Is 18 patients "the new normal"?

[SunnyRose]

I work in a peds acute inpatient unit (ages 5-17). Management decided to up our nurse to patient ratio to 1:18. We do all our own discharges and admissions (Admissions take 2 1/2 hours per pt. Usually 1-2 admits a day shift and 3-5 a night shift).

The kids are usually pretty acute: lots of active little fellers running around bugging the teens; sad future borderlines trying to cut themselves or bang their heads; psychotic teens having their first break, kids who come to us in shackles from juvie lockup and have to be watched so they don't jump another pt. Typical inpatient psych.

Boys and girls and littles are supposed to be separate, but I usually have just 2-3 techs, so it is just plain hard to keep everyone separate and keep eyes on constant observation pts. Conflicts arise among the pts because of this.

The unit is sooooo busy-with treatment teams, constant phone calls, helping calm pts through a crisis to avoid holds and seclusions, passing meds, calming somatic tummies, confirming orders, just listening to a kid vent, doing medical nursing tasks etc,. I usually have to stay late--sometimes very, very late-- to chart and finish an admission.

I have 1 1/2 years experience. I wanted to stay inpatient, but I am wearing out. I love working with kids and try so hard to make a difference in these kid's lives. Sometimes there is even a breakthrough-insight gained, behavior modified, a depressed teen sees they have a reason to live--but I still usually leave every 12+ hour shift feeling rushed, inadequate, and defeated.

Every nurse and tech has complained about the load. The whole hospital is short staffed every shift. We all feel it isn't safe. We all work well together, but there are not enough nurses or techs. Critical thinking is a luxury--I feel like I am putting out fires while running on a treadmill. Management listens sympathetically, but the end message is always, "Deal with it. It's going to get worse before it gets better. This is what healthcare is like."

So...is 18 patients the new normal? Is this what I have to look forward to for the rest of my career-14 hour days and never feeling like I've done enough? Any comments are welcome. Thanks for listening.

[smoup]

I'm still a nursing student but I am doing my practicum in geropsych. The ratio seems to be 6-7 patients per nurse. I can't even imagine managing all the patients on the unit (max census is 13).

[Ozzy84]

Here in New York City usually 1:6 or 1:4 , I think where you live there is no nurse Union. Therefor hospital gives as much as they want. It's not safe at all having 1:18 ..

[lasair]

Wow - 1-18 in acute....that is mad. How many are on the unit in total? Do you have a union, nursing law, nursing bord, mental health authority, department of health, department of safety, government, guidelines, who carries out inspections??? - Who protects your rights and patient rights?? This sounds really stressful!!My ward has 3 nurses to 25 patients, with 3 on floor HCA's and extra to cover specials

[SunnyRose]

Thanks for the validation, everyone. Makes me feel not so alone in the world :)

My State Nursing Board rules allow a VERY wide range of managerial discretion in deciding ratios. Since we are so short-staffed, my unit has 1 nurse at a time, so 18 total pts on the peds unit w/ 2-3 techs. An adult acute unit is across the hall, so I can "borrow" their 1 nurse or a tech if I have a crisis, but they are always short-handed too. Several upper-level managers have rounded my unit recently, hiding in the nurse station as though the patients were going to jump them if they came out on the floor, and never asking a nurse how things are going. No union in my facility...the only resort I have is the "nuclear option" of Joint Commission...no other way my voice can be heard within the corporation. Really love working with kids but am reaching the end of my rope...seems like $$$ is the bottom line, period.

[Ozzy84]

Which states is that ? I really wonder

[~Shrek~]

I have 1:18 sometimes but the pts r medicaly stable

[Natasha A., CNA, LVN]

1:29 sometimes

[twinkerrs]

I bet this hospital belongs to a huge corporate chain of behavioral health hospitals. The facility I worked at before becoming an APRN had census like this. The acute unit is staffed 1:15 or 1:whatever the census is some days and teacher count in the matrix so the nurse loses some techs on day shift. Crazy stuff when they want no restraints or seclusion a on top of that.

[PeacockMaiden]

Let me guess, is this a UHS facility?

[Stephalump]

Wow -18 kids? That sounds absolutely exhausting. I have a ratio of anywhere from 18-20:1 inpatient in an extremely acute setting and it wears me out most days...but I can't imagine doing that with peds! Way too high IMO.

[Natasha A., CNA, LVN]

I remeber back in the day if we had 15 pts, the staff ratio was 2:15 and it was lovely. Now we have 1:18+ and the have been writing more incident reports from patients falling due to one CNA on the floor. Yesterday at my job I was told they found a pt outside who feel in the rain. She was a line of sight pt and the staff manaager took it upon herself to canceel the other mhw and only have one on the floor smh -- results more incident reports