Staffing Shortages

punkdmm, BSN, RN · Nov 29, 2021

We are using multiple agencies to fill holes in staffing. The few aides we have left of our own staff are slowly trickling out for higher pay. When the bulk of our aides left we did have some LPN’s willing to work as aides but it wasn’t required. But we lost some nurses who were tired of being short aides and having to pitch in with meals, etc.

Matricies, BSN · Dec 1, 2021

My facility is doing nothing. Literally nothing. Normally how our high turnover, low hire rate goes is we have a period where we don't have a lot of people with agency involved and then we get people back for a few months and while not perfect was better then nothing. Since covid hit, its jjust been a slow trickle with no bounceback and we've had agency since the beginning. Management has not raised wages, provided proper compensation (though they do give bonuses...Sometimes.) and simply have people work more with less people (there are supposed to be 2 aides and a cook in a unit and sometimes theres only 1 aide and no cook on a shift!). Upper managements response? A thank you email around once a month for working so hard.

We've had state come in a bunch of times and I don't think its going to be long before we get hit with a massive F tag due to how awful our situation is and the elderly people we take care of hate it and hate the constant rotating agency and lack of permanent staff who know who they are and how they like things done and upper management refuses to fundamentally change how we treat healthcare workers in this place and just keep opening up new branches of the company that just fail just as bad as this one. Been the first time in years that I've felt like moving on but moving on to what? Another understaffed location problely.

litbitblack, ASN, RN · Dec 10, 2021

Honestly it has been a struggle. We are private pay so notoriously have a lower rate than others. We are the only one in town or I'll say in this area for of our kind and are managing to stay a float. We won't hire agency- just can't afford it. When we had to open Covid unit myself (ADON) and the DON worked the floor just as much as not. We just recently brought the minimum pay for CNA to $15 hr. but big company NH are giving huge bonuses and offer bonuses for working extra shifts. Our plus is the staff/resident ratio and the CNA's know that so it does help.

Dani_Mila, BSN, RN · Dec 30, 2021

Most of our aides leave the job and they come back to the facility as agency workers. They get double the pay. Of course they had to wait 3 months or so after leaving the job to qualify back to the facility. We utilize a lot or agency because we don't have enough staff. Most staff stays for a little bit and they're off to signing up with agencies. They provide bonuses but that does not help retain the workers. My facility is currently providing temporary nursing assistant courses where they assists people on getting their certification while they work on the floor. Even then, I heard she TNAs planning on leaving after they get their certification. LNs doing CNA jobs in LTC is preposterous. So basically, say while I take care of 30 or so patients, doing nursing tasks such as assessment, med/tx application, admission/discharge, and etc, you expect me to change diapers/turn patients/ AM/PM care on top of that? Now you really need to be prepared for staff shortages. Even agency workers would not do that and this is based on my experience.

Dani_Mila, BSN, RN · Dec 30, 2021

On 12/1/2021 at 4:17 AM, Matricies said:

My facility is doing nothing. Literally nothing. Normally how our high turnover, low hire rate goes is we have a period where we don't have a lot of people with agency involved and then we get people back for a few months and while not perfect was better then nothing. Since covid hit, its jjust been a slow trickle with no bounceback and we've had agency since the beginning. Management has not raised wages, provided proper compensation (though they do give bonuses...Sometimes.) and simply have people work more with less people (there are supposed to be 2 aides and a cook in a unit and sometimes theres only 1 aide and no cook on a shift!). Upper managements response? A thank you email around once a month for working so hard.

We've had state come in a bunch of times and I don't think its going to be long before we get hit with a massive F tag due to how awful our situation is and the elderly people we take care of hate it and hate the constant rotating agency and lack of permanent staff who know who they are and how they like things done and upper management refuses to fundamentally change how we treat healthcare workers in this place and just keep opening up new branches of the company that just fail just as bad as this one. Been the first time in years that I've felt like moving on but moving on to what? Another understaffed location problely.

I agree with you about moving on to probably an understaffed location but everywhere is. Nursing are leaving for higher pay. However, have you though about moving onto a hospital setting maybe?? I'm pretty sure hospitals are a not better than current LTC facilities.

