Too Many Patients

**RosesrReder, BSN, MSN, RN** · Oct 11, 2005

I'm gonna be honest. I've been a nurse(LVN) for about 6 months and almost already ready to forget it. I've only got 2 more classes to get in an RN program too. But I'm so frustrated.
My first job it was 38 patients for one nurse. Often I would find out that the previous nurse did not do the dressing changes, or they'd leave all kinds of paperwork and i'd get swamped trying to get it all done.
I tried to work at a prison for a bit, it was very easy, but scary, so I left.
Now I'm going to work at another long term care, and this place I would have closer to 50 patients.
Doesn't it bother anyone else that the ratios are that high? I mean, to get treatments, meds, charting, all the lil incidents done. How is it possible?
I handle it ok, but it's frustrating.
I'd appreciate any advice. Thanks

Sorry to read this. I don't think it is fair to want to forget about nursing just because of a bad experience. What have you done to change this? Have you documented that the other nurse does not do the dressing change/paperwork etc? Have you talked to mgmt?

If you are not happy there or if you think things will not improve the only thing I can suggest is to look for your happiness elsewhere.

Best wishes to you.

Antikigirl, ASN, RN · Oct 11, 2005

Let me explain where I work as an RN...I am in assisted living. There is ONE nurse per shift for 150 residents. CNA's or unlicensed caregivers do all meds (I know scary but I didn't write the rules) and care...

The one nurse has to handle all the orders, treatments, MAR's, 90 day orders, faxes or communications with physicians, appointments, lab orders, prn scheduling, injections (including all diabetics and all CBG's), wound care, caths, O2, oversees all CNA/Caregivers, assessments, admits, acute situations, approval and ordering of any in room meals (must have medical reason for trays), any staff questions, family questions, PR, staff injuries, all incident reports, check and make sure all charting is complete, fill in for receptionist or find someone to fill in three times a shift, Service plan additions/approvial, assignment and deligation...and inservice teaching twice a month!!!!!

Okay...think that is overwhelming...it gets better! They have chosen at my facility to have LPN's to work full time to do what they can do...and RN's part time minimum so they don't have to pay RN's for benifits or Lord forbid any overtime! (I just talked to one of the RN's and she was called into the office for...oh get this folks...she clocked in ONE MINUTE early from lunch break...and got chewed out accusing her of trying to get overtime!!!!!!! OH for goodness sakes!). Therefore anything that has to have RN approvial or doing...well, get to do it in the rare 8 hour shifts 2-3 times a week when you are allowed to come in!

Too many patients...heck yes!!!!!! Too much charting needed now by medicare or simply CYA...YES! Lack of nursing support or RN staff...YES!!! Administration putting additional non nursing tasks on RN's...YES...Time to actually do a real assessment or SPEAK to a resident??? HECK NO! Patch up and go and CYA is the name of the game now a days..and how sad that is!~

I don't blame you for questioning WHY and SHOULD I??? If I knew what I know now...I would have said...forget it! But I chose to be a nurse, I chose the facility...and I take it all down to one thing in my mind....

"no matter how hard it is...no matter how unappreciated I feel...no matter how much it hurts my spirit at times...if I wasn't here...can I trust someone with the care and support I give my residents to be done by someone else??? In the same way my residents are accustomed to, comfortable with??? Do I want this to ever be a regret if I leave??? (I am a biggie on not ever making a regret...especially thanks to my residents advice).... ALL of the time I come up with NO, no other nurse would put up with the Bullsnookles I do...so I better keep at it for the sake of my team (staff..we are a team!) and residents.

I wanted to quit after 3 months...I am now officially on year 4!

Think about WHY you personally do what you do...and keep that in mind when you falter or feel low...pick that reason well...and it will always guide you, even if it is a pain in the keester most of the times..LOL!

**NickiLaughs, ADN, BSN, RN** · Oct 19, 2005

Yikes, you have it worse than I did. I ended up not taking the position because I met another LVN who had worked there and said it was ridiculous. I ended up getting a job working with developmentally disabled adults. Less stress job, which is what I need right now with school.

