The Toxicity of Long-Term Care
Minimizing the Nurse Shortage
It has been three years since Covid-19 changed the course of healthcare. Whether that change has been good or bad is still up for debate. Relatively speaking, the business-as-usual prototype for long-term care still dictates how facilities operate.
It is within these models that underpaid and understaffed scenarios are the norm exposing the most abused profession in the workforce, the American nurse.
Nurse disparities have doubled since the onset of Covid, giving rise to trending shortages without considering a failing healthcare system.
If you question the validity, refer to the nursing board within your state and examine the staffing ratios for skilled nursing facilities.
State agencies deem 1 to 30, sometimes even 1 to 40 ratios as acceptable.
How is this even legal?
Keep in mind the same boards who regulate staffing are the same organizations who opt to suspend or revoke a license for deviation of care.
One nurse can not manage the med pass, chart, do skin assessments, answer the phone, do admissions, speak with families, perform treatments, and keep the residents from falling.
Long-term care is a mad house of mirrors and full of illusion.
Let us take a look at the expectation.
Charting- Who are you required to chart?
Patients on antibiotics, skilled services, incident charting including falls, behavior, elopement, and exceptional charting.
How long does the charting process take?
(2–4 hours per shift)
Medication pass
Most facilities typically have a medication pass at 8 am, 10 am, and 1 pm, and that is just for the morning.
Vital signs
Every patient receives two sets of vitals. One in the morning and one in the afternoon. Total time (2 hours)
Lunch- The standard lunch break is 30 minutes accompanied by two 15-minute breaks.
Except thirty minutes is not enough. Why?
It takes five minutes to walk to the restroom and 10-fifteen minutes to shit or pee.
Then try heading to the breakroom that is another 5 minutes. Heat a meal 6–8 min.
In real time, a nurse has only ten minutes to eat.
Communication
Throughout the day, calls from family, management, and physicians take place. Because most facilities don’t provide a 24-hour receptionist or even security, the nurse is also expected to answer the door and defend themselves against intruders after business hours.
New admissions are a critical part of reimbursement for the facilities but take anywhere from 3 or more hours to complete.
Fall Monitoring- Four to six residents fall per day in a facility.
When only one fall occurs, the nurse knows her day is over. Why?
A call to doctor has to be made.
A skin assessment has to be done.
A risk assessment must be initiated.
Management has to be notified.
The family has to be notified. A neuro-check requiring a set of vitals every fifteen minutes. Then every 30 minutes and again every 1hour. Then every 4hours to be followed by every eight-hours for 72 hours.
In most cases the resident will fall again during the initial fall, and the whole process starts again. Madness, right?
The nurse works harder than the U. S. President but without the perks.
One certified nursing assistant per 20 residents is the state-wide norm.
And you wonder why your loved one gets a pressure ulcer is undernourished and hasn’t had a shower in weeks.
It’s a fairytale to believe state approved ratios can adequately provide care. This false narrative not only endangers the resident but puts mounting stress on the nurse, leading to burn-out and worse health issues.
The data suggests LTC facilities could benefit from 1:12 staffing for nurses and 1–4 ratios for CNAs.
Secondly, switch to salary instead of hourly, with a minimum of a three-day work week. Lastly, remove the ancillary titles and direct those funds to the individuals who are providing clinical care.
And most import nursing education should be free for those seeking a career in nursing.
My proposed salary for nurses,
0–1 year $90k
2–5 years, $100k
5–10 years $130K
10 + year cap at $140k with a bonus each year determined by the facility.
The World Health Organization estimates the U.S. totality of deaths related to the Covid-19 pandemic was three million. With projected critical shortages predicted by 2025, is America prepared for the next pandemic?
Olivia Meadows
https://baileysavinglivesseries.medium.com/?source=post_page-----43a75dcb0f30
WHO Coronavirus (COVID-19) Dashboard | WHO Coronavirus (COVID-19) Dashboard With Vaccination Data
The U.S. Nursing Shortage: A State-by-State Breakdown | NurseJournal
Healthcare: shortage of 13 million nurses expected by 2030 | World Economic Forum (weforum.org)
