Sunday, January 2, 2011

The Short-handed Shuffle

Oklahoma is one of the states that has a minimum staff requirement for nursing centers. It sounds great until you realize that the staff that they can "count" are not necessarily staff that are working the floor.

We were short again last night. Short by my standards. I would like to see 6 CNA's, 2 CMA's and 3 LPN's. We had 4 CNA's, 2 CMA's, and 2 LPN's. According to the staff requirements, that's enough people to take care of the number of resident's in my facility. The nurses don't work the floor and the CMA's are limited by what they can do between dishing out medication. (Technically, they are not supposed to stop their med passes to help out on the floor, but they never get through a med pass without taking someone to the bathroom or helping someone to bed or something.)

I understand that I should be thankful that the state has minimum staff requirements because it's likely that we wouldn't have had even that many if they didn't. (I work for a "for profit" nursing center.) But we would have been more effective if we'd had more help. Minimum staff just means the resident's are getting the minimum amount of care. In some cases, barely that.

I've been trying to think of a solution. I'm sure that if someone asked the Administrator, she'd say that her nurse's and CMA's help out on the floor. This is not usually the case and when they do, the help is limited as they have to get their work done too. Maybe the state needs to require a certain number of staff who are specifically dedicated to working the floor, regardless of their title. That way, a nurse could stand in for a CNA only if she was not also required to perform LPN duties.

In the meantime, I use my feet as a barometer. If they really hurt at the end of the night, we didn't have enough help. They were still tender this morning. (Yes, I also need new shoes, but that's another post for another day.)


Dr. El said...

Happy New Year, K. Tree!

I'd love to see a study done which compared working truly full-staffed vs. working with minimum required staff on a variety of measures: resident, family, and staff satisfaction, absenteeism, staff turnover, depression, bedsores, and other medical outcomes. I suspect nursing homes are often penny-wise and pound-foolish, but I'd like some hard data.

I don't see a way to reach you privately, K. Tree. Please email me via my Contact Me button on my blog if you'd be willing to give me your email address.

Dr. El

K. Tree said...

I agree. Maybe now that the baby boomers are getting closer to the Nursing Center, we'll see some studies like that.

Anonymous said...

I agree, about finding some kind of study. It would be interesting. What could happen , too, with increased staffing levels is that the facility would simply be more accurate, timely and thorough (to a fault ) with paper/documentation compliance. Sometimes, I think as much as all staff can complain about charting, they use it as an excuse to avoid "hands on" practical Resident contact!
I am a Rec Director. How wonderful would it be if there was increased down time because of better staffing ratios( assignments could be finished quicker) and C.N.A.'s could do more in engaging Residents with "simple pleasures" or other meaningful, purposeful activities.

Hold my hand: a social worker's blog said...

It bothers me when some nursing homes count DON, ADON, and department heads as part of the staff. Those are not hand-on jobs. I have actually seen that most of the nurses don't help residents with toileting, or getting out of bed, or grooming. I really feel that the CNA's do the hardest job, and sometimes they are underestimated. And like you said, quite often the facility is under staffed. Let me say: CNAs rock!


K. Tree said...

Anonymous, it would be nice if we had more time to just interact with the residents. The biggest complaint I get is that everyone moves too fast. The residents appreciate our help, but they'd like to socialize a little bit, too.

Doris, that's one of those loopholes they use to get by with less staff and it drives me crazy, too. My DON hasn't worn a pair of scrubs since she started, yet she counts as staff. Kind of hard to lift someone when you're wearing 3 inch heels.

Anonymous said...

So, TRUE, "the moving fast" tone that is sent. Sometimes I think the Residents laugh at this and get agitated and angry at the same time Here's my take 1.)"Moving Fast": because staff are authentically busy/understaffed,working as a team trying to get things done!!! 2.) "Moving Fast": because staff are trying to "look busy" so that they can avoid Residents, other staff, paperwork...etc. 3.)"Moving Fast": trying to find another staff member,Resident or item that you put down somewhere (when you were moving fast) 4.) "Moving Fast": Don't want to feel disorganized and non productive or in over your head because you only got "2" things done on your to do list instead of the "10" !!!!

Best Practices/State approved: More blending of roles, and volunteer centers to generate volunteers who can function as "hall monitors"/hand holders/Listeners.