New law would require RNs at all nursing homes 24/7

Thinkstock | Fuse

Thinkstock | Fuse

They’re called “nursing” homes, but as you know, many nursing homes across the country don’t have registered nurses on duty all or even most of the time. Now, that might be changing: A new law has been introduced to Congress that would require all nursing homes in the U.S. to have at least one registered nurse on duty 24 hours a day.

Currently, federal law requires a RN to be on duty only eight hours a day. This stems from a 1987 law intended to reform nursing homes in America. Rep. Jan Schakowsky (D-Ill.) recently introduced “Put a Registered Nurse in the Nursing Home Act.” The title of the new law clearly spells out its purpose: to require a direct-care RN to be in every nursing home 24/7, regardless of the size of the facility. This would affect any nursing home that receives Medicare or Medicaid reimbursement.

If the House Resolution eventually becomes a law, it won’t require changes at every facility; 13 states already have the 24-hour requirement in some form, according to the New York Times. However, statutes vary in these 13 states, with some only requiring 24-hour RN staffing at facilities of a certain size.

However, the Times blog cites Association of Nurse Assessment Coordination research estimating that 11.4 percent of nursing homes in the U.S. do not have a RN on duty 24 hours a day. The article also cites research showing increased RN staffing results in overall cost savings in addition to improved care.

Nurses: weigh in on this. Do you think all nursing homes should have a 24/7 RN requirement, or can exceptions be made? Do you work at a nursing home that does not have an RN on duty at all times? If the resolution passes, do you see more nurse jobs being created in certain areas? Let us know in the comments below.



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10 Responses to New law would require RNs at all nursing homes 24/7

  1. James Gordon

    Dear Fellow Nurses,
    I am an ex-broadcaster turned Long Island, NY Licensed Practical Nurse and am reaching out to you to make you aware of a terrible injustice thrust upon Long Term Care residents by facility owners and administrators. They are allowing, and condoning short staffing. This unethical practice prevents nurses from providing proper care. This situation has forced thousands of our geriatrics to exist in dangerous and life threatening milieus. This premeditated maltreatment has been going on for many, many years. I have started a discussion on the Linkedin LPN Group site entitled, “The dangerous practice by nursing homes of assigning an exorbitant amount of patients to care for during an eight hour shift.” There you will find one hundred seventy nine (so far) responses from both LPN’s and RN’s from all across the country. Proof this is a nationwide problem. In these facilities nurses are expected to care for upwards of sometimes sixty patients, along with performing many other activities such as writing nursing notes and other necessary tasks in an eight hour shift. Many nurses are forced to clock out at end of shift then spend another one to two hours engaged in activities they were unable to complete during their tour of duty. The owners and administrators of these facilities are well aware of the highway to nurse burnout they have created. Yet, instead of correcting this very dark side of the modern health care landscape they are content to reap in billions of dollars annually to the detriment of this helpless population’s health and welfare. Please copy and paste this link to access the discussion group. If need be, please click on “Show more comments” to view all comments.

    Please read the heartfelt responses posted there. These administrators who should do right will not until they are exposed by the news media. The majority of the public is unaware of this tyranny because a huge amount of effort is spent to make everything look good on paper. It is my intention to help put a stop to this unnecessary suffering. Dear Nurses I hope you will be moved to add your voices to help put an end to this “secret nightmare.” Thank you for your time and consideration.

    • Carol Dimon

      James these issues are international . So? I believe by comparing information and attempts to alter situations, countries can assist one another .Of course there are political influences- ie profit and privatisation , plus less regard for “so called non-contributors”.

  2. saturn567

    we already have this rule at the facility where I work at, hence why I say I am only covering the building for the higher ups when I am supervisior on a holiday, evening or weekend shift, however they do pile on a lot of patient and other responsiblities on nursing which gives less time to provide the care we know we can provide but just don’t have the time to do so

  3. LISALPN3829

    I don’t think it’s necessary. The only thing an RN can do at my facility in Pennsylvania, that I as an LPN can’t do, is pronounce death. As a night shift nurse, with 4-5 other nurses on the shift, I am often the supervisor and it is not unusual for me to be the only LPN working. My experience, work ethic and ability to think quickly and calmly to emergecies is more important than the letters behind my name. I think DONs are qualified to decide if their staff require the presence of an RN.

