Although nearly all would agree that safe nurse staffing ratios are important and necessary, long term care (LTC) facilities (also known as nursing homes) and skilled nursing facilities (SNF) seem forgotten in the rally for safe nurse-patient ratios on units.
Federal law has few requirements for nurse staffing in long term care facilities, and the federal standards haven’t changed in over 30 years when the Nursing Home Reform Law of 1987 was implemented, requiring these facilities to have the following:
- A registered nurse eight consecutive hours, seven days a week
- Licensed nurses 24 hours a day
- Otherwise “sufficient” nursing staff to meet residents’ needs
These standards do not prove to be adequate in ensuring a competent, safe workplace.
SNF and LTC are also no longer just for geriatric residents. They also provide care for patients with a wide variety of higher-level nursing and rehabilitation needs.
In a typical eight-hour shift, a nurse is expected to pass meds at least twice per shift (within a two-hour time frame), monitor blood sugars and give insulin, check vital signs, manage certified nursing assistants, watch mealtimes, perform wound care, receive and transcribe physician’s orders, complete incident reports, complete documentation, arrange transportation and diagnostic testing, schedule appointments, and ensure residents are cared for including notifying physicians and family members of any concerns. This is a very long list of duties for nurses.
Bobbie Bacher, LPN from Illinois stated, “We need to stop using nursing homes as psych facilities. They require special care and training. We need to stop using nursing homes as prison release halfway houses. We need to get back to basic nursing with proper nursing ratios. When treatments are heavy, there needs to be a treatment nurse on the day and PM shifts. This is a safety issue for the staff and the patient/resident.”
Many nurses are working with unsafe nurse-resident ratios. Drumeka Rollerson, RN states the concern with these ratios well: “I think we confuse these staffing guidelines way too often. Just because you are able to do 60:1 doesn’t make it safe for the patients.”
Understaffing often makes it impossible for nurses to give each resident adequate attention, and overworked and stressed staff increases the risk of mistakes and committing abuse.
Studies have shown that residents who live in understaffed facilities are at a higher risk of malnutrition, weight loss, bedsores, falls, and infections.
One story that demonstrates how dangerous understaffing can be is shared by a nurse named Amanda, describing what she refers to as a “wake-up call.” On her fourth med pass during a 12-hour shift, Amanda and one other nurse were responsible for sixty residents. As she drew up insulin, she stopped and intervened as a demented resident began attacking another resident. Still distracted, she returned to her cart to finish drawing up insulin.
She only realized after double-checking her dosage that she had drawn up twenty units of insulin instead of three.
She realized she was spread too thin trying to safely administer medications and protect residents. She states, “The resident with behaviors should have been a 1:1, but that wasn’t possible with the ratio we had.”
No harm came to any of the residents, but Amanda admits how easy it can be to become overwhelmed.
This story is just one example of how understaffing in these facilities can be extremely unsafe for both workers and residents, and it is vital that we have safer nurse staffing ratios in long term care facilities and skilled nursing facilities.