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Case Review: Staffing Problems

Today, I have another case review for you; it's an example of the type of case you may review as a Nurse Expert.

Staffing problems in facilities…

Some of the staffing problems should never happen. But even though we have laws and regulations in place, staffing problems occur far too often.

So here’s an example of cases you may receive to review. You may wonder why these problems occur or how someone falls and/or is injured.

A nursing home is considered a “home” where individuals come to stay for a short period of time for therapy to get better and go home or stay permanently because they need “nursing care.”  But if there is no staff or not enough knowledgeable and skilled staff to provide care, many problems occur.

Not enough staff or no staff can be a culture or a consistent pattern of staffing issues due to incompetence in scheduling, lack of budget, or just a pattern of lack of staff due to management.

The problem of lack of staff goes directly to the top of the organization, the administrator, and corporate owners. They have a duty to know their organization and the residents who have been entrusted in their care. 


What to Ask

The Questions to ask when encountering a staffing issue include the following:

  • Is there staff available and scheduled?
  • Do they show up, and do they work?
  • Does the staff know and understand the needs of the residents?

Staffing is one of the most expensive cost items of running any healthcare facility. Good care takes time and money to pay the staff.  Delayed care is missed care, and the residents can suffer.  


What if Staff Members don’t Show?

You may think this will never happen. I wish that were true, but that’s not what happens.

Recently I had a case where there was one nurse to provide care for over 50 people. She worked 16-hour shifts. By herself!


It was beyond sad. And the lack of care, no turning, and repositioning. Food meal trays were not always given out, and some residents could not feed themselves. 

In fact, the food trays were brought into the room, placed on the overbed table, and left for the residents to fend for themselves.  

Later in the shift, the food trays, untouched by the resident, were picked up and sent back to the kitchen, and the food was thrown out. 

In one case, the daughter visited her mother at 2:00 PM and found her mother’s lunch food tray sitting in front of her mother on the overbed table, completely untouched. Her mother needed assistance with feeding and taking fluids.


A Different Case

Staffing problems can occur anywhere... 

Another situation was a recent hospital case in Washington State where there was not enough staff to care for the patients coming into the ER. 

The remaining staff in the ER called Emergency 911 and asked for the paramedics to come and help triage the patients waiting and take vital signs.

This was quick thinking on the part of the nurse. Not only did the ER staff need help, but the awareness of the problem was made evident to others in the community and even the nation by the news. 

Recently in Illinois, a nursing home in Lincolnshire, had a situation on a Monday morning when a medical provider showed up to make rounds on his patients at the facility.

There was no other medical staff around to be seen. The residents had been totally abandoned by the administration, who are at the helm of the nursing home operation.

But failure to schedule nursing staff is not an acceptable excuse.

These residents were left for hours with no one to care for them, assisting with bathroom needs, meal needs, turning and repositioning, and other essential personal care needs. 

Eventually, the police and fire departments were called to assist with the residents’ needs. 

Both Federal and State regulations are very specific about staffing.  If one on one care is needed by a resident, the facility must provide it.  For more information on required Nursing Services, check the link here.   

There are Federal and State regulations that are explicitly stating 42 CFR 483.35   Nursing Services Sufficient staff.

  • The facility must provide services by sufficient numbers of each of the following types of personnel on a 24-hour basis to provide nursing care to all residents in accordance with resident care plans.

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