Help! Min. safe staffing issue

Frankcah · Sep 18, 2002

it is my understanding that staffing levels are formulated at local policy level, and as such should reflect the level of care needed for each individual client. I have worked in units where there is a staff/client ratio of 1:1, and at the other end a unit with a staff client ratio of 4:1. Staffing budgets need to be taken into account, and if you as a group need more staff and have evidence to prove it regarding unsafe practice, then u need to submit your case to managers to reshuffle budgets to provide adequate cover.

Sorry, don't know any research on the subject though.

pattyjo, MSN, RN · Sep 18, 2002

jlc: One RN and one unit clerk for nine patients? There are so many things wrong with this I don't know where to start. The safety issue is primary; not only for the 2(YIKES!) staff involved but also for the patients. I can't even imagine what would happen if you had a situation with a patient escalating or even a medical emergency. Here is a link to the APNA site and their position paper on staffing. http://www.apna.org/papers/position_paper8.htm

Don't expect a strict by-the-numbers solution here: I have never been convinced that ratios are the only way to go because I think they reduce nursing to a rigid number system and don't take into account the wide variations in acuity. You might want to check out the ANA site http://www.nursingworld.org and just do a search on staffing ratios.

Beyond the safety issue, I have to wonder how you have any time at all to work with the patients. Do you do groups or 1:1 interventions? What about teaching? And meds? I would think that your administration would be concerned with the quality of care being provided. Health care is competitive, a savvy patient is going to go elsewhere if they are treated poorly. I can't even imagine how you are able to do even basic care with that ludicrous staffing plan. Is it similar on med surg?

On my unit, for 9 patients and above, we have four licensed persons, and the flexibility to up that if the unit is particularly active. On 7-3, in addition to the 4 licensed people (we only have RNs and LPNs) we have a unit clerk, OT, case manager and social worker. One of the licensed staff does UR as well as a patient assignment. On 3-11, we have only the 4 lic. staff, no unit clerk. In addition, one of the RNs is assigned emergency assessments and also has a patient assignment. Admissions are unpredictable, so sometimes that nurse is very busy, other times nothing. Again though, if we are getting overwhelmed with admissions, we can call another person to come in.

I hope this helps a little bit. Keep advocating for yourself and for your patients. Do you have a nurse manager? Get all your arguments together and make an appointment to see her/him. If that doesn't work, go higher. This isn't fair to nursing staff, and it sure isn't fair to patients. PM me if you have any other questions, and good luck.

Patty

jlc · Sep 18, 2002

Thaks for the thoughtful reply. We do have a unit manager, but budget concerns are her only concern. I will follow up are your suggestions and will continue to keep researching so that I can keep fighting for appropriate and safe staffing in the unit. jlc

RedWhiteBlue · May 12, 2004

Hey, the staffing ratio I see in this thread sounds like heaven to me. Our director is not a nurse and does not seem to understand it when the nurses say we aren't safe. Also the director of nursing seems to think that because our patients can get up and walk around that they very easy to take care of.

Ha! The director of nursing expects us to take as many patients as whatever is on the unit. Right now we are working with 2 RN's, a mental health tech or CNA, and occasionally a therapist or social worker for part of the shift. What's a unit clerk? (I'm joking - we don't have any.) The RNs on our unit have been taking 9 - 12 patients a piece. Yesterday, I had two patients that required physical holds because they were out of control, two patients needing to be sent to the state hospital, and two admissions (less admissions than usual). Yesterday one of our staff was hurt and today another was hurt. This past summer we had a nurse end up with multiple fractures - wrist, humerus, and foot. She also had sprains. We have a 40 bed unit, but have not had the staff for that many beds for a long time. Now with what our director and the director of nursing is saying, we are wondering when we will have to take 20 patients each.....

Comments?

Tiggur · May 13, 2004

I am trying to research what is the standard for staffing a psych unit. At my hospital they have just changed it from a 2 RN's with one aide or unit clerk for nine patients or less, to one RN with one unit clerk or aide. This does not seen safe to us and we need info from other hospitals in order to present a good case. We are turning in unsafe staffing papers with each assinment, but I can't seem to find anywhere where the issue has been addresssed. Either by legislation or by an orginazation. Any and all replys would be greatly appreciated. Thanks

i work in gero psyc and we work with one rn and one tech but of the time we have two techs usually have 5-7 patients average ... and we all feel the same way unsafe at times, overworked ,,,and very stressed ...

Crazy Mama · May 13, 2004

I am trying to research what is the standard for staffing a psych unit. At my hospital they have just changed it from a 2 RN's with one aide or unit clerk for nine patients or less, to one RN with one unit clerk or aide. This does not seen safe to us and we need info from other hospitals in order to present a good case. We are turning in unsafe staffing papers with each assinment, but I can't seem to find anywhere where the issue has been addresssed. Either by legislation or by an orginazation. Any and all replys would be greatly appreciated. Thanks

Not sure I can help, but, the hospital I work at is in S.A Tx. I work on a 15 bed unit that stays full most of the time. There are occassions when we will go to 7pt's. Our patients range from 45yrs. and up. Most of our patients have alot of medical problems. Approx. 1/2 are either in wheelchairs or use walkers and they have multiple dx.'s.

