Concerns About Patient Safety and Ability to Provide Quality Care

[JaneFidgets]

Hey all,

To provide a bit of background, I am newly licensed grad and landed my first nursing job back in October of last year. I was so ecstatic about having secured a job working with my dream population (Dual diagnosis/detox). However, I am a little over a month into orientation and am having some major concerns related to inadequate staffing. It may be worth noting that this seems to be a relatively common concern and frustration voiced by my fellow co-workers. We are on a 21 patient psychiatry unit that operates using the team nursing model. We typically have 4 nurses (seemingly at least one of those nurses is orienting) and 1 tech. It appears that approximately once per week we have 4 nurses and no tech. On these days we are absolutely slammed, as we usually have two nurses (with just one pyxis) administering meds to all 21 patients in the morning, 1 nurse orienting to charge, and 1 nurse acting as charge (doing admissions, discharges, belongings, skin checks with the RN orientee. This is scary to me because having no tech means that one of us must find a way to complete the 15-minute safety checks on all 21 patients, while also attending to various patient needs in addition to our own nursing duties. I have completed the safety checks on many occasions and am well aware that the minute you are done checking on all 21 patients, it is time to do it again.

Basically, my concern stems from the fact that with so few staff, something has to suffer, as it is impossible to be in two places at once. It makes me angry that I am being asked to choose between ensuring patient safety, providing patient-centered care, and providing timely and quality care. While for me, ensuring patient safety (completing 15-minute safety checks) will always be the top priority, I cannot guarantee that the other nurses share my sentiments. I am also concerned as to how my performance will be viewed if ensuring patient safety (completing 15-minute safety checks) when we do not have a tech prevents me from fulfilling my other job responsibilities (nursing duties, assessments, etc.).

In my experience, while completing my clinicals at a different hospital, staffing needs were taken much more seriously. At that particular hospital, the moment that the charge nurse became aware of a staffing deficit, she was immediately on the phone with the clinical coordinator negotiating for additional staff. Nine times out of ten that request was granted and we received additional staff (an RN or tech) from an outside agency.

While it seems that the directors are well aware of the problem, many of my colleagues have indicated that their concerns seem to fall upon deaf ears. Several have stated that they are regularly told that management is working on hiring more staff, but that they have yet to see any changes.

Funny thing is, we recently had a safety and quality inspection and there was a significant increase in the number of employee bodies on the floor/unit that day (5 nurses, 2 techs). For once we actually had adequate staffing. Unfortunately, my brush with adequate staffing levels was short-lived and the very next day (once the inspectors left) we were back to 4 nurses and no tech.

I suppose that I am simply looking for words of wisdom or encouragement or any advice that other nurses may be able to offer, as I absolutely love the patient population that I am working with and also really like my colleagues

[JaneFidgets]

Clarification, we typically have 3-4 nurses for 21 patients. Sometimes we have a tech, sometimes we don't. All patients are on 15-minute safety checks.

[GeminiNurse29]

Is it inpatient or outpatient? A locked unit? Voluntary?

At my facility, we usually have 2 nurses on the geriatric ward which can hold up to 17 civil patients (committed there for aggression or emergency detention), sometimes 3 depending on acuity. That's Bc it's considered an admission unit. All the admission units have 2 nurses and up to 22-24 patients. And there are always at least 3-4 techs.

are there any 1:1s? Doesn't sound like it or else you'd need better staffing. Unfortunately, short staffing seems to be common nowadays. You could break up the duties, such as one nurse does the checks for an hour while another one does the meds or whatever.

[JaneFidgets]

It is an inpatient locked unit and we typically do at least one admission during day shift and approximately two discharges. I would say that the majority of our patients are not voluntary. I have yet to have a patient requiring a 1:1. We do currently break up the duties. I suppose that my true concern centers around the days when we only have three nurses and no tech. That would mean that we have two nurses on meds in the morning and one charge nurse. Therefore, the charge nurse would be responsible for both admissions and 15 minute safety checks. If we took one of the nurses off of meds in the morning to do the safety checks, it would likely mean that we would end up being 2 hours behind on some of the patients morning meds.

[wingding]

4 nurses 2 techs for 21 patients would be a dream. We have 2-3 nurse, 1-2 techs (someone called in?) 5+ Discharge 5+admits. Welcome to Psych.

[RNGummy40]

Hi JaneFidgets.

Your safety concerns are accurate and I can't provide reassurance that it will get better. My last detox unit was locked with 28 patient load. Voluntary and Involuntary mix with dual diagnoses. Opioid and ETOH withdrawal, SI patients and Homicidal patients. The problem with the staffing ratio is that it can make it extremely difficult to form a complete assessment of your patients if you are not experience in working with these patients, not to mention even if you are, the difficulty still exists. Mandatory staffing ratios are needed and until they are mandated I don't think the system will improve.