SNF Transitional Care Unit: Staffing Ratios

[kwvath]

I am an ADON at a skilled nursing facility and am specifically managing the Transitional Care Unit at our facility. Our nurses are constantly saying that they are understaffed and our corporate admins are always saying, "no, you're over-staffed." I have searched the literature and have found very little in regards to guidelines on best practice. I would like to know how you all staff your TCUs and include some of the following information so we can all help each other and do a little informal research:

1. Nurse:Patient ratio for 1st shift (day shift if 12hr shifts)

2. Nurse:Patient ratio for 2nd shift

3. Nurse:Patient ratio for 3rd shift (night shift if 12hr shifts)

4. Nursing Assistant:Patient ratio for 1st shift

5. Nursing Assistant:Patient ratio for 2nd shift

6. Nursing Assistant:Patient ratio for 3rd shift

7. Number of TCU beds

8. Typical case load picture (Number of GTs, IVs, TPN, trachs, average age of patients, dementia, etc. for unit)

9. Staff makeup (number of RNs, LPNs, etc.)

10. Layout of unit (square-shaped, star-shaped, hallway, etc.)

11. Do you have similar complaints and problems? How have you solved them?

12. In which state are you working?

[noc4senuf]

Wow... what a load of questions!

First of all, my TCU is 28 beds and shaped in an "L".

I have 2-3 aides on days and PM's with 1-2 aides on nocs, depending on the census or acquity. Typically it is a ratio of 1:7.

As for nurses, up to 13-15, I use just a nurse and after that I add a TMA. Depnding again on the acquity I add a second nurse when the census gets closer to 20.

One nurse manager and a HUC.

We have lots of ortho cases (hips, knees), CVA's, medical, some hospice... the mix changes all the time. Tube feeders, occas IV's and or TPN's, wounds.

THe staff that work this unit love it due to the continual changeover of resident.

[sailnby]

The facility that I work at is actually transitioning into a TCU, and with that happening, we try to work and share staffing as if we are a TCU so the transitioning will be as smooth for both the staff and residents as possible. I actually do not organize the staffing since I am an RN on the unit, the charge nurse does all that. However, to answer your questions:

We have 23 rooms and in each room there are two beds for the patients.

All of our patients are either on IV abx, trache therapy, and/or GTs, we have been getting a few chest tubes as well . Once a patient has ended his/her IV abx therapy, he/she is moved on to the long term care unit.

There are usually 2-3 RNs per shift, 3 nursing assistants, 1 med aide...

Our unit is shaped as a L.

There are usually 3 nurses working on days and 3-4 nurses working on evenings due to admissions and other things. Night shift, there are usually 2 nurses. So for days the Nurse:Patient ratio is usually 1:7/8, 1:5/6 on evenings, and 1:11/12 at night. This is as far as the rooms are concerned (ie., 1 nurse for 7/8 rooms which will come to 1 nurse per each 14/16 patients for days). As far as the nursing assistant:patient ratio is concerned, there are usually 3 nursing assistants per shift.