Safe staffing levels

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    What do you consider to be safe staffing levels for an inpatient psych facility? We have 1 nurse for 16 patients and then two techs (our techs help with meals, smoke breaks and personal care). Sometimes this is overwhelming should anyone require extra attention...either sudden acute medical or mental episode. I believe it's just too much responsibility for one nurse but that is the "matrix sent from corporate". The state I;m in requires and "average monthly" of one staff for four patients except on nights.
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  3. 22 Comments so far...

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    I work at a free standing psych hospital with 46 beds, that's divided up between adults and C&A. We have 4 nurses on days and evenings, 3 on night. Around 3ish techs on Adults, 2 with the adolescents and 2 with the children. That's manageable for us.
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    Our psych hospital has about 650 pts. Each ward has about 25 pts. Staffing: 1-2 RNs, 1 LPN, 3-5 techs. This is NOT enough staff as we provide activities(like on-grounds walks, yard, gym, fitness, some off-grounds passes)--especially when a patient becomes physically abusive.
    serenitylove14 likes this.
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    That is crazy. I would talk to your union. The latter is more responsible 1:4 but I have never seen this ratio. Ted Ducharme RMHC London ON Canada
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    Wow.... those ratios are scary. We have a 1:4 ratio, and one psych aide (small unit). I could not imagine being the only RN for 16 psychotic and/or suicidal patients.
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    That's crazy... even for a crazy house!

    I worked in an Acute Psych facility before I became a nurse. The 35 patient unit is staffed for day shift as follows:

    2 RNs
    1 LVN/LPT (Med. Nurse)
    8 Mental Health Worker/Mental Health Aide
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    In CA, I have ratios on my side, so it can never be greater than 1 nurse:6 patients for inpatient.

    However, having also worked outside of CA...I'd say that a ratio of 1:8 max is safe. Of course, this has to take into account the acuity of the patients. On a high acuity unit such as stepdown or ICU, or for detoxing patients (or other psych populations) who are medically unstable, more staff is needed. Sometimes even 1:6 isn't enough.
    Last edit by Meriwhen on Mar 16, '13
    greenbeanio likes this.
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    Quote from chelleanne
    What do you consider to be safe staffing levels for an inpatient psych facility? We have 1 nurse for 16 patients and then two techs (our techs help with meals, smoke breaks and personal care). Sometimes this is overwhelming should anyone require extra attention...either sudden acute medical or mental episode. I believe it's just too much responsibility for one nurse but that is the "matrix sent from corporate". The state I;m in requires and "average monthly" of one staff for four patients except on nights.
    That sounds really overwhelming! I work on the psych floor of my local hospital and we have 5-8 patients a piece per night, plus one dedicated med nurse (so we don't have to give meds to those 5-8 patients!)I work nights, so I feel 8 patients is manageable, but some nights it can feel like too much depending on the acuity of the patients. I wish more states had ratio laws so places couldn't just arbitrarily decide what they think might be safe...
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    I work on a 16 bed child/adolescent (ages 4-18) unit and we ALWAYS have 2 nurses no matter what the census. Where they short us is not giving us adequate support staff (ours are Behavioral Health Specialists and all have a bachelors degree in mental health). The most we can have is 3 and thats when we're at a full census. We run groups and as many know children require much more time/attention and a higher liability than adults. What's frustrating for us is our grid is the same as our adult floors and its definitely the bare minimum for all of the responsibilities we have in a shift. Does anyone else work C&A and have more staff than their adult floors?
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    Quote from alb402
    Does anyone else work C&A and have more staff than their adult floors?
    I didn't work C&A routinely, but when I've been floated there, I've always had a minimum of 3 techs regardless of census: one to round on the children, another on the adolescents (we kept the two populations as separate as possible...as far as one could housing them on one unit anyway), and a third one to tend to the unit as a whole. If we had an abundance of children or adolescents, we'd get an extra tech so two techs could be assigned to that population.

    Nursing, on the other hand...usually 2 nurses. Not always. If the census was below 16, they'd tend to shortchange us in the nursing department.

    This isn't in CA, BTW.


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