patient/license safety

Specialties Psychiatric

Published

I work in an acute care psych unit of 30 beds. The ratio averages 10-15:1. Being the charge nurse, I have always split the pts with the other nurse so that more time can be spent with our pts and the charting can be more thorough. When working with an LVN or an RN, the patients are split. The interim DON just told everybody last week that LVN's are no longer allowed to chart on patients, that all they can do is give meds. The rumor is that the DON got permission from Medicare (CMS) who was just there and the CEO to implement this new rule. We do not understand why and are not happy about this. We think our licenses could be compromised since it can be difficult enough to be charting/giving meds for 15 pts especially when there are pts disrupting the unit but charting on 30 is ridiculous and unsafe. A nurse giving meds to 30 pts is too much as well. We don't know what we can do about it if anything can be done at all. Or, maybe we are just overreacting. The other charge nurse and myself are afraid that if we challenge, we will be fired since the DON and CEO just fired 2 nurses last week. I've been looking for another job but haven't found anything I like well enough to quit. Any suggestions would be appreciated.

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Specializes in psych, addictions, hospice, education.

Do you have techs? I surely hope so! Having 30 patients on an acute psych unit, with just 2 staff people, is soooo unsafe!

There's a movement toward having LVNs give all meds while the RN does all the paperwork. I don't like it since I like to assess patients myself, before medicating them. Besides, doing all the paperwork is just plain tedious, and how can you chart on someone if you haven't had a chance to interact with him? Interaction happens during medication administration.

Have you talked with your boss about your feelings? I think that's a place to start. What were those other nurses fired for? It could be they did something (or didn't do something) than had nothing to do with your concerns.

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For 30 pts we would have 3 techs. When the other charge nurse said anything, the charge nurse was ignored and didn't want to push it further. The other charge nurse asked to go to 32 hrs/week and was told the position was not available and had no choice but to go PRN.

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I worked in an almost identical situation years ago (and I got the heck out of there). One nurse was the med nurse and the other was charge however we all charted on the patients - including our 2 techs. What you're describing is crazy.

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Sorry...that wasn't helpful on the suggestion front. Just empathizing. Hang in there.

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Specializes in Outpatient Surgery, Psych, Emergency.

Do you happen to work in Arlington, TX? Your situation sounds exactly like mine, down to the time frame, interim DON, nurses who got fired, etc.

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My unit has 25-30 pts with 2 RNs doing all charting, admitting and discharging. One LPN doing meds and two techs. We are responsible for two groups on 7-3 shift also- as the charge nurse I go to all staffings with the physicians also. Our two RNs are charting on 13-15 folks every day. Never mind doing anything on the care plans! It is so frustrating and an impossible task most days. Any others have similar situation- I don't feel this is safe-

This is the day The Lord has made, we shall rejoice and be glad in it.

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Specializes in Outpatient Surgery, Psych, Emergency.

My hospital, at the job I just left, would be 30 to 36 patients with two RNs giving all the meds, and doing all the charting, admissions, discharges. It was incredibly risky, which is why I left. My new hospital has a staffing ratio of 11 pts max per RN, plus a nurse manager to help out. It's far safer.

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Specializes in Psych.

Holy Cow!!! Start looking for another job! I work on a 26 bed inpatient unit, normal day shift staffing is 4 nurses, 4 MHW's and one "nurses aide". The weekends we are down to 3 nurses. The MHW's help with charting, the meds are different every shift but we have found to get the 9am med pass done in the 2 allotted hours (plus now we have to scan everything...takes so much time) we have 2 nurses work together but it doesn't always work out. The evening shift the 4 nurses pass their own meds, but we end up pre-pulling them which we are not supposed to be doing, but hey, gotta get those meds out! Let's all move to California where they have legally imposed staffing ratios. I think in psych it's 6:1

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Specializes in Psych (25 years), Medical (15 years).

Lessee... Let me Figure this out.. Your Staffing is 30 pts w/ 5 Staff Members... that's 6:1.

On Day Shift, we have 2 RNs, 1 LPN, and 1 Tech for 15 pts. That's about 4:1. Eves has 1 RN, and 2 LPNs or 1 LPN and 1 Tech for 15 pts. That's 5:1. MNs has 1 RN and one other Staff Member ranging from RN to Tech for 15 pts. That's about 7:1

Yep. Our Institution's Staffing is Rather Tight, so that probably means you're Under-Staffed.

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Here's a scary situation, im a new grad rn working nights in a nursing home/snf. I am responsible for 2 halls with a total of 41 residents. I am responsible for meds, charting, treatments, and emergencies.im scared to death something will happen. But I follow all my safety rules and C.Y.A. all the way.

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Specializes in psych, addictions, hospice, education.

30 patients with 5 staff members? Wow, did I misread the original posting?

I'm used to one staff member for up to 8... THAT wasn't a safe situation.

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