SNF CNA ratio and abandonment

[DougDaRN]

Hello all,

Just wanted your thoughts on an issue that came up at work. Some background info. I work as an RN(almost 2 years of experience) at a California based SNF that has 4 floors holding patients ranging from 25-31 patients each floor. To my knowledge CNA to patient ratios are supposed to go as follows AM 1:8 PM 1:12 NOC 1:21 (correct me if I'm wrong.) We have a 4th floor where we have all our new admissions and is considered a PUI floor. The other 3 floors are either LTC, skilled, or a mix of both. Through DPH we are told to wear an N95 and a faceshield/goggles at all times. Only in the PUI floor are we supposed to don a gown and gloves before entering a patient's room. On schedule there are 3 "regular" cnas assigned to their respective floors. The following CNA already put in her 2 weeks notice to resigning.  

 I came to work my NOC shift as charge nurse/noc supervisor and there were 6 cnas scheduled for NOC shift so ideally 1 floor CNA each and 2 cnas floating. I'm the only RN in the building which makes me the supervisor of the building. I get a call from one of my cnas who was clocked in already while I'm receiving report for my floor. She complains to me that she won't float from the 4th(PUI) floor and the 3rd floor because it is too much of a workload and that the floors she's floating from are heavy. I tell her every floor has it's heavy patients/fall risks/demanding patients and that she'll only be taking 8 patients at the PUI floor and 10 on the other floor. She tells me this isn't fair and will make this her last day working at the SNF. Moments later I get another call from another charge nurse from another floor saying that the CNA that I just had a talk with just left the building turning off her phone and abandoning her patient assignment. This left the building with 5 cnas taking care of 116 patients. I reported this to my DON and DSD. My DSD calls me in the morning telling me I should not have made her float from a PUI floor. My plan of action should have been to have 2 cnas on the PUI floor and and then 1 male CNA float 3 floors. She told me we're not supposed to float anyone from the PUI floor as our mitigation plan for COVID. The DSD then tells me, she can't report the CNA to the state for abandonment now because the CNA can report the SNF for not following the mitigation plan. 

I was furious to hear that my decision with how I split my cnas that night was wrong.  3 of my cnas are over 60 years old and my DSD wanted me to float the only male CNA of the NOC shift who was also over 60 to float 3 floors. That would leave each CNA not on the PUI floor with about 25 patients if the floater took 6-7 patients each floor. I couldn't get anymore CNAs to work, no one from the previous shift wanted to stay and no one from AM could come in early to help. I just did what I thought was fair for the whole building. 

Was I wrong in that situation? What could I have done differently? Getting any input would help clear my mind. Thanks!

[TheMoonisMyLantern, ADN, LPN, RN]

In my experience, when something doesn't go as planned or something unexpected happens, the person with the most power who gets to sleep through the crisis and deal with it at a more "convenient" hour will throw the person who had to deal with the crisis under the bus no matter how you respond.

I have seen it done to countless nurses, and have had it done to me, no matter what decision you make when it come to staffing and there's a problem, is the WRONG decision the next day when management arrives. It never occurs to them that MOST of the staffing incidents that occur, such as your CNA walking off the job, occur because they are too cheap to staff facilities with adequate coverage to where when an emergency happens the remaining staff can absorb the hit and make it through the night.

But if you want to keep your job and not put a target on your back, keep your anger to yourself. Tell your boss the rationale for your decision, apologize for not knowing their policy regarding the PUI floor, and thank them for letting you know for future reference. 

[JKL33]

I wouldn't think it made sense to have the PUI floor CNA go back and forth between there and non-PUI areas, but...lots of weird stuff happening so it's difficult to know.

Regardless. Doesn't matter now.

 

6 hours ago, DougDaRN said:

I was furious to hear that my decision with how I split my cnas that night was wrong. 

Why?

WADR, it is not worth any fury. You learned what they expect and you can do that next time.

 

 

6 hours ago, DougDaRN said:

The DSD then tells me, she can't report the CNA to the state for abandonment now because the CNA can report the SNF for not following the mitigation plan. 

Oh well. ?

As above, this whole deal is the employer's problem ultimately. They are the ones without enough staff on duty. And if they have employees who cannot be expected to carry a certain workload then they need even more people to accommodate that. All of this is outside your purview. Do the best you can when you're there and refuse to worry things you don't get paid to worry about. I know it's difficult but you have to remove some of your emotions from all of this; it certainly isn't worth anything on the order of fury or significant distress.

??

[nurseguy213, LVN]

Bottom line, the staffing ratios in places that are NOT considered hospitals suck and is unsafe. I think the people making these decisions don't have family and friends that go through waiting for the 1 CNA caring for 10 patients. If a patient goes #2, how long does it take to clean them? The other CNAs are busy with their patients, the LVN is busy trying pass meds to their 30 patients, so yes people will be left soiled for a while. And that confused patient that can get up and fall who should be in a lockdown facility? That bed tab alarm does not prevent them from getting up, it just gives everyone who can hear it a headache. I don't know how many times RNs have said put a bed alarm, as if that solves the problem of the patient getting up out of bed. With the staff/patient ratios the way they are, it's like someone forgot that these are people and you can't just assign nursing hours to them, some take more time and attention than others.

[teddybearguy]

To me you sound like a very sexiest RN. I have worked with many who thing just because were guys we should get the heavier load.  You don't know how many times I have heard female RNs Charges say we gave you this hall because you're a big strong guy. I am just throwing this out here but if I told you to go get me a cup of coffee because you're a woman you would be in HR in two seconds flat. We all have the same job descriptions so one person. If the 60 years old can't cut it hire new staff. It shouldn't be up to the 1 male to pick up the slack. I know a lot of guys that can barely lift and I know other that can practically lift a patient by themselves. Not only that but come on your an RN and your going to cross contaminate between COVID and non COVID that freaking blows my mind because where I work granted its a hospital setting but we have "dirty" (covid) staff and "clean" (everything else)  staff. Even in the ED so it just baffles my mind that you would even consider having a CNA do that. EVen with correct donning and doffing its risky, and if she did it incorrectly or not at all as I see some CNAs do then you could spread covid through out the whole facility. To be honest your lucky she left. Because had she stayed and worked that whole shift and went to the DSD in the morning it would of been your license on the line not hers because she was doing it under the direction of you.