Stable Vent Patients in LTC

[TheCommuter, BSN, RN]

My workplace (an older nursing home) is thinking of admitting stable vent patients in order to raise the census and profits.

When I lived in California, the subacute facilities would be full of these stable vents. However, the nurses only cared for perhaps 10 or so patients due to the acuity level. My current place of employment staffs 1 nurse for every 30 residents. We already have residents with simple IV meds, PICCS, trachs, colostomies, etc.

I am willing to work with stable vents as long as nursing staff is increased, and as long as I am properly inserviced, oriented, and trained by the company to care for patients on ventilators. However, the company does not plan to increase staffing. The turnover rate for nurses is already profound.

I am praying that the admissions manager chooses not to admit the stable vent patients if they don't plan to include training and employee retention in their plans for the future of the facility.

I work full-time weekends (16 hour shifts on Sat and Sun) which enables me to attend school during the week. I need a weekend job for as long as possible, which is why I work at this place.

I hope someone tells me I'm overreacting.

[caliotter3]

No, you are not overreacting. If the training and orientation are not offered, I would refuse the assignment. That, I'm sure, would really make them happy.

[oramar]

One nurse to thirty patients including vents. Gee that sounds like a heavy patient load.

[TheCommuter, BSN, RN]

One nurse to thirty patients including vents. Gee that sounds like a heavy patient load.

I should mention that we've already got medication aides to pass all oral meds and administer all eye drops. Licensed nurses complete all assessments, charting, injections, IV therapy, blood sugars, wound care, trach care, ostomy bag changes, foleys, feeding tubes, nebulizers, inhalers, patches, topical ointments, etc.

[Magsulfate, BSN, RN]

It sounds like a really tough patient load, impossible. 30 patients a piece and vents to go along with it? It takes a little more time for vent patients, even if they are stable and long term. Will you have respiratory there?

[Lovely_RN, MSN]

How many of your patients out of the 30 would be vent patients? Would you also have a respiratory therapist on the unit? We have 2 trach patients per 41 (max census) and it's hard enough keeping up with their needs. I am really tired of having to drop everything when one of the trach patients asks for suctioning or a nebulizer treatment. I don't think there is anyway I could keep up with a vent patient with the kind of ratios I have to deal with but then again we don't use med aides. Why aren't they creating a unit solely for vent patients? Where I work the vent unit isn't a bad place because the staffing is much better (2 nurses, 1 RT, and 3 CNAs for 18 patients).

How many semesters until you graduate?

[TheCommuter, BSN, RN]

Will you have respiratory there?

How many of your patients out of the 30 would be vent patients? Would you also have a respiratory therapist on the unit?

No. This facility currently has no respiratory therapists on board, and they do not wish to spend the money to add one to the payroll. Nursing staff performs all respiratory therapy, trach care, nebulizer treatments, and oxygen administration. If we were to start admitting stable vent patients, the responsibility for their care would squarely fall on the shoulders of the floor nurses.

Out of the 30 residents, only a few would be on ventilators.

[caliotter3]

I should mention that we've already got medication aides to pass all oral meds and administer all eye drops. Licensed nurses complete all assessments, charting, injections, IV therapy, blood sugars, wound care, trach care, ostomy bag changes, foleys, feeding tubes, nebulizers, inhalers, patches, topical ointments, etc.

And vent patients on top of this? With no increase in staffing? Somebody's head is in the clouds it seems. I see retention getting worse.

[TheCommuter, BSN, RN]

How many semesters until you graduate?

My graduation date is in March of 2010.

[morte, LPN, LVN]

nope, not over reacting......you always need a second set of trained hands.....i did long term vents...we never had more than 14 patients and 2 nurses......

also, depending how "old" is old they may need to up date the wiring

[Lovely_RN, MSN]

It stinks that graduation is so far away but if you absolutely have to stay in this job then you will just have to suck it up. I really hate where I work but I like you have to work those 16 hours weekend shifts to make ends meet and keep my health care. The past year has been stressful and exhausting but it's almost over in a few short weeks. If I did it you can too! What kept me halfway sane was realizing that I wasn't going to have to work in that hell hole for the rest of my working life.

I don't like what your facility is trying to do but maybe it will work out. Sorry to say this but you can only do what is humanly possible for one nurse to do on a shift. If the outcomes are poor then the state will start to look at your facility and staffing ratios as well as that decision to not hire an RT will have to be re-evaluated. It sucks that facilities will take chances with people's lives but dollars always come first to administration.

My graduation date is in March of 2010.

[Straydandelion]

Surely a patient's family will look at some guidelines before allowing even a stable vent to be treated at a facillity without a RT http://www.ardsusa.org/inpatientrehab.htm If not, the facillity should be aware of the recommendations of organizations on vents patients. I am also assuming there are state and federal guidelines for LTC's with vent patients though may be assuming wrong. I would be concerned for my license depending on training and staff help however. There is a lot that can go wrong in this situation.