Our grid shows that if you have 7 pts its just the RN and LVN. With one SW on the unit to do the groups. When we get to 9 patients on the 7-3 shift then we can keep the secretary. Once we hit 11 we can have 2 MHT's (mental health techs) 1 RN, 1 LVN, secretary, and 2 SW's. 3-11 is the same w/o the secretary, or SW. 11-7 is always 1MHT, 1 RN and 1 LVN unless census drops below 11 then we are w/o a MHT. When we get to 14 we can have 2 MHT's, and 3 license, secretary and 2 SW's on 7-3. As a group the nurses decided that we would rather have 3 MHT's and 2 Lic. On 3-11 we are always w/o a secretary and the SW leave at 5p. We have wanted to change our grid for 3 years now, but instead we have a variance report that we fill out each shift. I believe this was required by law to show that staffing needs met acuity. Appears that some hospital in CA is staffing according to acuity and its working. I hope that I have helped you. I've been a Psych nurse for about 4 years now and love what I do.

JustOverBroke · May 18, 2004

I have worked the floor all by myself when the census drops to nine patients. Anytime I leave the nurses station I have to lock the door and have another nurse answer phones as I do 15 minute observation. Also I have worked with twenty pt by myself and only two psych techs. That same day I was getting more admissions and the CEO approved to a max of 25 patients when it should not go over 21 patients. The facility I work for just cut staffing even more because they hired a unit clerk to work 40 hours a week only in the mornings. The unit clerk is supposed to check off orders but she spends the majority of her time filing papers. What a joke! She isn't even a licensed professional. Not to mention they have fired greater than 7 nurses in the acute units ,which I have worked, in the last year. When the unit manager told management about how cutting staffing would force the good nurses to leave, they stated "Well we can always higher more". This facility is a joke and unethical institution which is only in it for the money.

Crazy Mama · May 20, 2004

I have worked the floor all by myself when the census drops to nine patients. Anytime I leave the nurses station I have to lock the door and have another nurse answer phones as I do 15 minute observation. Also I have worked with twenty pt by myself and only two psych techs. That same day I was getting more admissions and the CEO approved to a max of 25 patients when it should not go over 21 patients. The facility I work for just cut staffing even more because they hired a unit clerk to work 40 hours a week only in the mornings. The unit clerk is supposed to check off orders but she spends the majority of her time filing papers. What a joke! She isn't even a licensed professional. Not to mention they have fired greater than 7 nurses in the acute units ,which I have worked, in the last year. When the unit manager told management about how cutting staffing would force the good nurses to leave, they stated "Well we can always higher more". This facility is a joke and unethical institution which is only in it for the money.

I'm not to familar with the laws of other states or do we all have the same when it comes to nursing? But, envoke Safe Harbor. It doesn't help get more staff, but it will help keep your lic. safe. I told my nurse manager one evening that if I didn't get a MHT to help on the floor with 15 pt's and 9 were total care, that I would envoke safe harbor. He asked me if I was threatening him. He didn't know what it was. Its there to protect you! It appears that you have your hands full. There are no easy answers. I have also heard that nurses are "a dime a dozen". They keep giving incentives to nurses coming on (sign on bonus), but don't take care of the ones that have been reliable for a long time. I guess I can say that we are lucky to a certain degree. I work w/ 2 of the best Psych docs. in our area. They stand behind the nurses 100%. If we feel that we are under staffed the doc. will call and get the supervisor to find another person. We still have our problems and issuses. We did have a problem one evening on the 3-11 shift, they could not find an RN that would work till 7p when the night nurse takes over, so, when the RN left at 3pm, they had another LVN to come for 4 hours. On the assignment sheet they put the hospital supervisor as the RN. I was told that this is legal for 4 hours. My concern, is what happens if the supervisor is in a code on another floor and someone codes or goes off on our unit? The docs were not happy.

PRNMEDS · May 21, 2004

Where I work it depends on the unit, and acuity. But below are the general guidelines for how the 4 units are staffed. Usualy there are no major medical problems for these patients.

Adults (mostly 16 - 20 years old) - 8 patients = one nurse and 2 MHAs (Mental Health Assistants)

Childrens (5 - 11) - 13 patients = 1 nurse and 4 MHAs.

Adolescent Dual Diagnosis (12 - 17) - 16 pateints = 1 nurse and 4 to 5 MHAs on 2 floors.

Adolescent (11 - 17) - 24 pateints = 2 nurses (often 1 or at least 1 for part of shift) and 6 - 7 MHAs and the patients are spread over 3 floors.

Reading the above replies it seems there is a big difference in staffing from hospital to hospital. very interesting, good post.