How many patients per RN/LPN?

RN2begin · Apr 26, 2008

In NH the nurse:patient ratio is dependent upon the shift...most units have 24 beds...but we often run over this cap. On day shift, there are usually 3 RNs to about 24 patients...3 to 11, there are 2 nurses to the same ratio of patients...and on the 11 to 7, there is 1 nurse per unit. Granted, you do have techs that assist...sometimes more than others. Psych nurses are just as busy as a med surg nurse...but it is much more cerebral than tasky...and I assure you that when a patient becomes violent and/or dangerous...the process of restraining and medicating becomes increasingly more difficult as the shifts change. 11 to 7 could be smooth sailing...but when something does happen it is often made worse by the lack of staff available to help in a crisis...

medsurgrnco, BSN, RN · Apr 27, 2008

Thanks for the response. I found more info on staffing levels from older threads in this forum.

PMHNP10 · Apr 27, 2008

and on the 11 to 7, there is 1 nurse per unit.

I'm almost certain this is in violation of some sort of Medicare standard or something. So if the nurse has to do a takedown, is that nurse supposed to lay on the patient until they fall asleep so the nurse can get up and go get a PRN? I mean, really...1 RN is totally unacceptable.

To OP: a safe ratio is 1:6, but if you are going to fudge around with safety, 1:10-12 should be the max for 11p-7a only; the others need to stay at 1:6

wonderbee, BSN, RN · Apr 27, 2008

We're running 1:13 on days and evenings with 2 MTs, 1:27 nights with 2 PCAs. We have a complement of security officers who are available 24/7. I spend 5/8 hours on my feet. I work my butt off. It's unreasonable.

medsurgrnco, BSN, RN · Apr 28, 2008

Sounds like I should take the job I was offered where the ratio is 1:8 on 12-hour night shifts.

RN2begin · Apr 28, 2008

I'm almost certain this is in violation of some sort of Medicare standard or something. So if the nurse has to do a takedown, is that nurse supposed to lay on the patient until they fall asleep so the nurse can get up and go get a PRN? I mean, really...1 RN is totally unacceptable.
To OP: a safe ratio is 1:6, but if you are going to fudge around with safety, 1:10-12 should be the max for 11p-7a only; the others need to stay at 1:6

I agree with you. I am sure there are multiple violations happening at my hospital. I question administration constantly...there is never any doubt about my distaste for the working conditions...but I feel a certain obligation to my patients.

To answer your other question...if you don't have enough techs to "lay on them" until you get the shot ready...you just hope that somebody shows up when the code is called...and go from there:up:

aloevera · Apr 30, 2008

we have had up to 40 pts. with 2 RN's, 2 med nurses (LPN's) and 2 techs........very poor staffing in my opinion.....I think that ratio is absurd and we are meeting with management to discuss that very thing.....I have had 34 pts. and been the only RN with 1 med nurse and 1-2 techs....very unsafe conditions for the pt. and for the nurse in my book..............

Ultra Violet · Jun 13, 2008

Medsurgrnco - If you still review this thread, would you mind if I ask you a ?. How long did you do med surge before interviewing for a psych position? The reason I ask I that I've been in med surge for 4 months, and I'm considering a move to psych. I specifically have an interest in substance abuse and am trying to decide how long to stay in med surge before making a move. I don't think I want to wait one year.

aloevera · Jun 13, 2008

I just called to see where I am tomorrow and found out we have 49 pts. on the dual unit and will only have 2 RN's !!!!!! 2 med nurses (they stay busy with meds and taking off orders so they are no help to us)

I am almost afraid to go in tomorrow....but I could never call out and leave the other nurse by herself.....I am sorry, but I just had to vent about this to someone !!!! How unsafe can you get ????

medsurgrnco, BSN, RN · Jun 16, 2008

Ultraviolet - I've been in med/surg for several years, and moved to psych due to my interest in that area and my frustrations with the med/surg environments I worked in. I would suggest at least a year in med/surg before moving to psych.

