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Discussion

Ratios in acute psych

This is my first post so sorry if this is a dead horse topic. I'm a house supervisor in an acute psych facility. Our staffing ratios have recently been reduced, harshly imo. Staff injuries are up, but so is pt acuity. As there are no staff ratio laws where I live I am looking for some perspective. We generally run 1 run and 1mht at 15 pts. Anything over 15 we get a second Mht. A 3rd Mht is only allowed at 28 pts. I have had administrators begin to try to cut staff about 8 hours into my shifts recently - even if our census justifies the staff- and I'm very concerned about patient and staff safety. As a supervisori do my best to advocate for my team and feel I am fighting a loosing battle. Any opinions would be greatly appreciated.

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    • Featured Replies

    If patient acuity is up, and your staff down, it is something I would discuss with your manager. Is this a matter of needing more techs and some 1:1 sitters? Could you ask for a larger pool of per diems? Could you have some per diem crisis intervention nurses? I would have to think you would need to be very specific on what you need, and ask for same. If there is one nurse per 15 patients, could you have 2 CNA's per 15 patients and a sitter?

    The key here is the injury factor. If more nurses are getting injured due to work, then there needs to be more staff involved in the care of the patients. Which means each team of nurse/CNA's needs to stay together for the higher acuity patients.

    If you are a union hospital, I would employ the union's assistance in this as well.

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    • Experts

    Acute psych nurse/patient ratios are 1:6 per state law in California, but this is irrelevant since you've mentioned you are in a state with no legally mandated ratios.

    When I worked psych in Texas many years ago, day shift was staffed at 1:8, evenings were staffed at 1:12 and nights were staffed at 1:15.

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    • Experts

    The acute units I have experience with have varied somewhat but generally speaking with adults it has been around 1:7 RN and 2 techs per 15 patients. Unfortunately in psych now, as in most other areas, they are attempting to do more with less. It is sad because we are losing excellent staff who won't work in unsafe conditions and patient care is suffering.

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    • Experts

    When I worked outside of California, I've had nursing ratios as high as 1:16--I'd the the only RN and would have one, maybe two techs to help me out. Usually it would be 1:8-1:12.

    If you are working for a for-profit organization, they are going to try to get away with staffing as leanly as possible in order to maximize their profits. If this is the case, you may want to consider looking for another position as it's not likely things will improve unless Joint, Medicare or another accrediting body comes down on them.

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    Our facility is 1:8 RN and 1:6 Behavioral Health Specialists

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    Over all ratio is 1:4-1:5. Usually get 2 nurses 2 mts at 14, below 14 it's a crap shoot.... Could be 1rn/2 mts. 2 rn/1 my, 2 RNs or 1rn/ 1 mt. Nights it is a 1:8 1rn/ 1 mt till 16, over 16 gets 3 staff, usually 1 RN and 2 mts

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    On my unit if we are full house at 30 beds, it's 1:10. 1:9 if you are the nurse with the first admission assignment

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    I work acute mental health and we are 1:8, more if admit is a bounceback (return within 30 days of discharge).

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    California would be so nice with 1:6!

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    When you asked for acute ratios for psych, I assumed you meant acute psych. I have worked in an "acute" psych unit for acutely psychotic Pts who can complete their own ADLs. In this setting, which was non medical, our ratio is 2 nurses:16 Pts.

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    I work in an acute psychiatric facility. Our ratios are on adult 5:1, adolescent 4:1 and children 3:1. Those ratios include all staff on the floor. They do ours hospital wide so they count the number of adults, adolescent and children and base staffing on the big picture. Childrens unit is the only area where I see staffing true to ratios.

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    At my facility (which is state run) the techs can only have at most six plus we have one rn and one or two Lpn ( depending more on availability then census) and some times we still feel understaffed. I can't imagine what your guys are going thru.

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