What is the state guidelines for nurse to patient ratio in SNF's/LTC for California?

[ChickenJoyRN,BSN]

I am a new-grad and just started a position at a SNF in the Bay Area. I was wondering what the nurse to patient ratio, according to state guidelines, is in California. I have been working in this facility for about 2-3 weeks or so and I have to say that I am starting to regret it. I was oriented for only 2 days on the unit and they put me by myself for a PM shift. I figured I would have more time for orientation, right? Our current census is 68 patients and there are only 2 charge nurses for 3 stations. That's a 1:34 ratio!!!!

I have concerns about being overwhelmed with 34 patients with only 2 days of orientation. I still do not know how to do anything in the nurses station and all my meds are being given 2 hours late. I am worried that I may make a mistake that may jeopardize my license or even worse jeopardize a residents life!!! I'm not confident the management would have my back if something goes wrong, meaning I am placing my RN license, that I worked so hard for, at risk as I working here. I continue to ask for more days of orientation to my DON, but she insist I will do fine and start to get the hang of it soon.

I feel more on time after I have cared for about 20-25 residents. But then I think about the other 15 I have to attend to and it just get pushes back all my responsibilities. I have spoken to some of the nurses that have worked there for a long time and they said they used to have 3 nurses for each station (1:22 ratio). But not anymore:uhoh3: since the facility underwent new management.

I guess I'm looking for advice on what to do as well. I go to work scared, full of anxiety and uncertain. Now, as a new grad, I don't think that is a healthy way to begin a career. I don't want to loose my license. I originally wanted to work in a hospital, but none were taking new grads. I would be devastated if I lose my RN license over a job I didn't want in the first place. If this is the way SNF's operate, then I may have to consider looking for another one or just not consider SNF's at all.

Thanks for reading. Any advice or insight will help a lot.

[ilovemango]

Hi, I just got here in California last February, lucky to passed my NCLEX last May, Im so happy because after 1 month that my employment aithorization came I got the job in the skilled nursing facility(September) I got 9 days of orientation on the floor., after it was done I'm not sure if I should still continue. Probably I experienced everything that youve been through when you were still starting. I got 30 patients, wasnt able to take my lunch, most of the time I have overtime(without pay sometimes.). I just clock in and out for lunch then continue working on the floor. I just want to ask you guys how is everything going on right now after how many months of practice in SNF. Maybe I just want an assurance from you that everything will soon be okay.. I dont want to lose my license which I worked for so hard,. Thanks in advance..

[icu/don]

look at a current copy of title 22 in california. the ratios for snfs are in the law but they can't be enforced because of budget issues. it would cost the state way too much to implement because medicaid is supposed to reimburse based on cost. this is what is in title 22:

the department has determined that the ratios specified in the table below are required to meet the 3.2 nursing hppd minimum standard.

licensed nurse (day shift-1:20)(pm shift-1:25) (noc shift-1:30)

cna (day shift-1: 9)(pm shift-1:10) (noc shift-1:15)

these ratios are based on three controlled variables: (1) the ratios must provide 3.2 nursing hppd; (2) skilled nursing facilities should never provide less than 1 ln for every 30 residents and should never provide less than 1 cna for every 15 residents; and, (3) more care is required during the day and evening shifts than the night shifts.

this means that my 33 bed facility would need 1 licensed nurse for 30 residents at night and another licensed nurse for the other 3 residents. the nurses would still not get a lunch break because then the other nurse would have 33 residents for the half 1/2 hour lunch break. (skilled nursing ... should never provide less than 1 ln for every 30 residents).

i would also need 2 cnas for 30 residents and another cna for the other 3 residents on night shift!

i would need to double licensed nurses on the day and evening shifts as well to provide for that coverage.

as it is now, we add all direct care hours for the 24 hour period (licensed nurses, c.n.a.s, & mds nurse) and divided by the average daily census. this must equal 3.2 or greater.

[teeroze201069]

I work in Joshua Tree, CA. I would really love to see ratios for both nurse's AND aides. At the SNF/TCU/SA facility I work at, there is one RN for up to 96 SNF/TCU residents. Averages 88-90 at all times. There is also 1 RN for up 25 sub-acute patients. Averages 23-25 at all times. There is usually 1 LVN to approx. 28-30 residents on SNF and 1 LVN to approx. 11-15 TCU patients as well as 1 LVN for every 6-7 subacute patients. Of course there ARE other RN's in the building - D.O.N., A.D.O.N., Care Plan Coordinator, Staff Developer, BUT it is unheard of that they would come out of their offices to help. Even when the State is there for survey. Go figure. And the aide to resident ratio is even worse considering they do all of the hard labor. On SNF/TCU it is 1 aide per 11-13 residents. Average is 12. On sub-acute it is 1 to 6-8. Average 7. There absolutely needs to be ratios for SNF/LTC in CA. Wish that those who make the ratios could work in LTC for a month in each nursing position before they decided on what the ratios should be. Especially as aides. I work as an aide on the TCU. It is extremely hard to do ADL care for 11-13 residents in 12 hours when you have to get all or most of them dressed and OOB, do 3-5 showers, 3 meals, 2 snacks, PT, OT, out of facility appts., 3 activities, and deal with visitors, staying on top of call lights, B&B training, not to mention discharges, admits, post-mortem care and rounding them all up for the nurse's med passes and accu checks. Almost impossible to get your required breaks. And don't forget vital signs, ice water, ROM, ambulating, etc. It is not made any easier when you work with LVN's and RN's who feel they are to good to help you with anything. I love my job and helping the resident's but there are times when I wish my LVN or RN HAD to do my job for a month. Maybe then they'd be a little more compassionate and patient before they jump my case for not having all of their VS by 0715 while I am trying to do walking rounds and pass breakfast trays and our shift started at 0700. Just saying. I don't know how it would be paid for but maybe it could come from the money facilities might save for NOT having to pay for wound care from decubs aquired AFTER admission. Or wound care from falls. Or special equipment such as air beds for those decubs. Or from NOT having to pay for sitters for restless resident's who have fallen multiple times. Or from NOT having to pay for registry because attendance is optimal with fewer people calling off for illness and an increase in job satisfaction. Who knows?

[kasey1001]

Hello, I currently am employed in a rehabilitation/long term care facility in arizona and they tell us that the ratio here is 1:45. Now there are times where we have near that and every time I leave I feel that my liscense is at risk. I can see having maybe 1:15. That will allow us to spend more time with our patients and do proper assessments and documentation. I was also a new grad when I started there and only had 4 days of orientation. Now its only at nights that they allow us to have that many patients to one nurse, and let me tell you, its no easier than during the day. Medications have to be later than they should because simply we cannot see everyone at the same time and we have to do our assessments before we give them their meds. I just wish that whoever made these ratios (if indeed they have) that they would understand the need to staff properly. well that's my soap box for the day. I do have to say that I am starting another job shortly and will so glad to get out of this facility and hopefully will never go back to one.

[kasey1001]

one more thing in response to the previous post before mine....our aides sometimes have up to 24 patients to one aide. Added to this is that the nurse cannot stop med pass to do direct patient care because the patients have to have medications in a timely manner. This is not only long term care, but also on the sub-acute hallways where you have 20 to 30 of post surgical and other patients in pain. I would hate to be them in that nursing home to be honest. And management sees nothing wrong with this picture. Staff is beyond frustrated. So what is the fix to this? I don't know but they need to do something fast.

[CapeCodMermaid, RN]

Unless someone is ill, there is no reason to wake them up at nights for medications or treatments. People should sleep at night.