Sunday, May 10, 2015

Happy Mother's Day

Happy Mother's Day
Did you know that 91% of nursing homes lack
adequate staff to properly care for patients?
The difference in staffing in long-term (nursing home) care versus psychiatric is remarkable to me.

Most nursing home patients require around-the-clock care, including total care (cannot do anything for themselves).  In the nursing homes where I've worked, the staffing ratio was one nurse for 30 to 60 patients, with help from 2 to 5 nursing assistants.  Nobody in their right mind could look at this set-up and deem it safe.  Do the math.  When I had 60 patients, that's one minute per patient per hour, or eight minutes per 8 hour shift, assuming I didn't get a break, which I usually didn't.  The eight minutes was not in direct patient care, as I had to extensively document every patient.

People may think that lots of documentation is great, but think about it.  The more time a nurse spends with the chart, the less time the nurse spends with the actual patient.

On the psych ward, in contrast, the staffing ratio is double than that of the nursing home.  Some say it's because of the violence potential.  Yet most of the staff lack people skills, thereby increasing the risk of a patient acting out.  Whenever a staff member complains about the work load on the psych ward, I think about the work load in a nursing home, and laugh to myself.

A lot of nursing home patients have psychiatric issues, but are not medicated for these issues because it's a "chemical restraint."  I remember a patient in the nursing home who was very violent.  His PRN "as needed" medication was 1 mg of Haldol.  ONE, and giving it meant you had to write and write to justify chemically restraining the patient, as if the dose had any effect.  On the psych ward, 20 mg of Haldol is a more common dose.  When a patient ages out of the psych ward and is transferred to a nursing home, their psych meds stop.  No wonder they become so disoriented and agitated.

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