What is reasonable staffing?

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Another post about staffing. I just had an RN quit today because she said there was "just too much work to do". It's a 41 bed rehab/subacute floor with 7 or 8 long term residents mixed in. On day shift we have 3 nurses on the med cart...so that's 14 patients each, a unit manager, 5 CNA's and a secretary. Maybe it's me, but is that all that horrible? I know the patients are sicker than they used to be,but at the moment, we have only 1 IV and no g-tubes. Am I expecting too much of an RN, who by the way is a nurse practitioner as well, to be able to handle 14 patients?

Specializes in LTC, Med Surg, Doctor's office.
Another post about staffing. I just had an RN quit today because she said there was "just too much work to do". It's a 41 bed rehab/subacute floor with 7 or 8 long term residents mixed in. On day shift we have 3 nurses on the med cart...so that's 14 patients each, a unit manager, 5 CNA's and a secretary. Maybe it's me, but is that all that horrible? I know the patients are sicker than they used to be,but at the moment, we have only 1 IV and no g-tubes. Am I expecting too much of an RN, who by the way is a nurse practitioner as well, to be able to handle 14 patients?

Where I work I also work every weekend 7p-7a. I work on a unit from 11p-7a as the only nurse with 50 residents. I have 2 g-tubes sometimes up to 3 IV's and numerous foley's. Oh, and many times I only have 2 cna's. I am lucky when I have 3. Believe it or not where i worked before was even worse. You sound staffed well.

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Specializes in Geriatrics and Quality Improvement,.

well well well!!! A subject sore and laughable at the same time.

For 30 patients: Day shift used to be 1 RN, 1 LPN, 4 CNA, Eves, 1 RN, 3 CNA, and nights 1 RN, 2 CNA. Of course the days had all the interdiciplinary team... SWS, PT,OT, Nurse Managers to spare...(supervisors)

Now? Day shift:1 RN for 60 patients(treatments/bandages, IV's, MDS, CCP, and the monthly orders) LPN's with 30 each, Med pass daily, 2x a shift, and 3 CNA.

Eves and nights: 1 RN or LPN for 30 patients is a good night... Mostly we are 1 Licenced staffer with 60, and hopefully 2 CNA's per 30. Mostly we are 3 CNA's per 60.(thats 1.5 CNA's according ot the staffing sheet)

It keeps the nights moving thats for sure.

I smile because Im a nurse, I laugh because if I dont I will go crazy. :p

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I work in a LTC/subacute facility on the 11-7 shift. I am a new RN - graduated May, '05. On my shift, I am responsible for the Rehab and LTC wing. There are 12 diabetics, 4 g-tubes, and 1 trach - a total of about 52 residents. I was feeling a little overwhelmed, but I see it's not just my facility that expects nurses to wear roller skates! :chuckle

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We are all nuts. Everyone of us that does LTC. Nuts:chuckle

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It is really overwhelming at times on the floor...you have weeks to where the staffing isn't what it should be then you have a day or two when it is up to par. I guess that is just one of the draw backs to LTC nursing. I enjoy what I do and most of all the residents...they are the ones that make it worthwhile to me. I am currently after 15 years of on floor nursing doing the MDS position which is mentally to me more taxing than being on the floor. I commend each and everyone that has chosen this for their career...been there done that and still going... :-)

:coollook:

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Specializes in LTC, Hospice, Case Management.
We are all nuts. Everyone of us that does LTC. Nuts:chuckle

LOL - just what the heck were we thinking when we decided to do this anyway? Anyone else ever feel like we are the red-headed step children of the entire nursing field? As soon as you tell someone you work in a LTC - they look at you like you poor thing, couldn't make as a REAL nurse. I get this from the general public and other nurses.

:angryfire :uhoh3:

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LOL - just what the heck were we thinking when we decided to do this anyway? Anyone else ever feel like we are the red-headed step children of the entire nursing field? As soon as you tell someone you work in a LTC - they look at you like you poor thing, couldn't make as a REAL nurse. I get this from the general public and other nurses.

:angryfire :uhoh3:

Even nursing schools treat LTC like it's the easy way out! I did a paper while in nursing school that compared LTC to nursing in the ICU. ICU nurses have to have more techno skills, but LTC requires a broader sense of skills - assessment, psych, pharmacology. LTC is as difficult as ICU, just a different type of nursing. It is real nursing!!!

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Another post about staffing. I just had an RN quit today because she said there was "just too much ...work to do". It's a 41 bed rehab/subacute floor with 7 or 8 long term residents mixed in. On day shift we have 3 nurses on the med cart...so that's 14 patients each, a unit manager, 5 CNA's and a secretary. Maybe it's me, but is that all that horrible? I know the patients are sicker than they used to be,but at the moment, we have only 1 IV and no g-tubes. Am I expecting too much of an RN, who by the way is a ...nurse practitioner as well, to be able to handle 14 patients?

Yes, you are being very unreasonable. 14 rehab patients is a ridiculous amount for 1 primary RN to safely handle. Bottom line the CNA's and the secretary may be helpful, but they are not ultimately responsible for the patients. The RN is the one responsible. Any competent nurse would refuse such an assignment. 14 patients would be 8 too many even if the patients were all "self care".

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Specializes in LTC, Hospice, Case Management.

Oh please. REALITY is.. in LTC 14 patients is a breeze, luxury, etc, etc. I have had nights when I was the only nurse in the whole house for 80 patients. I had QMA's passing meds, but I did all tube feedings, glucometers/insulins, etc. It's almost a joke that anyone could even complain about this staffing (for an LTC)

P.S. I am a very competent nurse! Some general education for all of you non-LTC nurses reading this (plus you new LTC nurses that don't understand this yet) The LTC industry would cease to exist if it was staffed with RN coverage at 14 residents/nurse. Our reimbursement from medicare/medicaid system does not work like the hospital. At least here in Indiana we are payed on a reimbursement system, where as we do a detailed computerized assessment of each resident at preassigned incriments. These assessments are transmitted to state and federal government. Each assessment is assigned a "score" and that determines our reimbursement rate. (Our average REHAB resident receiving both PT and OT and requiring higher levels of ADL care may net us approx $350/day). From that rate we have to pay for ALL SERVICES for that resident, ie meds, X-rays, labs, medical transports, nursing care, therapy costs, etc. On some residents we go in the hole just on medications alone - Lovenox, Neupogen/Epogen, etc are VERY EXPENSIVE. Doesn't take long and your scraping to have any extra left over to pay staffing which is often the largest cost to a nursing facility. Any questions? :wink2: (My above example is for medicare only - medicaid rates are even scarier!)

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Specializes in LTC, Hospice, Case Management.

I have heard in the past that in this state.. the state pays more medicaid $$ to care for prisoners/day than they do for LTC residents/day. Don't know this to be a fact, but wouldn't surprise me either. I think we currently get about $110 per resident/day for medicaid rates. I've been told that prisoners are $140 or so a day

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Amen!:rolleyes:

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Specializes in Geriatrics, DD, Peri-op.

CapeCod, have you worked on the floor recently in a similar spot as this RN?

If you did, what did you think? If you didn't, maybe you should to get an idea of the workload.

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