  4. ashbeth78

    I’ve worked LTC since I got my license and I can say that most of the RN’s I’ve worked with do less and a few know less than any LPN I know. So no I don’t think having a RN on staff and there 24hrs a day would change much. Most of the ones I’ve worked with are strictly there for the money they earn. Don’t get me wrong I respect all nurses and CNA’s I just don’t think that having a RN on duty around the clock will really Change anything. These are not just what I am assuming about the RN’s I’ve had most of them tell me this. I’ve had maybe 1 or 2 that actually cared about what was going on but it still came down to the amount of money they were making.

  5. Carol Dimon

    Important info for UK/Australia where we have similar issues. /updates- not advertising- just international comparison.
    Nurse needed in nursing homes of course- UK has nursing or Residential homes. I know different set- up in USA. Is nurse ON duty proposed — actually in the home /part of shift? ie not ON call?? Here in Uk in Nursing homes- must have nurse on duty all hours everyday– (well that is the legal requirement).
    other factors are adequacy of nurse training in preparation for nursing homes- UK training tends to be geared towards NHS hospitals. This questions the need for a general qualified nurse? ie theatre trained–Thanks

  6. Candis

    Absolutely! I believe that the staffing barely meets requirements most of the time. I never worked in a Nursing Home and wouldn’t want to because of all that is put on the 1- R.N. That is there 8 hrs/day. There is not enough staff to possibly care for these patients adequately. From what I have seen some of the staff wouldn’t even know how to put a C-pap machine together, much less make to a patients room within the time it would take to save a patients life. I also believe that if it was your vulnerable family member, wouldn’t you want to make sure they are being treated fairly? Places like this should have hidden cameras and be monitored closely; might just be shocked to see what goes on in these places when the staff doesn’t know that anyone is watching!

  7. cgdonrn

    I have been a Registered nurse for 20 years. I can vouch without a doubt that a lot of my clinical skills were mimiced from LVN’s, they are some of the best nurses world wide. I do believe there should be a Registered nurse 24/7 and it’s not all about the money either. Until nurses understand what congruence is versus competency, “nurses” of all standards will not be on the same page. I read within these posts LVNs that are disgruntled toward the work some RNs do. Could this be from lack of or regret that they do not hold a higher degree? There are times I have seen LVNs want to do the work of RNs, not that they are not capable, they are just not licensed to do so. To gain a better perspective of what the job descriptions are, one must read their states practice act and understand their scopes of practice. I am not saying that “some” nurses on all levels do not pull their weight. But, lets not assume that just because a Registered nurse is not doing physical labor at the time that they are not bombarded in critical thinking skills that keep everyone out of trouble, and keep the state from breathing down their necks. Granted, all nurses are accountable, but cultural congruence, whether it be for your fellow nurses or your cultural different patient has to be the cornerstone to taking care of your patients. As I have stated, I have worked many facets of health care and have earned every stripe I have. There is a chain of command in every department. For those LVNs practicing outside their scope of practice, I would think they would be honored that an RN was available to give unbiased answers and opinions to those who expect outstanding care. I am a Nurse Educator, but a “nurse” first, and I believe education should be ongoing for all nurses. I have worked in nursing homes where I was the only nurse working with sometimes 1 aid in the facility. There are skilled nursing jobs that only nurses can perform and sometimes only RNs. When you are short staffed and you have several patients go bad at the same time, how do you triage those patients when there is not enough help? It would be nice to have an extra pair of hands, even if it were an RN that is “just there for the money”. If I were just in it for the money, believe me, I could find many other jobs that were much more stress free with less responsibility and get paid just as much. Just my thoughts.

    • cgdonrn

      By the way, just for the record. I have also taught a hospital-based LVN program for several years, so I know the scope of practice that is involved and what they are allowed to do.

    • cgdonrn

      First of all, I am a nurse, a “male nurse” as some like to say. I have seen many changes in nursing, accepted the challenges that come with being a male nurse, and I am an advocate for men in nursing.