Unsafe Staffing/Mandated Time

Nurses General Nursing

Published

So I am an LPN & I work at a SNF in MA. Recently company ownership went from 1 man, 1 company to corporate (multiple states, multiple sites).

VERY recently we were told "no more overtime". Not the first time Ive heard it, whatever. But not very long ago, I was mandated to stay until a nurse could come in and take the assignment I was on. Because there was no supervisor there to literally say, "Im mandating you", they're now telling me I wasn't staying, I chose to stay... despite the fact that I HAVE been mandated for this same reason before (again, not very long ago) & despite the fact that it was because of their staffing cuts that there was no supervisor on at the time (7AM).

I have pointed out to them that had I left that would have been patient abandonment, and they acquiesced to that fact, but are continuing to say it was my choice to stay. I took it to my DON, she denied me the time & a half mandated pay that we have been getting for years when mandated, I then took it to the administrator, who also denied me. I then took it to a senior executive who is now fighting me on it, and today avoided a scheduled meeting (Ill give him the benefit of the doubt, he texted his secretary and said his wife was in the ER).

This is the first incidence of them refusing to pay for mandated time. They are now telling me that there was another nurse on the floor... there was. We have a 32 bed unit on the unit I was on, each nurse has 16 patients. They are saying that because one of the scheduled nurses was there, she should have taken both carts and taken on all 2 patients. The unit is a rehab unit (post op, usually, hips/knees, some respiratory) and we have been seeing patients come in that have more & more acute conditions since they took over as well, increasing the workload on every nurse. I told the DON that having one nurse on the unit (with no supervisor, no other staff) was unacceptable and her response was, "Its how many other facilities run. Its perfectly acceptable."

Im COMPLETELY bewildered, angry, frustrated... and soon we will be taking over some administrative duties as well as taking the floor and I doubt very much our paychecks will reflect the increase in responsibilities.

I have filed what I think is their very first "workplace grievance".

What else can I do about such conditions? Rarely does a day go by without a nurse doing a double or getting mandated and the aides are constantly doing doubles. Ive stopped picking up shifts completely since now they refuse to offer time & a half for picking up. Now they're offering "gift cards".

Wouldn't it be great Karma if Mr. Ceo had to get a knee replacement, was needing a urinal and an analgesic .. and had to wait a couple of hours, because there was one nurse to 32 patients ? :)

There is no dealing with that level of corporate greed.. get outta dodge.

It would tickle me in ways too obscene to say. I WISH I could have that kind of "opportunity for education" (Im sure that's how they would phrase it lol).

Specializes in MICU, ED, Med/Surg, SNF, LTC, DNS.

OK. I think I get a couple of things now. Let me start by saying I don't know anything about MA regs, but I do know Federal regs. Also, and I know I will be flamed for this, most if not all states have made mandatory overages the choice of the nurse, NOT the facility. In Kansas, where I am from, the nurse has to guage how tired they are, and if they will be able to effectively care for the residents safely. The only hours you are required to complete are the ones you are scheduled for (if you are scheduled for 8, and walk out in 4, then it is abandonment). Now for the flaming part, and understand I spent roughly 1/2 my career as a DON. In most states (please check with your BON), once your shift is up, and if you do not want to stay, you may leave without being relieved.

Please, I DO NOT condone this! I bring this up to show that in most states, your BON WILL NOT TAKE your license for this. It is something that DON's and ADON's tell staff to make them stay. The more experienced ones come up with incentives (you know, flies, vinegar, honey). It sounds like that is what you are dealing with. Some DON, way back when, went and got it approved that if you worked over, no matter how many hours you worked that week, you got T 1/2. Now, it sounds like the DON currently there didn't stick up for it during a meeting, so they came up with a different incentive, gift cards. Which means, if you already have 40 hrs, you get T 1/2, plus a card. Since you are only working 32 hrs, it means you get reg time, plus a card (which I guess is where the facility is saving money. I assume you are not the only one working 32 hour weeks).

Sad to say, but that is perfectly legal, as long as they are paying you for every hour worked, whether they approved them or not. Actually, they don't even need to give you a card, though I think my incentive to my employees was cooler - I gave them a grilled pork steak dinner with fixings if they would come in or stay over. These extra incentives, and since it was not in your handbook, that is what it was, are wonderful ways to entice the employees to cover holes in the schedule; because even though YOU are not required to work extra, there IS a person, or persons, who ARE (by contract at least). Can you guess who? hint: they have a title with the letters D and N. That is why we beg, borrow, and steal to cover the holes. If the state finds out about said holes, we are fired because we didn't do our jobs. It's a way the facility can get out of trouble - "our plan of correction: fire the DON!!"

The second part with the resident ratio, I am pretty sure it is not legal by a long shot, but again, I don't know MA regs. If you check the nursing home regs from the state legislature, there should be a minimum staffing list per shift. These are the numbers that the state require to be in compliance. This varies somewhat state to state. In Kansas, it is 8:1 day shift, 10:1, evening shift, and 17:1 night shift. Before anyone gets excited, please understand those are STAFF to resident, NOT nurse to resident. That means, all nurses, med aides, nurse aides, and in a pinch, DON, ADON, activity staff, activity director, restorative staff, any dietary or office staff with a CNA certificate, etc. (they don't actually need to be on the floor, just in the building). Again, that is probably how the DON is getting away with the nurse to the residents, they might be counting themselves in the matrix, even though they will be in the office all day. Again, I DO NOT condone this!

Honestly, you would not believe how horrendous that job is. You get squeezed from both sides. And don't even talk about salary. Yeah, I might get paid more per year than any other nurse there, but if you went by my hours, I averaged $7.75 per hour. 80% of the time, we agree with the nurses, but we can't say anything to them because we are to be the voice of the facility. That doesn't mean we aren't fighting tooth and nail with administration to get the things you need for the resident, or the staff. We just cannot have a dissenting voice where the staff can actually hear. Honestly, that is one of the reasons I gave up being DON, though I usually tell everyone I got my sanity back one day, and left.

By the way, if you ACTUALLY made it this far in my ramblings (work nights, haven't been to bed yet), let me know where to send your pork steaks :)

Hey ShaneTeam,

Thanks for your thoughtful response. I understand my facility may be JUST on the cusp of legality & acting with the bare minimum of staff (which is not ok so far as I am concerned for patient & staff safety) but I am not willing to sit by while my coworkers are putting their careers at risk, and we have ever more increasing reportable incidents.

I would never want an administrative job for just about all of the reasons you listed. That and scheduling. But unless our DON/ADON is willing to advocate for their team (which worked almost seamlessly before) Im not willing to go to bat or pick up shifts when you blatantly ignore the virtual shouts of help from your staff. I didn't meet the DON until almost 2 months into her tenure here, which I found somewhat appalling as a leader.

We're going to be meeting with a couple of different union reps this week, and look into some legal angles, including meeting with a state legislator that my administrator made the mistake of mentioning by name. Good leaders are hard to come by, and if we had management that at least treated our staff like theyre actual people, I would have zero problems picking up. But until we see meaningful change, 90% of us have applications out, and Ive been on several interviews.

I really do appreciate your response, and I live on Cape Cod lol.

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