Staff Ratios at Nursing Homes

crissrn27, RN · Aug 18, 2009

I would LOVE 5 per CNA and 15 per nurse but that would be wonderland. I think what would be actually doable with all residents being cared for appropriately would be 7-8 per CNA and no more than 20 per nurse........even with those numbers it would be tough.

At our facilty it is 30 per nurse, and sometimes 12-14 per CNA on days, and no, its not fair to the staff or the residents.

lacylynnette · Aug 18, 2009

At my facility on nights it was up to 34 with 1 cna sometimes. Everyone thinks nights are easy, if they were that easy then they wouldnt have coined the phrase "sundowners" .

achot chavi · Aug 18, 2009

Yes it would be great to have ideal staff to patient ratios, and if u have the choice, choose to work in places where that is possible,

However most of us dont have that choice unless we start our own nursing home...complaining about it wont help unless the FAMILIES complain (and even then). Most directors provide the minimum (whatever is required by the state) because it is still a business and must be viable, patients that can afford better, usually go where the ratios are better, or hire private care.

Lets face it, you have this in all businesses, schools, organizations etc.

If you feel that pt care is compromised because of the staffing, then it needs reevaluating. When I felt I wasn't getting to everything I needed to do because of staffing, I kept a log and brought it to my supervisor, DON and administrators attention,... they could care less,( and I am a fast worker)... I left that place for one that cared more and had better staffing. Trust me, administrations are not created equal and you have to find the one that cares....good luck!!

JavaMama98 · Aug 18, 2009

I'm a night nurse. We have 60 patients each and each CNA has 30 (unless a CNA calls in or no-shows, in which case they may have up to 35 each). As someone posted before lots of people think nights are easier because "Doesn't everyone just sleep?" That is simply not that case. I had a 90+ year old woman who takes Valium routinely just decide one night that she didn't want to go to bed...so she didn't. If I took the meds that some of my patients take I'd be out for days. Talk about a good nights sleep.

pat8585 · Aug 18, 2009

Thanks for replying.

Long Term Care Columnist / Guide · Aug 19, 2009

I'm the charge nurse for 30 residents on the 3-11 shift, with 3 CNAs and a med aide that I share with another unit. It works fairly well most of the time if 1 or 2 of the aides are good, not so much if they're inexperienced or lack a work ethic, or if the nurse who likes to monopolize the CMA and pull my staff to help out with her 24 residents is on duty.

Then, there are always those days when you could put fifteen people out on the floor and it's not enough---like when there's an outbreak of UTIs on the unit, or a full moon. But for the most part it's pretty adequate staffing under the circumstances, and I rarely, if ever, have to turf any of my duties to the night shift nurse. :smokin:

levisandtees · Aug 20, 2009

Our ratio is 32-36 per nurse and 12-14 per aid on AM shift...I had 30 residents for two days due to low census and was astonished at how much of a difference that made as far as spending quality time with the residents/how smooth the day went...my case manager simply said "Ha don't get used to it". I agree that even complaints from family members don't seem to make a difference. I just do the best I can with what I have each day but I'm afraid of burnout under the stress of the circumstances.

GretaRN · Aug 20, 2009

I have 50 pts and 7 CNA'S! 3-11 shift.

vsink · Aug 21, 2009

I worked in LTC where I had sometimes as many as 23 patients and let me tell you that I worked non stop, doing medication administration with all the DM patients having to have BS checked q4hrs! I had two brittle diabetics that took turns having sugar levels at 27 one night and the very next night at the same time it would be over 500! of course this means calling the MD each time on top of everything else. There is always the ones that will not sleep, will not stop getting up out of the w/c setting off the alarm which sends me running because God knows I do not have time to deal with a fall! I felt like I was inadequate at my job because I just could not get all the meds out on time, do all the treatments, and properly take care of that many patients and do a good job! I always want to double check my meds because I did not want to make med errors and this slows me down but if I make one mistake do you think the people that allow this type of scheduling to go on in the name of profit are going to back me up in court when I am losing my license because I did not take the time to double check! It is not worth it to me! I think the way the nursing homes are run with the ratios the way they are should be illegal! There are better laws for animal shelters than for all the sub- standard elderly hidaways other wise known as LTC! I want nurses to stand up and demand better treatment for these people and for us nurses as well, this has got to change. I wish I had answers to this craziness, we nurses are going to have to band together and change this, nobody is going to do it for us!

GretaRN · Aug 21, 2009

and a med tech!

lacylynnette · Aug 21, 2009

Thats a point as well, at my old facility all the other units had med aides except ours, one nurse and one aide for 20 to 30 patients and that was it, I got outta there as soon as I could! Med aides make a big differance....