your name make all the difference.
I'm done venting.
Oh wait....one more thing....where are all the RNs??
Well, guess eventually I will have to get my RN now!! LOL!! I haven't gotten it yet, because I didn't want to work in the hospital. With all due respect, I know that there is a difference between LPNs and RNs. However, the nurse that currently works our rehab unit full time in an LPN and I think she does a better job then the other nurses who cover that unit on her days off (some of whom are RNs). I have a year of experience in the hospital that I obtained back when LPNs were allowed to work in that setting. I know that I am more than capable of caring for the acuity on the subacute/rehab units. CMS ratings are not always a good indicator in my opinion. My facility puts 1 LPN for 25 res on a rehab unit with no treatment nurse, no admissions nurse, absolutely no support whatsoever-you really are ON YOUR OWN. The funny thing is the RNs won't touch that unit with a 10 ft pole, because they all say they don't want to risk their licenses. Maybe CMS should focus on setting some SANE NURSE/PATIENT ratios instead of worrying how many RNs staff a facility. It doesn't matter whether you have RNs or LPN, what matters is that you staff appropriately for patient safety-something my company is not willing to do. BTW, I like to learn and would go back to get my RN if that is what I need to do to stay employable. I just can't believe that the government can be so stupid as to think that more RNs will matter when they are not willing to pass legislation that will really protect the patient.
Forgot to mention that my facility has a fairly decent 5 star rating, because the "higher ups" all come crawling out of the woodwork giving us the support that we don't normally get when the surveyers are there. Then when they are gone, supervisors all crawl back into their caves (offices) and we don't see them for another year unless of course they want to tell us what we are doing wrong.
Salisburysteak, BSN, RN
I work at a 5 star rated facility and we have more LPNs than RNs. I did not know the higher the rating, the higher the acuity.
And to answer your question....the RNs are at the hospital trying to get jobs. LTC may not even be on their radar!
Number of RNs is part of the score, but only part. If your facility scores well in other areas, you can still be a 5 star facility. Also, it doesn't have to be all RNs. My facility has quite a few RNs, but still is not 5 star since it is low in other areas. I think we rank average. We are low on staffing, but our core measures are at a 5 star level. Says alot for the staff IMHO.
I've worked in quite a few 5 star places that I wouldn't allow a dog to be admitted into. I've worked in even more places that were 2 stars, that were in reality much better than a lot of five star places. I think the average person takes the 'star' system with a grain of salt. By and away, I've seen location as being the main issue in picking a place for Gramps. As far as acuity, if your state has a restrictive IV policy for LPNs, and you admit a lot of IVs, you'd naturally need more RNs. But in that case, you're probably going to take a lot of financial hits with the IV expenses, and the added payroll costs for the RNs? In almost every place I've ever worked (LTC), the mere mention of an IV makes management shudder.
We take IVs. I've noticed that back when the acuity was lower our facility did not allow us LPNs to do IVs even the our state nurse practice act allowed it. Now that the acuity is getting higher, we are all required to get certified. And I agree that the 5 star rating should be taken with a grain of salt. Unfortunately, most of the people who make the rules are administrative types who haven't worked the floor in eons. The state agencies that survey the facilities make the rules so broad that they can pretty much interpret them any way they want to. That is why the acuity in these places keeps getting higher while the staffing doesn't change or in the case of my facility gets worse.
TheCommuter, BSN, RN
I worked in LTC for six years before throwing my hands up and leaving. Yes, the residents are getting more and more complex to the point that many nursing home units resemble med/surg floors. However, the staffing at most facilities does not reflect the increasing acuity levels.
savoytruffle, BSN, RN
Agree with the commuter. This RN is leaving LTC. After six years, AANAC certification, management experience, committee participation and feeling like my career was going places, I am just breaking up with SNFs. I cannot make the money I could elsewhere. Benefits are less in my facility now. I have very little independence or control over my floor. My head nurse, who is an LPN, thinks she is the boss. She disciplines the staff and has written telephone orders changing my treatments to heel ulcers without consulting me or telling me. Some of my CNAs and LPNs (not all- don't get crazy) are rude, lazy, and more concerned with their cigarette breaks than doing their work. And the DRAMA!! Wow. The interdisciplinary team all has their own goals and plans and the teamwork is poor. The residents are sicker and more demented with every admission. We started taking patients from the hospitals "difficult to place" list. The DON will not listen to me when I tell her I do not have the right products for wound care or skin care (the aides are using the antibacterial hand soap from the bathroom to do peri care- ouch!!) I'm tired of feeling like I'm running head first into a wall every day. I am looking for a position where I am no longer responsible for others; where my outcome is only a reliant on me and my quality of work; where my reputation as a clinician can be built up again. I don't think my time in these facilities was a waste. I learned a lot about how to work with people- only to find out that I want to be on my own. Looking into home care.
this is not RN vs LPN, it is a job qualification/requirement issue
i'm sorry people don't get that
Not neccesarily. An LPN has the scope of practice to work on any LTC unit in my state including subacute rehab. This is a CMS thing. The rating system makes it so that a facility is rated better with more RNs. Of course, it depends on your state and scope of practice. If LPNs are limited, then more RNs would have to be hired to handle things like IV meds.
I'm one RN who will no longer work in LTC unless I was on the verge of homelessness. I worked in LTC for six years before throwing my hands up and leaving. Yes, the residents are getting more and more complex to the point that many nursing home units resemble med/surg floors. However, the staffing at most facilities does not reflect the increasing acuity levels.
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