Nurse-Patient Ratio Adult Unit

[pennie4n6]

What is the average ratio for nurses? I just started on an adult acute behavioral health unit. When I was hired I was told 1/6. That seemed safe. Now it is changed to 1/8. We have a lot of acute psychotic patients. I just got hit or the first time this week. Several staff have had serious injuries recently. Now I am reconsidering if I made the right decision. I really like this new job nut I want to be safe and keep my patients safe.

[vintagemother, BSN, CNA, LVN, RN]

At my prior employer, we worked 2:16. I nurse And 1 charge to 16 pts. I loved it. I was accustomed to 1:45/54 so 16 was a piece of cake.

I typically passed meds to all 16 by myself.

[LPC2RN]

I don't see a 1:7 option. That's what I have.

[A&Ox6, MSN, RN]

On our 15 bed unit, we have two nurses (charge is always RN). Census above 6, we have a tech, and above 12, we get two techs between 0700 and 2300. Sometimes we don't get any techs.

[nickfitz1969]

Hi Vintagemother,

I would suggest that the ratio's that you worked to were unsafe. It is extremely difficult, even as an experienced mental health nurse, to ensure that you are aware of the patient's mental health status at all times during a shift, and know where they are at all times when you might be involved in other clinical interventions. Mental health care is an extremely challenging environment and to suggest that it is a "piece of cake" is at best, an over-exaggeration and doesn't truly reflect the true interpersonal therapeutic relationship building required to truly assess an individuals risk or mental health status at any given time. As a mental-health trained RN with more than 15-years experience, I never under-estimate the complexities of this high-risk environment.

[TCASII, ADN]

At my facility I typically have 11 to 14 patients. It's way too much. I never have time to talk to patients or have any clue what's going on with them. I barely get enough to chart an assessment. The shift change is always a disorganized mess. Nothing is finished from shift to shift. The paperwork takes hours and there is so much that you can spend a whole night fixing charts, auditing, and putting labels on papers. We're always out of meds and supplies. Horrible. :-(

I was told 1/8 upon hire. The original team was told 1/6. It's been 1/14 more than I can count. We often only have 2 techs on the floor with 35 or more patients. Very sketchy.

[nickfitz1969]

TCASll, It sounds that your clinical environment is unsafe and is not conducive to enhancing recovery. It amazes me that the mental health system is set up to function in this manner in some countries. Mental health is normally underfunded and does not promote specialist care and actually meet the needs of the patient. Many wards are like cheap motels where the minimum is provided and medication is the principle form of treatment, and as we all know creates many more problems than it serves to resolve.

[vintagemother, BSN, CNA, LVN, RN]

Nickfiyz: I did not mean to say that mental health nursing is easy. Rather, what I meant is that, in my area, mental health facilities are not tasked with "medically acute" pts.

As an LVN I was accustomed to high ratios, in SNFs as well as LTCs.

I had learned, the hard way, to make it work with high ratios.

What I meant is that 1:16 was indeed a lower ratio than I was accustomed to working, both in LTC Memory care, as well as in a long term mental health facility.

I believe I applied critical thinking and time management in order to do my job well.

In an ideal world, we'd all have lower ratios.

However, in my area, at least, high ratios are the norm for LTC, SNF and psych.

I agree that mental health nursing is not easy, by any means. Yes, I agree that the provision of quality care involved an understanding of the complexities of pt care and tx.

I'm curious as to the type of facilities you've worked in that had lower ratios.

[nickfitz1969]

As an IEN I don't know some of the terms to which you refer.

What is LVN, SNF, LTC?

I've worked in a variety of clinical settings including:

Community addictions, acute adult, acute forensic and rehab, asylum seeker (detention centres in Australia), acute child and youth, private acute adult, GP liaison and education.

I am currently working in New Zealand in a small team that supports patients to return to primary care. I also have a very small online education business. I also been accepted onto a PhD program at Washington State in June this year.

The ratio's that I have experienced have usually been between 1:2 on an acute child and youth unit and up to 1:8 in private facilities.

[Meriwhen, ASN, BSN, MSN, RN]

Where I work, it's 1:6 come hell or high water, as it's state law.

That doesn't always mean that 1:6 is a safe ratio, because a lot of it depends on the acuity of the patients assigned. Having 6 patients isn't the safest ratio if 3 of them are very acutely psychotic.

[Meriwhen, ASN, BSN, MSN, RN]

At my prior employer, we worked 2:16. I nurse And 1 charge to 16 pts. I loved it. I was accustomed to 1:45/54 so 16 was a piece of cake.

I typically passed meds to all 16 by myself.

I felt the same way because before I came to California, I was used to being the only RN for up to 16 patients. On my first day working in CA, the charge nurse apologized for having to give me 4 patients, and it was all I could do to keep from cracking up :)

[chevyv, BSN, RN]

I work in acute and have anywhere from 5-9 pts. I'm fine with 6 or 7, but after that it gets way heavy. All it takes is one incident and I'm not getting out on time.

I'm sorry you were assaulted. It's tough when you love your job and now have to reconsider. Take care of you!