RN shortages in long term care

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I've recently noticed that the RN's at mom's nursing home have been putting in double shifts (one nurse I spoke to at breakfast told me she would be there until midnight!). I've also been told of the struggle to find enough qualified staff to cover shifts (even when a facility is actively trying to hire) and of RN's being told they aren't allowed to leave at the end of their shift because no one is available to replace them when a colleague calls in sick.


I understand the difficulty filling shifts in psw/cna positions because they are usually part time and workers have to juggle schedules in 2 or 3 places of employment, that is a whole other problem. Where are all the RN's, is there a shortage of people graduating from nursing college? And why aren't we hearing more about this?

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No worries, I'm not in USA so rules are different. Frankly I thought our care plan meeting was a big farce anyway.

I'm not really worried about the quality of care from the mom's nursing staff, just concerned that the current system(s) aren't sustainable, and it seems nobody outside the workers themselves are talking about it or have even noticed.
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Like Shane stated, "(an) assessment along with the Care Plan must be completed for all residents in Medicare- or Medicaid-certified nursing homes and non-critical access hospitals with Medicare swing bed agreements. This cycle (Comprehensive assessment – Quarterly assessment – Quarterly assessment – Quarterly assessment – Comprehensive assessment) needs to repeat itself annually for the resident" unless the resident has had a Significant Change in Health Status Assessment or was hospitalized and returned to the nursing home.

It sounds like the nursing home is having a Care Plan Conference with the family only when the "Annual" or "Comprehensive" Assessment is completed. You need to talk to the Nursing Director and the Nursing Home Administrator and find out why Care Plan Conferences are not happening every 3 months. If they don't give you a satisfying answer, you can contact the State Long Term Care Ombudsman and tell them about the situation.
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Cwillie, I get what your saying.. at one meeting we actually asked if the SW and DON had brought the correct patients chart.. Nope, no diabetes heart problems or high BP.. and why is that drug her DR ordered 6 months ago still not here?
Our recovery room is still staffed by mainly nurses from other countries,, one of our float pool staff got fired for finally asking a nurse to "speak English" Not PC I know but as my own department is getting filled with people with limited ability to speak English in an inner city area.. getting report is a nightmare, the Drs complain to us ( but never to management) that they have no idea why they went along with some crazy idea because "that guy was non stop about it".. they can't understand what the RT/RN was trying to say and they figured one of us "old timers" would be in for the next shift and "just fix it".
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In the US care plan meetings  are required to be quarterly in nursing homes. If that is not happening that should be reported to management first, then up the chain of command. It is required in Medicare/Medicaid facilities to post the complaint procedure for all to see.
Yes DeeAnna, 1979 here too. Nursing is hard work!
I was a candy striper- I used to fill the water containers with fresh ice. That actually was very rewarding.
I always encourage people to go into nursing. It’s been great for me. But I’ll be ready to hang up my cap soon - need to work 6 more years for full SS - not sure I will make it. 
I know many who do begin the nursing curriculum then can’t pass anatomy and physiology, or the other prerequisites. You have to have smarts to do it.
I didn’t care for Pediatrics or OB/GYN either, lol.
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Quarterly care plan conferences? LOL, we get them annually.
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Hey, Shane, I graduated from a diploma hospital-based school of nursing in 1979 and then received my BSN 15 years later. There are a couple of other people who post on this website that are also "old time nurses". What a difference 40 years make!?!

I LOVED working at Long Term Care facilities or Nursing Homes. I was a "Candy Striper" when I was in Junior High. I wore the pink and white pinafore with a white blouse and later I worked a nurses aide at the same facility. I could have worked there as a RN if I had wanted to. There are so many specialties that nurses can work in now. And so much more medical and health information. It is mind boggling as times.

