Safe nurse to resident ratios in LTC?

kat7ap · Jul 10, 2007

My first job was 20:1 with usually 2 aides to help me. Most of the time this was "ok" but if you were to have any incidence or an admission (no admitting nurse), it could get hairy. Generally 20:1 seems decent, but any more than that would be tough. Depends a lot of what how much and what kind of support staff you are working with.

BigB · Jul 11, 2007

In my first and only LTC job, I had 47 - 48 patients. This was an absolute nightmare. Average in California seems to be 30 - 35+ per nurse in LTC. This is still a terrible ratio. I wouldn't feel safe with over 20 patients..and would prefer 15 or less.

gennavieve · Jan 21, 2008

I'm working in Indiana in a Assisted living home, that is a JOKE (Assisted), many are full care and should be in a skilled nursing home, it is for profit and for 40-43 resident there is one Nurse ( that's me) and one CNA. I pass meds 2x a ahift for all 40-43 residents, do TX's, Blood sugars, insulin, escort residents to dinner, serve meals, escort back to rooms, clear tables and rinse dishes, put in dish washer racks, chart etcv,etc,etc--just 1 CNA and ME. If there is a fall, cardiac problems etc,etc I am the only who can handle it. I was just told the CNA may not come till 4:30pm so I'd be alone from 2 till 4:30, to toliet, get residents up for dinner, pass meds (they don't have to pay for a CNA for2 1/2hours, administration said they'd help the nurse they are sitting at their desk and won't answer the phone or answer the door (which the Nurse or CNA must do). There is no receptionist. That is the nurses job!!! So NO this IS NOT A SAFE RATIO!!!! All this is for PROFIT, that the company receives, the administration recieves when they keep the salaries down by having only 1 CNA and 1 LPN. OH, we also do the laundry, vacum the halls and serve everyone snacks at 8pm!! Anything else you'd like the two of us to do in our spare time.

Gennavieve

bluegeegoo2, LPN · Jan 21, 2008

I would be looking for another job!! I live in S. Indiana, and there are PLENTY of LPN positions available that are nowhere near the load you have. I work in LTC on a skilled unit with 31 residents, and we almost always have 2 nurses to split the hall. I would be worried to death about the liability working with as many residents as you do with little (no offense to the CNA) to no help. Seriously. RUN AWAY!!!

mbotts · Jan 21, 2008

I was also wondering what is the nurse patient ratio in LTC in the state of ohio? The facility i work at just took a night position to cut back so to say. so the other nurse will be responsible for her floor and the other floor which will be 44 residents. That is to many, a nurse could not give good patient care. At 6am both of these floors has a huge med pass. The hall where they are cutting back it takes about 1 1/2 hours itself. the other hall take about an hour. Is there a law that staes how many residents one nurse can take care of? it is unsafe and i feel your nursing license would be put on the line and that company doest care about you.

gennavieve · Jan 21, 2008

I have just done that!!! Am 64years old aND DECIDED IT was time to RETIRE, at least for that type nursing. I feel so guilty tho! I love the residents and have been there for 5 years, ( I know I'm insane) but I truly love the resudents and the CNA I work with but I just had enough. I have had polio and has post polio syndrome and falling alot ( not at work) but after because of the length of time I am on my feet. My husband retired in June and I'll bwe 65 in Sept and was hoping to stick it out till then, for insurance but NO MORE. I left 3 days ago, will visit the residents and so what I can for them (perasonally) but I too was afraid of the legal issues in the last 6 months when a new administration come in and made lots of changes....the corporation will make more money their way but the staff and residents will and are suffering and the residents spend a SMALL FORTUNE to live there. Gennavieve

paulla29 · Jan 21, 2008

I was also wondering what is the nurse patient ratio in LTC in the state of ohio? The facility i work at just took a night position to cut back so to say. so the other nurse will be responsible for her floor and the other floor which will be 44 residents. That is to many, a nurse could not give good patient care. At 6am both of these floors has a huge med pass. The hall where they are cutting back it takes about 1 1/2 hours itself. the other hall take about an hour. Is there a law that staes how many residents one nurse can take care of? it is unsafe and i feel your nursing license would be put on the line and that company doest care about you.

Where I'm at, on day shift we have 25 residents. The night nurse on the back wing has both wings, for a total of 50. Management doesn't seem to get it, even though we've all told them again and again that the acuity is higher than it has ever been, and safe care cannot be given. It all boils down to the all mighty dollar. It is not right.

FrustratedLPN · Jan 22, 2008

Be thankful you're in a position to be able to retire!!! Good Luck to you and Congrats!. I'm 60, been an LPN for 17 years, and most recently lost my job because I forgot to give a patient's meds. This patient was asleep, had various problems with aggression, acting out, and insomnia. During the last medpass, I elected not to wake them, and decided I'd give the meds an hour later (permissable to give an hour before scheduled time or one hour after scheduled time). I forgot to give the med, oncoming nurse found the meds and called the DON to report the offense.

Yes, we've all found pills not given at some point, and usually we have the professional courtesy to ask the nurse that worked before us, suffice it to say... this nurse was quick to "be the judge and jury" and report me, rather than come and ask me. (As soon as I got home I remembered the meds, called work to tell her... she had ALREADY called the DON.) That night, I had an admission, a patient with no bowel sounds, a patient actively dying that needed a physician's order for pain meds, and I was the senior nurse working with two "new" nurses that had less than a year's nursing experience. Overwhelmed is an understatement.

I work in Tennessee, and yes the acuity level is getting more complicated. In LTC the average nurse to patient ratio is one nurse to 30/35 (on 3-11 shift). For the 11p-7a shift there are 50 patients to one nurse). Of this group, there can be patients that are: Total Hip replacements, Post CVA, ESRD, CHF, Alzheimer's, Post MI, etc. There were patients there that weighed over 300 pounds. It was myself and two CNA's to look after these patients. Most had to be fed by staff, and assisted to the bathroom, or were incontinent.

