how many patients do you recommend on an adult inpatient acute psych unit?

StuPer · Jun 16, 2005

Hello loprem,

While I havent worked on an acute ward with more than 20 beds, but I would say its more about adequate staffing levels isnt it?

However many beds you have, the staffing levels have to be right, otherwise a 10 bedded unit could be more dangerous than a fifty bedded unit....

regards StuPer

mobaby · Jun 16, 2005

I work in a state facility, Our patient census on my med-psych floor is 33 patients to 1 Rn, 2 LPN. Aid numbers depend on how many 1:1 status patients we have.

StuPer · Jun 17, 2005

satchmo.... OMG!!! how do you cope...

We have a psych admission unit here that has staffing of 5 RN/EN am shift, 4 RN/EN pm, and 3 RN/EN night and thats with 20 patients

lil'nurse · Jun 17, 2005

I can't imagine being the only rn with 33 psych beds, yikes. Are they more long term, stable? I work in a hospital and we have 21 adult beds although at the moment we are short on docs so we are only at 14 beds. At 14 we need at least 4 licensed staff, perferably 3 RN's and an LPN. Not including a CNA who does checks and a unit secretary. If we were at full capacity, we need 5 staff.

CharlieRN · Jun 19, 2005

tough question

Our psych Intensive Care Area is a 2 private room unit with is own small sittingarea, bathroom and a desk for the staff. However we have rarely found it possible for one than one severely disturbed pt to be in it at a time. So one bed is usually wasted. For the more ordinarily disturbed pts who meet criteria to be on a locked inpatient unit, but who can tolerate the company of others, about 20 private rooms seems to work well. That number is large enough for there to be meaningful group dynamics. Yet small enough for reasonable staff control. The number that can be managed depends on the mix of diagnostic types. Too many personality disorders will destabilize the unit because they actively prefer chaos and are praticed and skilled at manipulating the social environment. A large number of florid psychotics will make things chaotic as well but for different reasons.

The largest psych unit I have worked on was 28 beds in a 2 to a room with one shared bath to each room, configuration. It was not possible to manage a very acute population there. As little as 4 borderlines and a couple psychcotics made it barely manageable.

My perference is for each patient to have a small private room. So that they can have a private, safe space. I know I'd want one if I had to be confined to a psych ward. Baths attached to each room are not a good idea. Some diagnostic groups need to not have unlimited access to bathroom facilities. Group bath rooms are ok but toileting is another area where humans feel vulnerable. If you have a highly sexualized population, like say adolescents, bathrooms may need to be locked and staff charged with allowing one pt and only one in at a time. We have to do this on our adolescent program so the community toilets there might as well be singles. I think lockable single toilets with showers but directly off an observable community room or hallway would be best. Ideally about half as many as there are beds on the unit.

The ideal unit also needs one large observed community area, and a rec room with tv, table games, maybe ping pong, etc, and at least one group therapy room. These community areas should be attractive and airy with windows with an interesting view if possible, so as to encourage patients to socialize in them rather than stay in their private sleeping rooms. There should be a couple of glassed in, interview offices, where staff could have private theraputic conversations while still being observed by other staff. You need a locked observable "quiet room" to manage short term outbursts of extream behavior. My ideal acute care unit would also have at least 2 intensive care suites for patients who cannot maintain minimal social behavior,(screamers, feces throwers etc), are assaultive toward other patients or are insensely self destructive. When in use, these are staffed one or two to one, with staff rotated out hourly.

loprem · Jun 20, 2005

tough question
Our psych Intensive Care Area is a 2 private room unit with is own small sittingarea, bathroom and a desk for the staff. However we have rarely found it possible for one than one severely disturbed pt to be in it at a time. So one bed is usually wasted. For the more ordinarily disturbed pts who meet criteria to be on a locked inpatient unit, but who can tolerate the company of others, about 20 private rooms seems to work well. That number is large enough for there to be meaningful group dynamics. Yet small enough for reasonable staff control. The number that can be managed depends on the mix of diagnostic types. Too many personality disorders will destabilize the unit because they actively prefer chaos and are praticed and skilled at manipulating the social environment. A large number of florid psychotics will make things chaotic as well but for different reasons.
The largest psych unit I have worked on was 28 beds in a 2 to a room with one shared bath to each room, configuration. It was not possible to manage a very acute population there. As little as 4 borderlines and a couple psychcotics made it barely manageable.
My perference is for each patient to have a small private room. So that they can have a private, safe space. I know I'd want one if I had to be confined to a psych ward. Baths attached to each room are not a good idea. Some diagnostic groups need to not have unlimited access to bathroom facilities. Group bath rooms are ok but toileting is another area where humans feel vulnerable. If you have a highly sexualized population, like say adolescents, bathrooms may need to be locked and staff charged with allowing one pt and only one in at a time. We have to do this on our adolescent program so the community toilets there might as well be singles. I think lockable single toilets with showers but directly off an observable community room or hallway would be best. Ideally about half as many as there are beds on the unit.
The ideal unit also needs one large observed community area, and a rec room with tv, table games, maybe ping pong, etc, and at least one group therapy room. These community areas should be attractive and airy with windows with an interesting view if possible, so as to encourage patients to socialize in them rather than stay in their private sleeping rooms. There should be a couple of glassed in, interview offices, where staff could have private theraputic conversations while still being observed by other staff. You need a locked observable "quiet room" to manage short term outbursts of extream behavior. My ideal acute care unit would also have at least 2 intensive care suites for patients who cannot maintain minimal social behavior,(screamers, feces throwers etc), are assaultive toward other patients or are insensely self destructive. When in use, these are staffed one or two to one, with staff rotated out hourly.

thanks so much for you input. I appreciate you remarks. I am still trying to find if there were any studies done regarding beds per unit and how it effects the therapeutic milieu of the unit. I will bring some of your remarks to my next meeting. As it stands, there has been some recent changes to RECONSIDER this combining of the units by the administration. Instead will are going to try to make some changes to both units seperately.

TitaniaSidhe · Jun 20, 2005

Satchmo I can totally relate as I work in the VA system. Our unit has census of 26 with usually only 1 RN maybe if we are lucky a LPN & the # of NA's depends on the # of status patients. Mind you this is for the night shift as usually on days they have 2 RNs. This is for locked psych admissions. I can agree however that the safety is directly proportianal to the amount + training level of staff.

RickRN · Jun 20, 2005

I work in a state facility, Our patient census on my med-psych floor is 33 patients to 1 Rn, 2 LPN. Aid numbers depend on how many 1:1 status patients we have.

I work on a floor of the local state hospital with 43 mixed male and female acute psych patients. It is an unmanagable situation at times. I think 16 patients of the same sex is the optimal census for a unit.

MisPlacedTexan · Jun 22, 2005

Our intensive care unit has 20 beds, male and female mixed, with 2 RN's and 1 tech. Many times it's a dangerous, explosive environment. We have BEGGED management for 1 more tech. Naturally it fell on deaf ears. :angryfire