Unsafe nurse patient ratio? Should I look elsewhere?

[Tachycardic_RN]

Hello all,

I'm a new grad RN and I've been working as an RN at a SNF for a little over a month now. I find the nurse to patient ratios at my present place of employment unsafe. Lately because the census is "low", they have been calling off nurses and giving the remaining nurses that nurse's patient load. Today, they had me leave early and gave the other nurse my patients (so she had 24 total), to complete med pass and treatments. Last week, I had 16 patients and still had to admit a patient. Who has time to admit a patient when you have to give meds and change dressings or do other treatments for 16 people? Meanwhile, some of the patients that I have get IV antibiotics via PICCS, have colostomies, feeding tubes, etc. Plus, they are sending aides home early too.

Initially, I was excited for the experience, but now due to lack of time, I hope the physician writes the order for a PICC and not a peripheral so I don't have to start the IV because there is no time. I have read of much higher patient loads than 24 on this forum and wonder how those nurses still have a license. I am ready to look for another place of employment because I am feeling the quality of care I am able to provide never measures up under these unrealistic ratios and time. I have talked to other nurses at our facility and a few have started looking elsewhere. One unit manager quit effective immediately today. We have a new DON who has only been there a few weeks and some staff are starting to look elsewhere.

I am not having the experience of having difficulty with fellow co-workers; my co-workers are awesome. The management, however, doesn't seem to be concerned about patient safety. Should I look elsewhere? I think I am ready when I feel scared for my patient's safety and not for lack of giving it my all.

Any feedback is appreciated.

Thanks.

Tachycardic_RN

[TheCommuter, BSN, RN]

These ratios are normal in SNFs. Whatever you decide, please have a job lined up before you resign from this current workplace because the nursing job market is rather merciless at the present time.

When I was working in a SNF, I would have up to 17 patients with no medication aide, or up to 34 patients with a medication aide to pass all pills. I was still responsible for finger sticks, injections, wound care, CPM machines, charting, IV antibiotics, topical creams, respiratory treatments, and collecting vital signs on all 34 people.

Many of the patients were postsurgical cases from the hospital: laminectomies, ORIFs, knee and hip arthroplasties, kyphoplasties, hysterectomies, CABGs, thrombectomies, etc. I also had plenty of medical cases: cancer, debility, end-stage renal disease on HD, end-stage liver disease, pneumonia, cellulitis, and so forth. This was a stressful place for me to work because the patients and families think it is the hospital, yet you have two to three times as many patients as the hospital nurse.

Also, you mention that management is not concerned with patient safety. You are going to find this attitude in many facilities because healthcare is a business.

[grandmawrinkle]

Agree with some of what TheCommuter said -- but what raises red flags for me is that people are quitting left and right, from the bottom all the way up to the top positions. You might not be working in a very good facility if that is the case.

That said, I do think SNF nurses are used and abused on a regular basis. I think some parts of the country are better than others -- in my neck of the woods, nurses take 15 patients (at least, that is what my friend who works in one - she is an RN - takes.)

[MassED, BSN, RN]

Hello all,

I'm a new grad RN and I've been working as an RN at a SNF for a little over a month now. I find the nurse to patient ratios at my present place of employment unsafe. Lately because the census is "low", they have been calling off nurses and giving the remaining nurses that nurse's patient load. Today, they had me leave early and gave the other nurse my patients (so she had 24 total), to complete med pass and treatments. Last week, I had 16 patients and still had to admit a patient. Who has time to admit a patient when you have to give meds and change dressings or do other treatments for 16 people? Meanwhile, some of the patients that I have get IV antibiotics via PICCS, have colostomies, feeding tubes, etc. Plus, they are sending aides home early too.

Initially, I was excited for the experience, but now due to lack of time, I hope the physician writes the order for a PICC and not a peripheral so I don't have to start the IV because there is no time. I have read of much higher patient loads than 24 on this forum and wonder how those nurses still have a license. I am ready to look for another place of employment because I am feeling the quality of care I am able to provide never measures up under these unrealistic ratios and time. I have talked to other nurses at our facility and a few have started looking elsewhere. One unit manager quit effective immediately today. We have a new DON who has only been there a few weeks and some staff are starting to look elsewhere.

I am not having the experience of having difficulty with fellow co-workers; my co-workers are awesome. The management, however, doesn't seem to be concerned about patient safety. Should I look elsewhere? I think I am ready when I feel scared for my patient's safety and not for lack of giving it my all.

Any feedback is appreciated.

Thanks.

Tachycardic_RN

what about the licensing board for your facility? Doesn't it state what a safe ratio is for residents?

[Guest717236]

what about the licensing board for your facility? Doesn't it state what a safe ratio is for residents?

Many years ago I was an aide for a SNF. The State official came to review and inspect the facility.

We had 3 floors, the first was staffed fully. The second floor had only one nurse and one aide(me) due

to very inadequate staffing. The third floor was short staffed, but adequate in aides.

The Administrator waltzed the State person around everywhere but the 2cd floor each day.

They passed inspection for manipulating the reality that week. It always stayed with me that

passing may mean not inspecting completely...

It was a disappointing lesson for me...

and I left for another job not long after.

[Leelee2]

These ratios are normal in SNFs.

Also, you mention that management is not concerned with patient safety. You are going to find this attitude in many facilities because healthcare is a business.

If not caring about patient safety is the norm, because healthcare is a business, sooner than later the business is going to go under. As a patient, my primary concern is safety! For my family members, my primary concern is safety. If the business is more concerned about money than safety, they should get out of the business!

[TheCommuter, BSN, RN]

what about the licensing board for your facility? Doesn't it state what a safe ratio is for residents?

California is the only state in the union that has legally mandated ratios, but these only apply to acute care facilities such as hospitals. There is no state that has specific nurse/patient ratios mapped out for SNFs and nursing homes. Other states usually have vague language such as "adequate staffing."

[Tachycardic_RN]

Thanks all for your responses. I just wanted some input. I figured it would be bad (staffing wise) as I worked as an aide for a year at a hospital...just didn't think it would be THIS bad. Three nurses covering 47 patients and left to do your own admissions just doesn't seem reasonable. But this is just based on my observations of things falling through the cracks such as not scheduling of follow up ortho appointments, IV getting started too late, no time to answer family questions more than briefly. Anyway, I appreciate your thoughts.

[Tachycardic_RN]

@TheCommuter: "adequate staffing"... leaves everything up to interpretation and discretion, which I am coming to find that to one person the choice may be "reasonable" and to another is "ridiculous". Adequate and inept have the same meaning anyway.