shocked at what I saw!

[Purple Princess]

I recently started at a new facility. We average 16 or 17 residents a piece. If it's real bad you have all 34 to yourself. We just have enough time to meet the clients very basic needs and that's it. I was changing a man last night for bed and I undid his diaper and I'm like what in the heck is a towel stuffed down in there for? It was soaked with urine and poop towards the back. I seen this done on other clients too. I guess they do this on daylight to save time so they don't have to change them as often. But unlike the diaper absorbing some of it and congeling the towel just presses against their skin and makes everything red. I'm not going to go against the tide this time but just make an effort to do the job and correctly myself. I try to change them often, cleanse the skin apply any necessary ointments or powder to protect the skin and keep it dry. They said they were having a staffing problem right now and newcomers come in from other facilities and just can't keep up and leave. I spent 3 hours giving pm care minus my 15 minute lunch break. I can't imagine having the full load of 34. is this the norm for a CNA? Also I might add this is a skilled nursing unit, few can even walk, most are in diapers, and all pretty much need complete care. We don't even pull basin, we just wipe them off , slap a gown on, and change the diaper.

[chayslip]

First of all I need to declare an interest here. I am not a nurse. I am a licensed health educator and a state approved community visitor (which basically means I have a badge which allows me to walk into certain facilities - public or private - which are licensed and regulated by the government at any time of the day or night without warning and cannot be refused entry). In the time I have been a community visitor I have learned to spot the difference between a facility which just happens to be short-handed on a temporary basis (which happens in every facility from time to time) and one in which tolerance of departure from basic licensing standards has become the norm and is excused and justified at the highest levels.

While I'm aware that the legal issues involved are slightly different in the US than here, my understanding is that the duty of care issues are not and that "junior" staff can be held legally responsible for not taking their concerns to the highest possible level (which in my nation is the state and federal ministers for health). Unless I have totally misunderstood US laws, your legal duty to the patient totally trumps any other consideration every single time and in the event that something goes very wrong and you say that the DON or the facility administrator or somebody else told you that they would handle it and didn't it is YOU who will be called to account for not going over their heads.

Document everything. 34:1. You've got to be kidding. We demand better ratios here for assisted living facilities and those are mostly old people who want to maintain their independence but want the assurance of onsite medical care being available in an emergency. High school classes aren't allowed to be that large here (and they're full of young, healthy people), and much as I think that you have some odd standards and benchmarks for medical care over in the US, I very much doubt that they include that kind of ratio under either state or federal laws.

While I appreciate Cherybaby's comment, any DON who doesn't know that ratio is unsafe and who isn't actively protesting against it on a daily basis probably isn't going to be of much assistance.

Well I hate to say it but this is the norm for many nursing homes and suprise it is legal! You see there is a major loophole in the staff/resident ratio, and that is they can count all staff! The nurse, med tech, and yes even housekeeping. Suprised, dont be I have worked in this field for 15 years and although sad it is common and state says and does nothing about it. A trick that many admisnistrators use is having numerous people work when state comes in and when they leave so do all the staff. That is why we do care for the love of the residents and not for the money or great working conditions. Sad but true!

[mitchsmom]

OMG... I would freak. I don't know anything about anything yet but I did just do clinicals in LTC this semester. The facility I was in had about a 10:1 CNA/pt ratio with a RN or LPN/pt ratio of about 20:1 (each "pod" had about 20 residents with 2 CNA's and a nurse, usually an RN). The worst thing I saw treatment-wise was a huge mat in a lady's hair that should not have been there. It wasn't a fancy place but it sounds great compared to your description. I know that heads would have rolled in a second if someone pulled that mess where I was. Our student clinical groups were in several facitlities in our area and I didn't hear any bad stories, thankfully.

I would definitely report the situation asap.

[mitchsmom]

OMG... I would freak. I don't know anything about anything yet but I did just do clinicals in LTC this semester. The facility I was in had about a 10:1 CNA/pt ratio with a RN or LPN/pt ratio of about 20:1 (each "pod" had about 20 residents with 2 CNA's and a nurse, usually an RN). The worst thing I saw treatment-wise was a huge mat in a lady's hair that should not have been there. It wasn't a fancy place but it sounds great compared to your description. I know that heads would have rolled in a second if someone pulled that mess where I was. Our student clinical groups were in several facitlities in our area and I didn't hear any bad stories, thankfully.

I would definitely report the situation asap.

[Thunderwolf, MSN, RN]

I agree. Document, document, document. Report it. It takes courage. But, it is the right thing to do. You know this.

[Thunderwolf, MSN, RN]

I agree. Document, document, document. Report it. It takes courage. But, it is the right thing to do. You know this.

