Who knows what the "LPN to Resident" ratio is and what is safe?

TheCommuter, BSN, RN · Jan 29, 2009

There is NO legally mandated LPN-to-resident ratio in nursing homes and LTCFs anywhere in the US. There is no exact number or limit written into law.

California is the only state in the union with any type of legally mandated nurse/patient ratio, and it only applies to RNs employed in the hospital setting.

In my area, a 3-day orientation is the norm for a new LPN in a nursing home. An experienced LPN might get a day or two unless more time is requested.

systoly · Jan 30, 2009

Whether the nurse to resident ratio is reasonable or safe depends on numerous factors such as level of acuity, which can change suddenly and frequently. It also depends on your support staff and what duties other staff can perform. That's why the minimum staffing levels mandated by the state do not differentiate between LPNs, CNAs and other direct care personnel, but rather lump them together in one number. As for orientation, again, it depends on the situation. Are you the only nurse in the building on night shift or are you working days when there are other nurses, maintenance, and admin. In general, I believe five shifts, considering that one shift is usually filled up with completion of paperwork, watching videos etc., is reasonable for a new nurse.

stdntograd06, BSN, RN · Jan 31, 2009

Well, I just read this post and had to reply. I agree with The Commuter that there is no "official" nurse:resident ratio. At my facility, we used to have 5 LPN's for the 11-7 shift, but the powers that be cut us down to 4 nurses and of course we always have an RN Supervisor there. There are 48-50 residents on the one floor I predominately work on, and their acuity seems to go up higher with each one. There is only 1 LPN for all these residents too, with only 2 aides. Occassionally, we get an extra 1/2 of an aide which is only 4 hours (11-3:15). Most of the residents on the floor are lifts, or need 2 people to turn/roll them. So, your question as to what is safe is very appropriate. Besides resident care, you have your VS, assessments, med passes, tx's, and god forbid you have one hit the floor and have to do incident reports and neuro checks., and that doesn't include all the paperwork that needs done on the night shift. It has become so overwhelmingly stressful knowing that your license is on the line.

We get 20 days of orientation for LPN's, which is nice. It gives you time to get your feet wet, and feel relatively comfortable.

Here's hoping that wherever you work, you have a good staff to work with. Not all places are like this, but nursing is never easy either.

Kelly