I just think that if there's ratios in hospitals, there should be some sort of ratio requirements in long term care and assisted living. I wonder how we could fight that?

purplesdk · Dec 4, 2005

:chair: I agree, that's too much for one nurse to handle! I work in a LTC facility, that is 38 miles from where I live. I am an RN and work the 10-6 shift. We have 61 residents (9 of which are in the locked Alzheimer's unit) and at night (my shift) there is only one nurse and anywhere from 3 to 4 aides. Our new DON (4 months employed) keeps changing wheather we are to work 8 hour shifts or 12 hour shifts. We have a total of 7 nurses working the floor (the DON and ADON do not count, they only work the floor if they have no other choice). There are 3 nurses who work days, 2 who work evenings, and 2 who work nights (one nurse only). Two of the nurses who work days and evenings bounce back and forth between those 2 different shifts. The night shift nurse (me) works 4 on and 2 off most of the time, and the other nurse works 2 on and 4 off. On her 4 off she doubles as a med aide on occation. We have 4 med aides (who are invaluable) and 2 of them may be leaving soon (one retiring and the other going back to school). When I worked the day shift, I never seemed to get every thing done, the paperwork, labs, treatments....tending to every whim of the DON...! I finaly told them that I could only work the night shift, and I have been able to get most everything done. Oh, did I mention I am one of two RN's at this facility (not counting the DON). The other DON drives 150 miles to come to work and he works the Day shift and he is about to quit. I may be jumping ship soon too. All we hear are the gripes and get no thank you's for the work we do. We are all tired of being told after the fact that something has changed, and get chewed out for not doing something:nono: . That we were never informed about what had changed does not matter.

Sorry for the rant. :Melody: Just got off work and am well... tired and frustrated.

But, yes, some of you out there DO have it worse than I. Good LUCK!!!!!

Hope it gets better for you. :confused:

CapeCodMermaid, RN · Dec 5, 2005

Yikes, you have it worse than I did. I ended up not taking the position because I met another LVN who had worked there and said it was ridiculous. I ended up getting a job working with developmentally disabled adults. Less stress job, which is what I need right now with school.
I just think that if there's ratios in hospitals, there should be some sort of ratio requirements in long term care and assisted living. I wonder how we could fight that?

OKAY, this seems to be a major point of many of the threads on here. What to do? The nurses in the hospital settings usually have the MNA (at least in Massachusetts it's the Massachusetts Nurses' Association) AND the patients fighting for them...who do we have? Our specialty is looked down upon by most hospital based nurses, except, of course, those who have worked LTC. We need a PAC for LTC nurses. It's not like it used to be even 10 years ago when most LTC patients were stable, not medically complex, old people. Today, especially on a sub-acute/rehab floor, we have many very sick, clinically complex patients. In my building, even the so-called long term floor has rehab patients and sick people. We need to join together....we need to speak NOW before it gets any worse. Can you imagine what it'll be like when WE'RE old people? I'd rather take my chances and stay home.

RNadvocate · Dec 5, 2005

Don't give up!! It's hard but worth it, nursing is changing and can get better!

HappyJaxRN · Dec 5, 2005

I don't know how ya'll do it. *G* bless you all. Wow...I'd be a nervous wreck 24/7. My heart goes out to you.

BigB · Dec 8, 2005

40 - 50 patients for one nurse is an outrage. It's like this where I work as a cna, dressings don't get done, some meds (creams ) don't get passed and the nurses have to stay over 2 extra hours (unpayed) to finish charting. And people wonder why the LVN turn over rate is insane at nursing homes.

Nascar nurse, ASN, RN · Dec 8, 2005

I don't have the solution either. Just wanted to put in my $.02 that I completely agree. The staff patterns are outrageous in LTC and the residents come in sicker all the time.. I'm sure all of you have had admits like we have lately.. They are admitted and within a couple hours were are sending them right back where they came from (full codes and horribly unstable). I just figure that the "top dogs" in the corporate food chain in this business must be getting rich, cuz it sure ain't in my pocket. I really enjoy working with the elderly for the most part but this staffing is just nuts. We need a big federal grant and research studies about staffing patterns in LTC and resident outcomes as a result of current patterns. Then we need to get some staffing mandates in place. Anybody willing to vote me for president next election so I can get this all done? Tee Hee Hee:lol2: (I will need Sundays off during race season tho :lol2: ).

GooeyRN, ADN, BSN, CNA, LPN, RN · Dec 8, 2005

I was a CNA for one year in LTC. I was also an LPN in LTC. I only lasted 4 months. And its not because I didn't like the elderly. Staffing is terrible just about everywhere in LTC. Not just because there aren't enough RN's/LPN's/CNA's to go around, but because facilities are to stinking cheap to pay for more help! I would have stayed in LTC if ratio's were more realistic.

RNadvocate · Dec 8, 2005

In Florida there are staffing ratios for nursing homes; they started with allocating a certain number of care hours per patient and then increasing it in steps. They had found that patients were getting less than an hour or so of care per patient, then the ratios up'd it to 2, now healthcare workers are trying to get 2.9 funded. SEIU Florida Healthcare Union lobbied for that and won.