We have a short-term/rehab Med A unit which holds 40 residents. I am the Charge RN, but the ADON position has been empty (er…departing) of late and much has been falling to me. A new ADON will be placed in July.
Problem is, during the evening shift we have managed to work out staffing with 2 nurses, 1 cma and 6 cna’s. This works and can still get rough. "Corporate," however, has become involved and with the start of our new ADON wants to make the budget set for 2 nurses and 5 cna’s per eve shift. Period. The leaving ADON and the DON both have requested I set myself to "gathering information" to present the strongest case for needing at least a CMA…or a CMA for 5 hours… Any ideas from veterans of these struggles? This "info" I should be gathering? Perhaps information sites with ratio norms or other valuable gems?
Maybe just advice?
Thanks in advance!!!
does your state have a standard for number of hours of nursing care per resident?
most don’t they just require sufficient staff to meet the needs which is very subjective but a few states actually have a set standard.
i have experience as a resident as well as a staffing coordinator(volunteer basis). i don’t see any corporate position approving a CMA for evenings as the nurses should be able to handle most needs and can write phone orders without assistance. 20 residents for a nurse and 8 per CNA is an excellent ratio depending on the quality of both nurses and CNAs. with just one meal and probably limited restorative nursing happening i don’t see you getting more help. i would focus on the quality of the individuals not the quantity. as far as patient care and ADLs i have found that a great nurse with only mediocre CNAs gets very limited patient care provided but great CNAs can easily make up for a weak nurse (as far as ADLs and hands on care of the residents). Medicare has such strict guidelines for charges and nursing homes end up spending so much out-of-pocket for most residents care it is hard to increase the bodies that most homes can afford to have on the floor.
THANK YOU for what you do and i hope you can convince them to add a CMA but don’t expect it, it is extremely difficult to justify.
a side note:
you are working in some of the most trying, underpaid, underappreciated work there is and………………….
you are blessed to be doing some of the most rewarding work possible. Thanks!
EDIT:
your state should have a website for the department of health and human services and generally all nursing facilities state/medicare surveys are listed with all deficiencies, harm tags as well as the number of hours per resident used, % ocupancy, average stay etcetera. try looking there for some numbers that would be applicable to your area.