Unsafe staffing

Published

:madface: I know, I know. I ask a lot of questions on this forum but you guys help me a lot.

In our facility with 100+ residents they have decided to have 1 nurse and 1 med tech. This is for the 3-11shift. We feel this is unsafe for the residents and overwhelming to the nurses. Our facility is spread out over 4 wings. I don't have to work this shift much but the nurse has to do meds on 2 wings plus all assessments, charting and crisis management. If you get any admits or send someone to the hospital you get so far behind that you can be passing 8pm meds at 10p.

We have to do insulins for the entire building, there are about 20 patients who are on insulin. You have to do the bs on the patients on your wings and the tube feedings on all wings. If someone needs a prn shot stat you have to drop what you are doing and do it. There are doctor calls to answer, orders to note, skin assessments and tx's. The techs can do tx's on their end unless it includes a dressing change. Most of the nurses on this shift are getting burnt out. I got called in to replace a sick nurse the other night and the day shift had left a ton of paperwork on 2 admits that need done. The pharmacy was not pleased when I had to call them at 1am because those admits needed meds before the 7am meds. By the way I was supposed to get out of there at 11p. We had a fire alarm go off at 11:15 and I had to help with that since I was in the building. I got out of there at 2:30am after doing all my charting, checking orders and etc. I think we should all ask for a meeting with the don to discuss this but the others say she will do nothing about it. I have decided I will not go fill in on this shift anymore.

Up Vote Up Vote ×
Specializes in PeriOp, ICU, PICU, NICU.

I am not a nurse, but IMO 1 nurse and 1 med tech for 100+ residents is ludacris! :stone

Up Vote Up Vote ×
Specializes in LTC, ER, ICU, Psych, Med-surg...etc....

Are you saying that there will be just ONE licensed nurse in the building for all 100 residents???? What kind of facility is this??????

Up Vote Up Vote ×
:madface: I know, I know. I ask a lot of questions on this forum but you guys help me a lot.

In our facility with 100+ residents they have decided to have 1 nurse and 1 med tech. This is for the 3-11shift. We feel this is unsafe for the residents and overwhelming to the nurses. Our facility is spread out over 4 wings. I don't have to work this shift much but the nurse has to do meds on 2 wings plus all assessments, charting and crisis management. If you get any admits or send someone to the hospital you get so far behind that you can be passing 8pm meds at 10p.

We have to do insulins for the entire building, there are about 20 patients who are on insulin. You have to do the bs on the patients on your wings and the tube feedings on all wings. If someone needs a prn shot stat you have to drop what you are doing and do it. There are doctor calls to answer, orders to note, skin assessments and tx's. The techs can do tx's on their end unless it includes a dressing change. Most of the nurses on this shift are getting burnt out. I got called in to replace a sick nurse the other night and the day shift had left a ton of paperwork on 2 admits that need done. The pharmacy was not pleased when I had to call them at 1am because those admits needed meds before the 7am meds. By the way I was supposed to get out of there at 11p. We had a fire alarm go off at 11:15 and I had to help with that since I was in the building. I got out of there at 2:30am after doing all my charting, checking orders and etc. I think we should all ask for a meeting with the don to discuss this but the others say she will do nothing about it. I have decided I will not go fill in on this shift anymore.

does your state board offer a "safe harbor" option??? I'd look into it.

Up Vote Up Vote ×
Specializes in Gerontological Nursing, Acute Rehab.
does your state board offer a "safe harbor" option??? I'd look into it.

Ditto.

What a shame for those poor residents, not to mention the staff. Something needs to be done, and quickly. Be an advocate for these people, and contact your BON if need be. 20 insulins?? One nurse?? Unbelievable!

Up Vote Up Vote ×
Specializes in Geriatrics/Oncology/Psych/College Health.

Dang.

Let's do the math: 8 hours = 480 minutes (assuming a lunch break) - 4.8 minutes per resident assuming you run non-stop and including travel time around the various units.

Are you still at this place? Isn't this the one you mentioned that the state cited for poor staffing?

Up Vote Up Vote ×
Specializes in Geriatrics, DD, Peri-op.

I am convinced that most places don't care about nurses. They just want a "warm" body to fill a slot.

I just started a new job working on a subacute. Apparently, the average load is 25 patients. For regular LTC, this is not bad...but for rehab folks that just came from the hospital...no.

I am so sore today from all the running I did yesterday that I can barely move. What's more, I don't feel like I will be a good nurse at this facility. I'll have to make short cuts and barely scrape by doing my job. Uh-huh. I don't think so. It's a good thing that I am just waiting for boards....I am so out of there. :uhoh3:

So, basically, I'm with you. I just don't understand how people can do this sort of thing. 100 patients to one nurse. Yeah...and management walking out the door at 4-5 telling you to have a good night. What hypocrites! :uhoh21: I'd find a new job if I were you.

Up Vote Up Vote ×

No Way! Not for any amount of money! What if two patients crump at the same time? That is HORRIBLE!

Up Vote Up Vote ×

I researched this alot with the BON, OSHA and the iowa health department. There is only one state that has a required staff/patient ratio. Iowa is not one of them.:no: The rule here is that a nursing facility needs 8hours of RN staffing a day, doesn't need to be in the building :confused: and 24 hour LPN staffing. I am trying to stick it out for 6 months since I have been off for 11 years. I will not work that shift again unless mandated. I am telling the DON in a note (photocopied for my records) why I am not going to work this shift and my concerns. I am going to document problems that occur on this shift when I am on call and keep records of mistakes and forgotten tx's etc. I will make photo copies of it all. I think that if I am let go for refusing to work that shift or because the DON doesn't like my attitude they won't have a leg to stand on if I get legal. In my note I think I will also mention how assessments, txs and charting are being fabricated by some. I am not going to mention names because she throws a fit when those check marks aren't put in the charts. Most of the other nurses leave a bunch of their stuff undone for the next shift. When it his 3p, 11p, or 7a they are out the door in a shot. Maybe I am obsessive but I don't like it when I come in to finish their stuff and I won't do it to someone else.

Up Vote Up Vote ×

Best to document everything you say or do cause when the poop hits the fan things could get really ugly. I wouldn't be surprised to see some lawsuits come up and you want to CYA. Also, IMO you should look for a job somewhere else. There is only so much advocating a person can do and if they're not willing to do anything it's just like hitting your head against a brick wall.

Up Vote Up Vote ×

Staffing requirements are based on on 24 hours, not per shift. So, in essence, if they are overstaffed on days (like most facilities are, with all the extra licensed personnel like DON, ADON, 2 MDS nurses, 2 RCC's, Tx nurse who work day shift) they can legally be understaffed on nights. Happens everywhere all the time. Dealing with it right now at my facility. Pisses me off to no end. Only one time since I've been at my facility did someone come in to help on nights when we had a call out, and this was only because it was a holiday weekend, and they had numerous nursing and CNA call-outs on 7-3 and 3-11 which caused the required nursing hours to be less than legal when we had a call out on 11-7. Every other time, the response is "you can legally work with one nurse or 3 CNA's" on 11-7 with 120 residents. Yeah, right. Legal? maybe on some skewed report sheet, but safe? Never.

Up Vote Up Vote ×

I assertively said I wasn't going to work 2nd's anymore. I think Nicole though really emphasized the point. After doing it for a week she went into the DON's office and told her she was quitting cuz she wasn't putting up with working in those conditions. She didn't put in such polite terms and it was at the top of her voice but they have an ad in the paper now for a full time 2nd shift nurse.

Up Vote Up Vote ×
+ Join the Discussion