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Discussion

Where Are the Nurses????

  • Columnist

Since most long-term facilities are still referred to as "nursing homes", one would assume that means there are nurses on the premises most of the time. But the fact is, many of them do not have nurses all the time or even most of the time.

In 1987, President Ronald Reagan signed into law the first major revision of the standards for nursing home care since the 1965 creation of both Medicare and Medicaid. This legislation, known as the Federal Nursing Home Reform Act or OBRA '87, forever changed society's legal expectations of nursing homes and their care. This law "required a registered nurse to be on-site only eight hours a day......regardless of the size of the facility".

"Most people would be both shocked and appalled that there's not an RN on duty around the clock." Representative Jan Schakowsky, democrat of Illinois, was so appalled that on July 31, 2014 she responded by introducing the "Put a Registered Nurse in the Nursing Home Act". "It would require that a direct-care registered nurse (not an administrator) be present 24 hours a day, seven days a week, in all the nearly 16,000 nursing homes that receive Medicare or Medicaid reimbursement."

While adding registered nurses around the clock will not solve all the quality problems at nursing homes, it is a step in the right directions.

What are your thoughts on this? Do you think this law will pass?

For the full article, please go to http://newoldage.blogs.nytimes.com/2014/08/13/where-are-the-nurses/?_php=true&_type=blogs&_php=true&_type=blogs&smid=fb-share&_r=1&

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    In nursing homes LPNs and RNs many times perform the same roles. I see no problem with a nursing home having LPN in house over night coverage with DON on-call. So far every facility I've worked has had RNs on 24 hours a day. Due to the job market in my area RNs seem to be the majority in skilled nursing facilities.

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    Most nursing homes have an RN either on call or in the building, but for how many residents. Sure, there's an RN. Is it safe? No, not really. The other day I had 8 units. That's fine when they're stable, but geriatric patients go bad quickly. They are more acute than people realize.

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    The facility I work at we have often been told that the DOH ration is that where ever possible there is a RN present and working 24/7. If short on days M-F the site manager is a RN so gets round that and may be no RN present for approx 2-3 hours. Weekends have known the on call manager ring all RN's if short to cover even if it is a few hours and the RNs split hours needed to work. Nights the policy is LPN used only in emergency and that where ever possible RN covers which sometimes has resulted in RN working 24 hours.

  • Quote
    • Author
    • Columnist
    In nursing homes LPNs and RNs many times perform the same roles. I see no problem with a nursing home having LPN in house over night coverage with DON on-call. So far every facility I've worked has had RNs on 24 hours a day. Due to the job market in my area RNs seem to be the majority in skilled nursing facilities.

    According to the article:

    Ms. Schakowsky’s bill specifies registered nurses because they play a specific role. Licensed practical nurses are vital to good care, and of course the lowest-paid certified nursing assistants — the aides — provide most hands-on help. But only registered nurses are trained and licensed to evaluate a patient’s care and conduct assessments when his or her condition changes, which can happen rapidly — and at 3 a.m.

    “Without someone to make an assessment right then and there, that resident could be at risk,” Ms. Grant said. Maybe he won’t be hospitalized when it’s necessary. Just as dangerously, maybe someone will call 911 when he could be treated in the nursing home and avoid being hospitalized.

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    In our facility we have 3 stations and each one is maned by a nurse and a med tech 24 hours a day.

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