Seeking opinions on 35:1 patient ratio.

[VSsn]

For those who have worked at LTC with 30:1 patient ratio, would you care to share your thoughts? I'm hesitant to accept an offer with such a high ratio, and mulling over whether I should or not. Any advice would help.

Thanks,

VSRN

[SuesquatchRN, BSN, RN]

wHAT SHIFT?

[Racey328]

It really does depend on the shift. I work 3rd shift with roughly 50 residents, which is okay as long as you have someone else there to help out if needed when things go wrong. First or second shift 30 is about the max I would go. You would have to be quick on your toes for that job.

[NotFlo]

It's way less than ideal but it's the norm where I'm from. Certain things will either make it tolerable and do-able or make it an impossible situation. How many CNAs will you have for that number of residents, do you have a unit manager and/or unit secretary to help with desk and paperwork issues, will you be charting by exception or will everyone require daily charting, how many medicare/short term/rehab pts that require more time, charting and assessments will you have mixed in? Also, are the meds timed in such a way that the med pass is in any way, shape or form do-able.

[yadda_yadda_yadda, LPN, LVN]

I have to second the "are the meds timed so it's at least do-able" question.

Also-it's not just going to be medications...You'll have your treatments, skin assessments, the inevitable falls & incidents, and likely at LEAST 1 meal where you'll have to assist or supervise feeding of the resident population that requires assistance...and this will be at least an hour taken away from you.----and then you've got your charting.

My shift is 0600-1430

My max resident load has been 32 for a long time. The med pass seems never ending. I typically have 2 strong aides.

Time management is priority #1.

I've been @ this since 1993 and a resident load of 32 is FULL. Consider it carefully, weighing in all the factors above.

Good luck to you

[VivaLasViejas, ASN, RN]

That's the maximum I would be comfortable with on an evening shift, and that's only if I've got a CMA, two strong CNAs dedicated to the unit, and another "float" aide who can manage a full load on the split between two sections. It's doable........but having 22-24 is a lot better.

[oryxandcake]

I worked 30:1 as an LPN and after awhile found it to be exhausting and really, not worth it. Like the others mentioned, the people you are working with and whether or not they work as team, has a huge impact on your ability to work at your best.

I found myself rushed on the best of days to finish meds (on days and nights). Although, I also had to do personal care for 3 patients in the AM and PM.

I would encourage you to think over what your goals are in terms of where you want to work and what you want out of the position. Maybe trial it out and see if it works for you. There's no harm in looking elsewhere if it doesn't meet your needs.

[Leelee2]

a ratio of 35 to one nurse, is not ideal at all. Would you have a med tech to do all of the med passes?? How many CNA's, what shift, and is there a nurse manager (without a group of her own residents to care for) that would be available to assist in crisis situations?

[jrw03282009]

Seriously? How do you do this!?!? I am not out of school yet, I have one more month, but we have heard 8-1 or 9-1 but 32-1? Are you allowed to breathe between pills or is that done after a 20 hour shift? I'm not being a smarty pants, I just cant wrap my mind around that...

[Not_A_Hat_Person, RN]

I spent a few weeks working the day shift on the rehab unit at a SNF. I "only" had 17 patients, but I had to do all of the meds, treatments, dressing changes, vital signs (every day), PICC line maintenance, and skin assessments. Aides' shifts started 45 minutes before the nurses' shifts, so by the time I got report most of the residents were either getting up or in the dining room. There were never enough aides (we were lucky to have 4 on a 50-patient unit), and they all went to the dining room at mealtime. I was lucky if I finished my 8am med pass by 10:30. Between chasing down aides and chasing down patients, it was hell. A fall or a phone call could screw up my entire shift.

If I ever work in a SNF again, I'll do evenings or nights. I refuse to work days.

[Selene006, BSN, LPN]

I recently resigned from my SNF job, after almost 2 years. It was my first job after graduating nursing school, and I didn't have any other job offers to entertain. Initially, I enjoyed the patients--all 30 of them on a subacute/rehab/long-term care unit. But it became cumbersome with the large amounts of high fall-risk patients to be monitored, the lack of support from the managers, the growing heap of paperwork, the constant inservices that took away time from the massive med pass that kept you on your feet for hours straight, the brittle diabetics who needed glucose sticks round the clock, the noncompliant detox patients who were mentally and pysically unstable, the CNA's who were ALWAYS calling out sick, the NP's who never wanted to give new orders and only stating, "Follow up with the MD," the endless wound treatments, lack of supplies on the unit, the needy and demanding family members who don't understand why you can't sit and talk with them for an hour, the chronically ill patients who shouldn't be at a SNF but the administrators want to keep ALL of the beds filled, receiving report from the night nurse who always says "This patient doesn't look good at all" but refusing to transfer ANY patients to the hospital because she doesn't want to fill out the 10 packets of paperwork it takes to send one patient to the hospital, finding lab reports that have not been called in and meticulously tucked into a pile of other paperwork to be filed, stopping to toilet patients during your nightmarish med pass where almost each patient gets a slew of narcotics and 20 meds because your CNA's are tied up, a nursing supervisor who is frequently MIA throughout her shift, a manager who leaves the building in the middle of a code, patients who complain that the night nurse is asleep at the front desk with her feet up, patients who complain that the night CNA's are asleep and blatantly refuse to answer their call lights, patients attempting to elope while your CNA's argue in the middle of the hallway, unprofessionalism at all levels of the nursing ladder...sorry for the long vent!

30:2 days, 4 CNA's

30:1 evenings, 2 CNA's

30:1 nights, 1 CNA

Each facility is different and not all SNF's are equal. I wish you the best with your decision!

[CapeCodMermaid, RN]

I worked on a busy sub acute unit..I had 30 patients, 25 of whom were sub acute. I think I had 3 CNAs and no med tech since they are not allowed in Massachusetts. Was it easy? No. Did I do it safely? Yes. You get to learn in a short amount of time how the residents take their meds, where you can find them at med pass time, how to do your assessment while you're in their room watching them swallow their pile of pills. Certainly having 20 residents is better, but 30, even on the day shift is doable.