Where I was employed was also for PROFIT. The frontline staff was stressed to the max, forced to work overtime, and still having more, more, more added to the "to do" list. No, it's not safe, no....patients don't get the quality care they need and deserve. As long as healthcare is "for profit" there will continue to be this conflict. Managers are given bonus pay for keeping their respective departments under budget. The food served is portioned by the spoonful, and needed supplies go unordered. DON's and ADON's along with the rest of Administrative staff get promotions, bonus pay, and incentives to keep frontline staff to a minimum, while adding more and more work and responsibility to us.

Since Tennessee is a "work at will" state, you can be fired for something as silly as not smiling at the right time, or for no reason at all. We have no collective bargaining power, no representation, and no voice. Yet we are supposedly the "patient advocate".

As far as "ratio" when talking about nurse/patients, the "powers that be" have figured out how to get around that one long ago. The law is based on "nursing hours" to patients, not actual nurses per shift to patients. Thus, all those "management" nurses that "work" day shift have their hours counted. This includes the ADON, DON, Nurse managers, MDS nurses, Restorative Nurses, TX Nurses, Skilled Care Coordinator, etc. The hours they work, PLUS the nurses that are actually working the floor are added together. This amount is then averaged among the shifts and patients. Looks good on paper! No one seems to notice that most of these "nursing hours" include nurses that never touch or see a patient.

This is almost across the board for every LTC facility. I'm ashamed to say that the largest "for profit" LTC corporation has it's Headquarters in my hometown. Hundreds of office and administrative staff work in several of the largest buildings in town. Suffice it to say millions of dollars are made, while the frontline staff are left begging for equipment, supplies, all the while being paid an income far below what the Administrative staff makes.

Fair? Not in any way, shape, or form. The families that think their loved ones are receiving care based on what adornments the facility may have are being deluded. All those smiling faces in the front offices see prospective admissions as another dollar, NOT as someone needing nursing care.

While I'm expressing my frustration here, anyone got any comments on how Physical and Occupational Therapy Departments are operating on the "legal edge"? By that I mean charging for therapy given to medicare patients that could not possibly benefit from the therapy. I've seen therapy employees whisk patients with kidney infections, pnuemonia, to "therapy" and have them sit in the corner, or toss a ball. I've seen patients with contractures in both upper and lower extremities (that have been present for years) be rolled from one side of the bed to the other, and medicare is billed for "therapy".

It's all justified by using the correct coding, and taxpayers are footing the bill. Reporting does no good, all the "correct" paperwork is there. Physical Therapy assistants, (the one's tossing the ball) make more than frontline nurses with 17 years experience. PT Department heads have even made the statement...."WE are the one's that bring in the money to this facility".

This is what it's become, MONEY.. FOR PROFIT, not healthcare!

Lexxie, LPN · Jan 22, 2008

DON's and ADON's along with the rest of Administrative staff get promotions, bonus pay, and incentives to keep frontline staff to a minimum, while adding more and more work and responsibility to us.
The families that think their loved ones are receiving care based on what adornments the facility may have are being deluded.
This is what it's become, MONEY.. FOR PROFIT, not healthcare!

At my not-for-profit LTC Facility, we have 2 nurses on LOA at the moment. Scheduler is not allowed to use agency LPNs, although agency CNAs are acceptable. They'd rather burn the rest of us out filling those open shifts, or just let us suffer (more) with one med nurse and the RN charge nurse.

I don't know how much truth there is to this, but it's been a rumor going around for awhile now: the DON gets a bonus at the end of the year if she doesn't use agency nurses.

This facility keeps building and/or renovating every year. "We have to put the money back into the company, since we're nonprofit".... yet they can't - or lately, won't - staff what they already have.

These residents pay WAY too much to be where they are for the bare-bones care they're getting. To hear on a regular basis, "I'm sorry, but you can't have because we don't have enough help today".. just makes me angry and sad for the resident.

FrustratedLPN · Jan 22, 2008

It really wouldn't surprise me if the DON did get a bonus for not using agency nurses... I've seen this happen more than once. The facility where I worked maintained the philosophy that "we have never nor will we ever use agency nurses, because we believe it is in the best interest of the residents/patients to have someone committed to the facility where they work, and take "ownership" in the patients they care for". sounds good on paper as if the Board of Directors actually cared for the welfare of the residents, what they care about is the extra money forked out to "agency" nurses. What they don't get is "what about the overtime that's paid to your regular employees in addition to the stress and exhaustion they face?"

Most regular employees will come in on their days off, work over, whatever it takes to assure these people are cared for. What you WILL NOT see is the DON or ADON picking up a shift. It's been said before, but worth repeating...."if administration or owners cared about the patients/residents and the employees, follow an LPN for a day, on an off shift." It would be interesting to see how many of them would remain on a job with the conditions they face, for the pay they receive.

It's also interesting to note, that once new graduates are hired, and trained by the senior staff, it's not long thereafter that for "some reason" the senior nurses are either terminated, laid off, or pressured until they leave. The new graduates work for less money. Personally, I wouldn't want my family member's welfare entrusted to anyone with less than a year of nursing experience under their belts, and NO ONE physically there with more experience. (Happens all the time on the off shifts).

ALF_LPN · Jan 23, 2008

I currently work in an ALF and the ratio is 1:40 and one aid. After morning cares (which we do together and I pass medications, insuling, accuchecks) the aid is away completing whirlpools, and I run the floor. I am busy, but unless something out of the ordinary happens, it is a comfertable busy. We also work as a team, and if we get too busy on the floor, the activity director and receptionist will help out when they can.