Serious staff shortage. Any ideas?

[Datev]

Sorry for the long post. If you don't want to read it then the main question is: if you have had a serious staffing issues at your LTC facility, how did you resolve it?

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I am writing this in hopes that maybe some of you have ideas about how to resolve the staffing issue (CNAs) at the nursing home that I work at.

First of all, my nursing home is different. I work at a facility for developmentally disabled people of all ages. Most of them are wheelchair users, incontinent, non-verbal, high risk for falls with many behavioral issues.

This is the routine (what aides are supposed to do during their shift):

- 5-9 am - Get up the residents, feed, and get residents ready to go to daytime training. Most residents leave anywhere between 7:45 am to 10:30 am.

- 6-2 - Same as 5-9, but they care for those residents that do not go out to daytime training.

- 2-10 - Get residents to activity rooms once they come back from daytime training. Change incontinent residents. At around 4:00 pm to 5:00 pm get residents ready for dinner. Dinner ends around 6:00 pm to 7:00 pm. Shower ALL residents. Make last rounds.

- 10-6 - Make rounds. Put out clothes. Check backpacks (for daytime training) and prepare two outfits. Stock all rooms. Clean wheelchairs. Reposition and change residents' briefs every two hours. Do vitals and chart. Get up assigned residents who eat (usually 7-11 residents).

For the day shift, each aide is supposed to have up to 8 residents and for the night shift it's supposed to be up to 16 residents.

Well, this is not happening. Lately, day shift aides have been assigned over 16 residents and the night shift averages close to 22, but it can go up to over 30 residents.

This is what I believe lead to this staff shortage. During summer, the administrator took immediate action and said that we are no longer able to use hoyer lifts by ourselves. In addition, if anyone was late even for one minute, they were given three warnings and at last they were suspended. Being tardy has always been an issue and people were not really cooperating. So aides started calling-off. Then they started suspending people over the call-offs.

And everyone had enough so most simply QUIT. They quit at the SAME TIME.

So now what? Those who stayed are given double the work load and have to start working at near impossible speed. How fast do you think you can shower 16 total care residents who are all over 100 lbs and are very constricted? You got less than 3 hours! How fast can you get 12 residents up (dressed, cleaned, put in the wheelchair) before 6 am? You got less than 1.5 hour! How fast can you feed, change briefs and get 16 residents ready for daytime training? You have less than 2 hours! When you actually have to do this by yourself it's tough as hell (I've been there). Nurses don't help since they each have over 30 residents, lots of meds pass, and charting.

Do you think that everyone is able to do this? No. And residents' care and safety are compromised. I won't go into details but when I start my shift sometimes, I cry because of the state that these residents are left and how they are being treated.

So what is the administration doing to solve this? In my opinion they are doing nothing to solve this. Whenever they hire someone new (usually 1-3 CNAs at a time), once they start working on their own, they get so scared that they don't come back (we had aides walk out in the middle of their shifts).

I've asked co-workers about what they think would solve this problem and they all said that if they increased the pay to $15-18 per hour then they would stay. We get paid $10 per hour. BUT increasing pay rate is not an option. On the top of that, we do get treated like garbage and get no respect (you should hear the way managers and bosses talk to us).

The worst scenario would be that those aides who have worked at this facility for 2-25 years will start quitting. And then there will be no one to work.

If you have had a serious staffing issues at your LTC, how did you resolve this? I just don't want a resident's death to be the wake up call. Any ideas will be greatly appreciated and thanks for reading this.

[MarggoRita]

Still working on resolving our shortage, and about to lose another great CNA d/t her feeling she gets no respect from the administration for all the hard work she puts in. I do feel treating the frontline employees with respect is going to make the biggest difference, reward those who have stayed with a bonus...one time expense goes over better when crunching the numbers than a commitment to hourly increases that are a repeated expense, over hire if you can and let the staff rest up and take some time off, then perhaps schedule an extra aid each day to help in the busy time with the intent of sending an aid home by a certain time, it can be on volunteer basis or assigned who leaves, but it gives the extra help when needed yet allows for a break if needed by someone...and stays in "per dium" if worked right. These are some thoughts we came up with at our burnout meeting, not trailed yet as we lack qualifying applicants at the moment to over hire. If anyone has trailed anything similar, how did it work out?

[litbitblack, ASN, RN]

Until management realizes that they are the problem Im afraid those poor residents are going to continue to be mistreated by understaffing and the high potential for injury r/t short staffing. What is the staffing ratio? Why do ALL the showers have to be done in the evening time? Why do they need to be completed everyday? If you are talking about elderly thier skin is fragile and daily showers is not really good for them. I feel for your residents as they are getting shorted the care they deserve and I feel for the staff that are having to stay in those conditions.