Aloevera, I'm curious what tasks are done by nurses that are not med nurses. We don't have specific med nurses at my current job.

sarmedic70 · Jun 17, 2008

Hey all. .............I am a psych RN at a state facility. The ratio of RN to patients is generally anywhere from 1 RN to 20 patients to where one unit has one RN to over 40 patients. Most units have LPNs who do the med pass (but they are there limited time..........so RN does the med pass a lot of the times as well); however, a LOT of the times, the RN will end up doing both med pass and RN duties. On my unit, I have 19 patients at the moment with capacity of 22-23, and then the LPN to do meds. Generally, we have an LPN (if they don't call in sick) except on Saturdays:eek:.................it is a nightmare a lot of the times........... I don't know about any other psych facilities around the country, but I put in a LOT of OT as a result of not being able to get all the charting and all of my important nursing stuff done to get off on time............and it is not a time management issue either. I am VERY good in my time management. But when patients are unpredictable and you end up with Area Restrictions, Seclusions, restraints et al............the amount of time spent on doctor's orders, and then the documentation that goes with it, is tremendous.......................I have the MOST active unit of the entire hospital overall...................so a LOT of charting and especially PIRS due to seclusions et al..................

I am far more busy than I ever was on a Med-Surg unit............... and with having considerably smaller RN to patient ratio when I worked M/S...................but you know what?..................the worst day on my psych unit is better than any day I worked in M/S :yeah: ..........................

I also agree with "medsurgrnco" post about having M/S experience prior to going into psych........I would say 6 mo minimum and ideally 1 year..........

I don't know what federal guidelines are (or even state) for the RN to patient ratio in psych facilities. I do know this, and especially for my unit of which is the MOST active (and sometimes the most violent) unit in the entire hospital (I have childrens) that I am almost always short of staff.......not enough psych techs....................and that bugs me to no end............too many times we have felt that our unit is not safe nor is our staff............I could go on and on about it..................however, till some things change within the entire hospital (another long story in that alone as well), this is the way it is..............unfortunately.........I do what I can to ensure that all are safe on my unit: staff and patients.....................and a LOT of praying......................

Another issue that we ALL hate at our hospital. :angryfire If two RNs are scheduled to work on the same unit, one will normally get pulled to another unit (of which is not their own)...............we do not like that at all: (1) generally we may not like another unit (I don't like working geriatrics at our hospital) (and MOST HATE working our unit); (2) we don't know the patients at all on the unit we are getting pulled to, but we are yet required to give staff guidance/direction, due the monthlly and weekly charting on patients we do not know anything about , et al ; (3) "fighting" as to whom is going to go when getting pulled (I hold my ground and insist on taking turns!!! ........I had a situation awhile back in where I waiting for an RN from another unit to come (our unit night RN had been sick); at any rate, she and this other RN were fighting over as to whom would be coming to my unit since neither wanted to work it.............the RN who ended up coming (and was very angry about it) was late, and I didn't get off on time............Argh!!!!!:argue:.............Again, I don't know how it is done at other state facilities, but this is the "reality check" at our state facility.................the hospital "owns" us and no such thing as having our "own unit" essentially................Most people cannot handle our unit as it is................... :crying2:

We also have 12-hour shifts, but................I put in well over 20 hours yesterday/last night....................kinda "active" night to say the least, and the documentation/charting was a nightmare...............no such thing as getting off on time on my unit..................... :jester:

Additionally, we will have one campus police officer on duty (especially in the evenings)............that is a bad set up and situation.........yeah, we can call a Code 10, but............where our building is located, and for us to call for assistance from throughout the hospital.................Well, we have been down that road......and I don't want to even think about it........were last night again!!!!!.....................

Well, I could write a laundry list of frustrations we have at our hospital (and on our unit)...................however, what I have posted are the "highlights"......................just adapt, improvise and overcome....SEMPER GUMBI (Always flexible)...................

Cheers

C :yeah: