Published Oct 24, 2018
I just left a job at a Kindred LTAC. One of the issues I had was struggling to keep up with the workload. It was entirely normal for me to have 5 patients who were all total care. All needed to be turned q2h, some needed vital signs q4h (due to being on telemetry), at least one in restraints. It was normal to have 2-3 trached and/or ventilated patients in my load as well. At some points, I could have 6 patients. Again, all quite heavy. We had CNAs some days, other days we were primary, but since we only had one CNA for the entire floor of 12 patients it didn't feel like it made a difference; I still took all of my own vital signs and other nurses frequently had to help me turn or change linen (and I helped them). The other nurses I spoke to said that they cried frequently their first six months, and none of them were new grads.
Is 5-6:1 a safe or normal ratio for LTAC? My patients just seemed so ill and the expectation on the nurses so high. I worried every shift that I just didn't have time to be as thorough as I needed to be with my people. The nurses orienting me were always telling me to go faster, yet be more thorough. I could not do both.
Reading this is giving me ptsd. I just wanted to acknowledge your post; the expectations are unrealistic. I hope you found a better position!
MatthewSN, BSN, RN
I spent the first year and a half of my nursing career as an LTAC nurse. After spending the last 3.5 years as a critical care nurse, I consider my LTAC experience to be on par if not harder than step-down level care. Our patient/nurse ratios were creeping up and we hardly ever had even one PCA which was why I left. 5 was standard but it was more becoming more common to take on 6-7 patients. The majority is as you described- trach to vent, restrained and total cares. More than 3 is to me unsafe- you can’t even meet your patient’s basic needs much less meet their clinical needs and provide a safe environment. It’s incredibly discouraging and not to be overly dramatic, has given me a touch of what could be termed PTSD like symptoms. On the positive side, I felt like it gave me a very strong skill set and made my transition to critical care fairly smooth. It is an incredibly busy environment to practice in. LTAC nurses do not get the credit they deserve.
Thank you both for your validation. I made serious errors from trying to juggle the load, the first of my career. I left that job due to feeling unsafe every time I was on the floor. But everyone treated it like it was normal, so I felt unsure.
I mean, at some point time management can only get you so far. I remember that during codes the entire floor would be left unattended because all available staff was needed at that code.
I left that job feeling like a terrible nurse, and many other nurses on that floor felt the same way. But I really feel that I can take very adequate care of a critically ill patient. I just can't do it with that expected ratio. Many people on that floor were burned out, tired, and wanted to find a new position as soon as possible. I really feel that we should have had at least 3 RNs/LPNs and two CNAs per floor. The CNAs were overwhelmed as well. I certainly would not want to try to bathe 12 patients with all of the many needs our folks had on my own.
I worked in a town where the nurses on the MED SURG floors refused anyone who needed to be suctioned... they had 5 patients but people who work in LTACs or nursing homes are expected to do this and more with far less staff. Something has to change!
On 2/2/2019 at 4:24 PM, ShadowNurse said:I left that job feeling like a terrible nurse
I left that job feeling like a terrible nurse
You were so smart to leave that job with a horrible work environment and unsafe situation for patients. It's a crime that conscientious, hard-working nurses are made to feel they are terrible at their jobs when there's not enough staff to do the jobs!
IF there are enough support staff, a CNA for every patient, and CNAs are also given a reasonable load, then there should be no more than 1-4 patients per RN depending on patient acuity. For LTAC and step-down, absolutely no more than 3 patients. For MedSurg, absolutely no more than 4 (and less if there are no CNAs and a difficult group!). To assign RNs more than that is to disregard patient safety.
If a delivery company forced the safest truck driver in the world to drive cross-country in a day, that driver will either kill himself trying, give up and feel like a failure, or realize that his employer is a bat-dung crazy fool who doesn't mind crashing loads of their own goods to save on hiring enough staff. Likewise, no matter how safe a nurse strives to be, it's all for naught in an unsafe environment or when attempting to meet unreasonable expectations.
Yes thats the norm right now. Most days I work with 6 patients per shift with all the issues you state. However i truly love my job.
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