[Bjo]

First of all I need to declare an interest here. I am not a nurse. I am a licensed health educator and a state approved community visitor (which basically means I have a badge which allows me to walk into certain facilities - public or private - which are licensed and regulated by the government at any time of the day or night without warning and cannot be refused entry).

:rotfl: No disrespect to you or your job, but here in the US, I used to have one of those badges. I walked into facilities day or night without announcement and I was called a surveyor.

What I saw on the part of the surveyors was that money talks and b---sh-- walks. Facilities were given special treatment many times and the staffing was so trumped up when we were there that it was obvious. If they were friends with the administrators of the nursing homes, they let 'em off easy. If they had been a little hostile in the past with other administrators in other facilities, they would dig deep to find something that was really nothing. I saw surveyors cite one facility and go into another one the next week and let the very same thing be swept under the carpet. Now if you ask me if I'm proud of that, well heck no. And I no longer do that kind of work. (lasted about five months before I moved on) The nurses (and STNA's) in the long term care facilities are working their buns off and not getting any relief from the short staffing and brutally demanding physical work that they do every day.

Anyways, I AM a nurse, and I worked in long term as an aide and an LPN before becoming an RN. Been on both sides of the fence, so to speak. Currently I work in a psychiatric hospital. Don't plan on going back to a nursing home and I have the greatest respect in the world for the people who work there. You are angels!

[Bjo]

First of all I need to declare an interest here. I am not a nurse. I am a licensed health educator and a state approved community visitor (which basically means I have a badge which allows me to walk into certain facilities - public or private - which are licensed and regulated by the government at any time of the day or night without warning and cannot be refused entry).

:rotfl: No disrespect to you or your job, but here in the US, I used to have one of those badges. I walked into facilities day or night without announcement and I was called a surveyor.

What I saw on the part of the surveyors was that money talks and b---sh-- walks. Facilities were given special treatment many times and the staffing was so trumped up when we were there that it was obvious. If they were friends with the administrators of the nursing homes, they let 'em off easy. If they had been a little hostile in the past with other administrators in other facilities, they would dig deep to find something that was really nothing. I saw surveyors cite one facility and go into another one the next week and let the very same thing be swept under the carpet. Now if you ask me if I'm proud of that, well heck no. And I no longer do that kind of work. (lasted about five months before I moved on) The nurses (and STNA's) in the long term care facilities are working their buns off and not getting any relief from the short staffing and brutally demanding physical work that they do every day.

Anyways, I AM a nurse, and I worked in long term as an aide and an LPN before becoming an RN. Been on both sides of the fence, so to speak. Currently I work in a psychiatric hospital. Don't plan on going back to a nursing home and I have the greatest respect in the world for the people who work there. You are angels!

[emeraldjay]

34:1 for direct care!? I don't think I have much room to complain about the 20:1 on 11p-7a. On my floor it's just 2 CNA's 1 LPN and 40 pts for overnight. These last few nights have been sheer H-E-double-hockey-sticks. During the day seems great, 1 RN, 2-3 LPNs and 5 or 6 CNAs, but they have had trouble keeping up with pt's demands since Sat night.

Long story short, facility failed to inform the staff about a possible outbreak of a GI virus and the overnighters got left elbow deep in stool and other yuck when it hit in the middle of the shift. NYS dept of Health sent a memo to be distributed to hospital and LTC staff on Nov 29, we just found out about it on Dec 18 3 hours too late. The memo basically said that contact precautions should be initiated when providing care to infected pts (including masks), not to float staff to the affected unit (they did anyway).

It was amazing, no sooner than we start cleaning one, two more call lights went on. midnight rounds lasted until 3am LPN (a 6p-630a) was still trying to catch up with charting from previous shift. The shift super snagged two aides from other floors so we could at least accomplish AM cares and I&O/repo charting, the five of us could not keep up. My heart goes to any of my residents who have been harmed by the virus in one way or another.

I'm seriously thinking of risking getting blackballed by writing to the state DOH about this. When administration tells the super that she should be advocating for pts and not staff, there is a serious problem somewhere. She just doesn't realize that you need to spend more than 3 minutes an hour for each individual patient* no matter the time of day.

I feel for you.

* 20 patients per aide, 60 minutes per hour, 3 minutes per patient per hour. 7 hours actually working if one takes the entitled 2 15s and 1 30. For a whopping total of 21 minutes an aide can spend with any given resident. We won't even discuss the variables of how long it takes to find linens that laundry can't provide enough of.

[highasthesky]

Wait a minute........I was supposed to get breaktimes?? (Haha)

[Jo Dirt]

Sad to say, that's probably not the most shocking thing you'll ever see in your CNA career.