cwillie, Communication with the nursing staff is VERY IMPORTANT. The Quarterly Care Plan Conferences that are held to discuss your loved one's care is another important way for you to communicate with the nursing home staff. Ask questions, but do it with a desire to learn how your loved one is doing and not with a desire to find fault. Nurses have a tendency to "shut down" if they think that the family member is trying to get them in trouble and they won't be as cooperative with you if you are always "looking for trouble". Treat the nurses as you want to them to treat you--with respect and kindness.
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If you suspect a staffing shortage then make a call to the state ombudsman or DPH to investigate the staffing and timecards. If something is out of place, they will either get fined or be required to reduce the number of beds until they are compliant with best practices
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I am a working RN, BSN trained for almost 40 years. When I was in training I worked at a nursing home one summer. I realized I could never do that full time. Why? For me, it was the sadness of seeing elderly people never having any visitors, not enough staff to feed those seniors, the long hours and feeling there was minimal if any satisfaction in the job I did and I was just a student nurse!

Nursing has changed. The newer grads seem to come out of training not ready to really work - there’s no sitting with the patient for an hour taking a history, no time to complete a complete physical assessment, and in my experience as a patient in a hospital, no desire noted by the floor nurses to complete the above. And these nurses are assigned 6-8 patients a shift with Tech support! On evening shift back in 1982 we had 2 - 3 RN’s for 60 patients. 2 if one called out. Everything got done correctly. 

When I was a new grad in 1979 nurses did it all. Now a lot is delegated to CNA’s who you can’t even be sure took a patient’s blood pressure correctly.
To me, the only accurate blood pressure is taken the old fashioned way - cuff & stethoscope. I cringe every time someone takes my BP with a machine because there are so many factors in taking an accurate blood pressure that are ignored using that damn machine. 

Long term care? I could never do it. During my summer working as an aide at a nursing home I was just horrified in what I saw - elderly folk left to sit all day in gerichairs in excrement, no proper skin care, no one to feed them or hold their hand, & patients that never had a single visitor. Lots of  helplessness and hopelessness.

I’ve worked direct patient care my entire career except for the past  3 years. I can just look at you and know if you are sick. Not so with many nurses these days. 
BSN vs AA or diploma? In my opinion BSN’s are better trained hands down.  

Fast forward to 2011; my mother needing to go to a nursing home herself.

Nothing has changed in the 35 yrs from my summer as a student nurse working at a LTC center.

I never give a nurse a rough time until I have tried all courteous avenues first as I know how a nurse needs time to process symptoms, not to be interrupted when giving meds, etc. Thankfully I haven’t had to set many straight. Give that nurse taking care of your loved one respect as she/he is doing what many cannot ( or will not ) do. 

My advice - Be There! Be your loved one’s advocate, stay involved, question care but with courtesy, attend those care conferences, let the staff know that if anything happens to that 
86 y/o  ex dynamo (using my mom as an example) they would have to deal with me. I may have lived 4 hours away, but my brother visited my mom every day & we were fortunate to be a team. 

It’s not going to get better.  

 
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Where I live, nursing homes/care facilities are just a training ground for new RNs. most RNs want to work in hospitals but can’t get hired without having experience so they start out at nursing homes/long term care/rehab and get a year of experience & then get hired on at the hospitals. Also LVNs are being phased out, now everybody wants RNs with a bachelors degree! It’s also hard to get into the nursing programs around here, the waitlist is several years long, it’s not first come first serve—they give priority to single women with children and others but I forget the criteria. My friends sister will start the nursing program this fall after being on the waitlist for 6+ years! She was unmarried with no children when she applied for the program. Have a few friends with 2 kids who only had to wait a year or two. These are AA programs too by the way. So these new RNs still have to go back for their B.S degrees.
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I remember that RN shortage in the 1980s and the hospital that I worked at had some Filipino nurses working there. The ones that I worked with were great--once they could understand our English lingo.

Part of the problem with the nursing shortage is that there is a storage of PhD-ready Nursing Instructors for the BSN nursing programs. I was a Clinical Instructor at a LPN School of Nursing, but since I didn't have my MSN in Nursing Education, I had to quit teaching. BSN nursing programs REQUIRE PhD nursing instructors and many states require that they have PhD in Nursing Education and not a PhD as a Nurse Practitioner (NP) in any nursing specialty (which is sad because there are some GREAT NPs that could teach a lot about their specialty to the BSN students.)
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