Staffing Levels Tied To Resident Injury Ratio

One problem that has plagued the healthcare industry, especially nursing homes, is staffing. Almost every facility has run into the problem of there not being enough aides to cover a shift properly. While this may seem like a staff only problem, studies suggest that there is a direct relation to resident injury and staffing ratio.

This isn’t really news to aides, though it may be to those that have loved ones in nursing homes. Aides are the backbone of all facilities and without them, the number of injuries rise. Aides transport residents, help them go to the bathroom, dress, and assist in every aspect of resident’s lives. Without aides, residents have to rely on their own locomotion, which isn’t always the best.

Aides also must work together often when moving a resident from bed, to chair, to toilet, and back to bed. Some residents are known as ‘2 assist’ which means that there must be two aides with the resident while moving at all times. If there are not enough aides on duty, these residents may be dropped by a single aide who is trying to move the resident! This is bad for both aide and resident. Both can be injured or worse.

Residents that know staffing is bad may try to do things for themselves when they shouldn’t. Some residents should not try to get out of bed or chairs on their own. These residents may not want to call an aide that seems overworked. While the resident is trying to ‘help’, it isn’t fair to the resident to be unable to go to the bathroom or even get out of bed.

When there aren’t enough aides, even residents that can be mobile can fall prey to injuries. A resident that is mostly independent may be failing and without enough staff on hand to see the deterioration, the resident can fall or trip resulting in an injury.

Another source of injuries is abuse. When there is not enough staff, the overworked staff on duty may forget to do something that a resident needs and this results in abuse by neglect. It may not be intentional, but it is still abuse. In other situations an aide may be increasingly burned out and suddenly lose his or her temper. This may not be the fault of the aide – but the victims in this type of situation are twofold – the abused resident is hurt and the aide will suffer emotional pain over what they have done.

There are Just Too Many Residents

We’ve all experienced it – short staffing.  You head into work, it’s looking to be a great day, suddenly you walk into what every can fears: their hall partner calls off.  You take a deep breath…at least the extra aide assigned to your hall will be there…oops…another call, she’s out, too.

Suddenly, you’re the only aide on your hall.  One aide and an entire hall full of residents that will need to be washed, transported, fed, and toileted.  How are you going to do this?  That’s the question that every aide who has faced this situation has asked themselves, along with the supervisors on staff.  The same answer in most facilities is:  you just do what you can.  Ask for help from other aides from other halls if you need it.

The problem with this entire scenario is not the fact that not every person will receive good hygiene, but that someone could get hurt. Many aides will try to rush through their job – this can lead to residents not being situated in wheelchairs properly, being left in a bathroom to fall, or aides receiving injuries when they try to move a two person transfer resident alone.

I’ve been in this situation quite a few times when employed by a nursing home with a less than stellar reputation.  Many CNAs are employed at such homes now and will continue to be.  The reality of short staffing and of low-grade homes – sometimes there is no other place to work. When your partner calls off and you are left to your own devices, do the best you can.

Head to the clean utility room or where the peri-wash is kept.  Fill your pockets with the things you will need: peri-wash spray, barrier creams, and anything else that you may have a need for during your first rounds.  CNAs on the morning shift will have more of a need for oral care supplies and razors, while aides on the second shift will benefit from a quick stock of items such as briefs and washcloths in every room.  A few minutes of preparation can set the tone for an easier shift.

No matter how strong you think you are, never try to move a two person transfer resident on your own.  Check the next hall for an aide or if you must, ask your supervising nurse for help.  Machine assisted transfers may seem safe with one aide – but if a Hoyer lift tips, you or your resident can be seriously injured.  It does not matter if another aide tells you, “I’ve done this a hundred times alone.” – ask for help! Your health, your resident’s health, and your career can be lost in just one mistake.

A good idea is to keep a small notebook in your pocket and jot down notes from your day.  Note times and dates of short staffing, so that if you need to provide a list of dates for any reason, you can.  There are situations, such as an investigation by the state health department where you will need to know specific details and dates.  A small notebook (pocket sized) can help you if you need a reference.

What Would You Do If You Worked for a Bad Nursing Home?

What do you do if you work for a nursing home that is breaking the law?  Even with all of the laws and safeguards in place, many nursing homes find ways to cut corners.  The nursing staff and residents suffer when these home are allowed to operate with low quality conditions.

Here in New York,  I was employed by a nursing home with deplorable conditions for staff and residents.  Aides would try their best to give the proper care to residents most of the time, but there were a handful that had stopped caring.  While they did not physically abuse the residents, you could see that they did not enjoy their job and the residents were not happy, either.

Every week there were staff shortages.  Higher quality homes will try to schedule five CNAs per wing – two CNAs per hall with an extra aide to fill in for two person transfers and transporting residents through the facility.  This particular home would schedule only two aides per hall with no extra aide.  At least three times a week several aides around the facility would call off, leaving other aides to shuffle around the building.  This resulted in one CNA per hall – one aide per 20 residents!

In addition to short staffing, needed supplies were rationed.  We were allowed one cart with a set number of linens per hall.  If you ran out, that was it.  No extra linens were issued.  We were told to use pillowcases as washcloths if we ran out!  We were never sure why the linens were rationed, one supervising night nurse took a few CNAs to the supply room once, there were brand new boxes of washcloths stored.

Briefs were rationed as well.  Residents were given a basket with a number of briefs based on the number of changes that were marked on their care sheets in the past month.  The average number was six.  You may have a resident that needed eight changes but had six briefs.  We would need to raid the brief stash of another resident who in turn may need another resident’s briefs raided…at the end of the week if the number of briefs were over the ration limit, we could have our pay docked!n the number of changes that were marked on their care sheets in the past month.  The average number was six.  You may have a resident that needed eight changes but had six briefs.  We would need to raid the brief stash of another resident who in turn may need another resident’s briefs raided…at the end of the week if the number of briefs were over the ration limit, we could have our pay docked!

Finally, after many other such things, a group of CNAs decided it was high time to complain.  After the group called the county health department a surprise inspection came up.  It was interesting to see the look on the faces of the inspectors when an announcement came over the intercom for a doctor that did not work nor had ever worked for the home came, just as they had been informed.

Most nursing homes have a code for inspections, a few will announce over the intercom, “Call for Doctor ______”.  If this is heard, it means that all staff must be on their best professional behavior and should check all of the residents stat. This time the health inspectors knew the code and knew to go out on the floor ASAP.  This particular home was fined and several higher members of staff were let go.

In the weeks that followed the facility hired more CNAs, more nurses, and we finally received that boxes of washcloths stored in the basement.