Accepted nurse to pt. ratio

GooeyRN, ADN, BSN, CNA, LPN, RN · Feb 15, 2008

Acceptable? I dunno. On the acute floor I worked night shift there was 1 RN and 2 techs for 22 pts. Dayshift got another RN normally.

RNMike68 · Feb 17, 2008

Interesting question. At the inpatient psych hospital I work at, we work 8 hour shifts and have 2 units: An adult-dual diagnosis unit with 25 beds and a geri-psych unit with 14 beds. All things being equal, we try to have at least 3 RN's staffed between the 2 units during 1st and 2nd shifts, and one RN on each unit for 3rd shift. The A/D unit generally gets the 2nd nurse, until census and/or acuity reaches the point on the geri unit where we need a 2nd RN (usually around 10 or so patients or less if there is cathing to be done, tube feedings, trach care or the like). A/D unit generally needs 2 RN's on their unit unless really low-census since they tend to get more admits/discharges (typical stay on our A/D unit is about 3 days versus about 14 days on the geri-ward).

Now, to muddle the issue, my hospital doesn't currently use an acuity rating system to determine staffing needs. We did use a paper & pencil system once upon a time, but now-a-days we have a census grid which determines staffing levels for RN's and techs based only on patient numbers, not acuity. So, whichever nurse is currently playing charge subjectively determines the needs of each unit and staffs accordingly. Most times this works, sometimes it doesn't. Some nurses want a second nurse to work with, some would rather have a second tech.

This all leads me to a closely related question, how are other inpatient psych hospitals determining their staffing needs? Just by the numbers? Or is someone out there using an objective, acuity based system? And is your staffing system working? This has been a burning question for myself and the nurses I work with as we strive to maintain a safe, healing environment for our patients.

Thanks, and good wishes to you...

Male Filipino Nurse · Feb 17, 2008

In my psych unit we go by the nurse/pt ratio which is 6:1. We also use the Acuity system as well, however, as an LVN i' don't know how that works, unfortunately. We average around 30pt for our unit which means we SHOULD be staffed with 3 RNs and 2 LVNs with 30pt. Let me emphasize "SHOULD" because our staffing is ridiculous sometimes. Last night for example I was the only nurse giving meds to 31 pt. when i arrived at 3pm. I then learn that we have 5 pt's in the ER to be medically cleared and transfered to our unit. Around 1830 the first pt. comes, then around 1845 the next pt. comes and for the next hour/half ALL the 5 patients from the ER have been admitted. All this happened with 3 RNs, 1LVN (ME), and 2 Mental Health workers. We were short 2 licensed staff and it happens all the time. The hours are a bit unique for the staff in our unit. RNs have 12hr shifts while LVNS and Mental health workers work 8hr shifts. By the time we finished admitting all the patients the next shift (NOC) is getting report. By the time i left my shift we staffing didn't meet the ratio of 6:1. We had 4 RN's and 1LVN (ME and the oncoming shift).

Lauranj · Feb 23, 2008

I am a new psychiatric nurse (LPN). I dont really know how things go, but i have about 50 patients. Its so hectic every morning. imagine having to count narcs for 50 patients, and then give am meds to all of them. can some 1 give me some feedback pleaseeeeee....

Thunderwolf, MSN, RN · Feb 24, 2008

What did you get yourself into?

Could you elaborate more about your unit/floor?

Lauranj · Feb 24, 2008

well my unit is roughly 48 pt. its more of a long term facility. pt range in age from 20-60. most self sufficient. most of them were taken from the streets of ny. they all have multiple diagnosis. more than half have dm so im giving a round of 8am meds and then the 9's. i've been there for a month and learned to manage my time better, but in psyche u never know whats gonna go down, so sometimes i dont get a break or even lunch. its hectic.

TopazStone · Feb 25, 2008

Good heavens! I work at a psych crisis facility and have been complaining about the ten to 16 patients I've had to manage. Of course, our tech is not able to complete VS or blood sugars and I am the only medical staff available on my shift (free standing facility so we can't rely on staff or house officers in a pinch). I can have a new arrival, one in restraints and a few in active detox on any given night with q2-4 hour VS, fasting BS on clients without diabetes (just because the doc feels like throwing that order on with the rest), and q15 min VS and circ checks on the restraint. What is it with psych (and nursing homes) that they can get away with this kind of staffing? Even in states that have mandatory staffing, psych units are usually the highest nurse to patient ratio!

Yosemite, RN, ASN, EMT-I · Mar 7, 2008

...What is it with psych (and nursing homes) that they can get away with this kind of staffing? Even in states that have mandatory staffing, psych units are usually the highest nurse to patient ratio!

Answer: In states that don't have ratio laws... because the can. For California, free standing acute in-patient psychiatric facilities did not have their ratios set when the law was enacted, it was to be finished later but, then Governor Grey Davis was recalled. The new Governor, "Arnold," is staunch pro-business and the Dept. Health and Mental Health KNOW better than to try and push the issue. It will take another liberal Democrat and the will of the California Nurses Association to finish the job. It is not likely to happen any time in the near future.

Little Panda RN, ASN, RN · Mar 8, 2008

The psych hospital I am working at does not have a certain nurse to patient ration. Recently are census has been 35 beds filled (total 67 bed hospital) between adults and adolescents. With the majority filled on the adolescent side. If you are the unlucky one you are assigned to work the adolescent side and pass meds to 20 patients and that is during the day. If you work nights then there has been one lpn passing meds to both sides. Nights have 1 Rn, 1 lpn, and 2-3 MHT's. Days are better if everyone shows up for work. Just the other day the RN called off, she was the only RN scheduled for the whole building, so the DON had to work the floor. They actually did not have an RN for the whole weekend so the DON will be working. We are short staffed quite often.

wonderbee, BSN, RN · Mar 8, 2008

I realize after having spent time on the unit that my original question is an irrelevant one. I see that psych units aren't staffed like med-surg units. I'm still trying to make sense out of staffing and who does what.