Neats, BSN · Jan 2, 2022

I am not only a nurse but have had a career as an Administrator too. This is my soap box about LTC;

1. We can all continue to voice our frustration about LTC, this is what we have been doing for decades.

Now for solutions

1. Contact your nursing, medical and state health department. Contact your local senator and contact CMS for and to demand changes in staffing, and in payment for services--demand DRG codes for specific tasks like full assist with dressing, need assistance with ambulating, full assistance with eating/bathing...tasks based on ADL's.

2. Take your time when you are with a resident. Be safe. If you cannot get it done then let the next shift do it, just be sure you are doing your fair share. We cannot do it all.

3. Document what you do and time it took. This also keeps you safe.

4. Go to your nursing board, and any other meeting you can to talk about your concerns, be brief and make your point.

The LTC situation will not change until we get Diagnostic Related Group (DRG) codes based on reimbursement from CMS and insurance companies. Nothing will change until we get staffing ratios based on acuity at a local/federal level. If as a collective and based on evidenced based practices we come up with specific tasks that should be reimbursed each time perform that task present this to your senator at least 4 times a year.

Lastly remember the profit margin for LTC is slim less than 5 percent. Many times, just breaking even is appreciated.

Newgurl17, CNA, LPN · Mar 9, 2022

so far, I heard my workplace is giving $10k sign on bonuses (Canadian) to the RNs, but no other bonuses to the other disciplines ? we've also had to fill the gaps with agencies, but let's face it.... they come and go and won't be there forever ?

Newgurl17, CNA, LPN · Mar 9, 2022

On 12/1/2021 at 1:17 AM, Matricies said:

My facility is doing nothing. Literally nothing. Normally how our high turnover, low hire rate goes is we have a period where we don't have a lot of people with agency involved and then we get people back for a few months and while not perfect was better then nothing. Since covid hit, its jjust been a slow trickle with no bounceback and we've had agency since the beginning. Management has not raised wages, provided proper compensation (though they do give bonuses...Sometimes.) and simply have people work more with less people (there are supposed to be 2 aides and a cook in a unit and sometimes theres only 1 aide and no cook on a shift!). Upper managements response? A thank you email around once a month for working so hard.

We've had state come in a bunch of times and I don't think its going to be long before we get hit with a massive F tag due to how awful our situation is and the elderly people we take care of hate it and hate the constant rotating agency and lack of permanent staff who know who they are and how they like things done and upper management refuses to fundamentally change how we treat healthcare workers in this place and just keep opening up new branches of the company that just fail just as bad as this one. Been the first time in years that I've felt like moving on but moving on to what? Another understaffed location problely.

have you considered vaccine clinics or acute care?

Tired nurse · Feb 18, 2023

Genesis never replaced staff they keep agency but they are refusing to stay staff do such heavy work loads. They could careless about old people or staff. They are trying to get only high acuity pts, old people are not getting good care.

Tired nurse · Feb 23, 2023

No amount of damn pizza is getting any nurse back to LTC. I work as a travel nurse it is hard but I will never go back to being a slave to some brand new RN who does not know her *** from a hole in the ground. This is what goes on in LTC. Corporate only wants to admit only high acuity pts but donnot have the staff so they neglect the old people for very demanding hospital rehab people. This is driving more staff to leave. The whole system is headed for collapse floor staff sees this but corporate does not care. The idea that higher acuity pts will draw more RNs is totally laughable, why would any RN want to have a dozen or more pts is crazy talk and totally unrealistic. This is also driving the nurses already there which are almost always LPNs to be disrespected by management and drives them away or onto traveling as the LPNs say we always get *** on because we're not RNs so we might as well travel and at least make more money.

new teacher · Mar 15, 2023

Health care for profit - the very issue. One company is using their IP and CRC subtracting 80 hours a week from direct care (they are not). Unit of 24 with charge med tech and 2 aides 7-3. Who cares for the other 4? CRC? IP? The charge does ALL of them med tech all meds. The new so-called regulations DO NOT ADDRESS the underlying issue. Use of two people who are NOT DIRECT CARE STAFF. This does not address the underlying issue, lack of staff. Then there are those private equity investors.
They are allowing the facilities to understaff pretending they are not and meanwhile the skilled admit acute patients who think they have arrived at a hotel/resort, not rehab.