Safe staffing levels

TerpGal02, ASN · Mar 16, 2013

I work at a free standing psych hospital with 46 beds, that's divided up between adults and C&A. We have 4 nurses on days and evenings, 3 on night. Around 3ish techs on Adults, 2 with the adolescents and 2 with the children. That's manageable for us.

Midwest4me · Mar 16, 2013

Our psych hospital has about 650 pts. Each ward has about 25 pts. Staffing: 1-2 RNs, 1 LPN, 3-5 techs. This is NOT enough staff as we provide activities(like on-grounds walks, yard, gym, fitness, some off-grounds passes)--especially when a patient becomes physically abusive.

TedDucharme · Mar 16, 2013

That is crazy. I would talk to your union. The latter is more responsible 1:4 but I have never seen this ratio. Ted Ducharme RMHC London ON Canada

WannaBeNrse · Mar 16, 2013

Wow.... those ratios are scary. We have a 1:4 ratio, and one psych aide (small unit). I could not imagine being the only RN for 16 psychotic and/or suicidal patients.

Nurse_ · Mar 16, 2013

That's crazy... even for a crazy house!

I worked in an Acute Psych facility before I became a nurse. The 35 patient unit is staffed for day shift as follows:

2 RNs

1 LVN/LPT (Med. Nurse)

8 Mental Health Worker/Mental Health Aide

Meriwhen, ASN, BSN, MSN, RN · Mar 16, 2013

In CA, I have ratios on my side, so it can never be greater than 1 nurse:6 patients for inpatient.

However, having also worked outside of CA...I'd say that a ratio of 1:8 max is safe. Of course, this has to take into account the acuity of the patients. On a high acuity unit such as stepdown or ICU, or for detoxing patients (or other psych populations) who are medically unstable, more staff is needed. Sometimes even 1:6 isn't enough.

WantAccel.BSN, BSN, RN · Mar 18, 2013

What do you consider to be safe staffing levels for an inpatient psych facility? We have 1 nurse for 16 patients and then two techs (our techs help with meals smoke breaks and personal care). Sometimes this is overwhelming should anyone require extra attention...either sudden acute medical or mental episode. I believe it's just too much responsibility for one nurse but that is the "matrix sent from corporate". The state I;m in requires and "average monthly" of one staff for four patients except on nights.[/quote']
That sounds really overwhelming! I work on the psych floor of my local hospital and we have 5-8 patients a piece per night, plus one dedicated med nurse (so we don't have to give meds to those 5-8 patients!)I work nights, so I feel 8 patients is manageable, but some nights it can feel like too much depending on the acuity of the patients. I wish more states had ratio laws so places couldn't just arbitrarily decide what they think might be safe...

alb402 · Mar 18, 2013

I work on a 16 bed child/adolescent (ages 4-18) unit and we ALWAYS have 2 nurses no matter what the census. Where they short us is not giving us adequate support staff (ours are Behavioral Health Specialists and all have a bachelors degree in mental health). The most we can have is 3 and thats when we're at a full census. We run groups and as many know children require much more time/attention and a higher liability than adults. What's frustrating for us is our grid is the same as our adult floors and its definitely the bare minimum for all of the responsibilities we have in a shift. Does anyone else work C&A and have more staff than their adult floors?

Meriwhen, ASN, BSN, MSN, RN · Mar 19, 2013

Does anyone else work C&A and have more staff than their adult floors?

I didn't work C&A routinely, but when I've been floated there, I've always had a minimum of 3 techs regardless of census: one to round on the children, another on the adolescents (we kept the two populations as separate as possible...as far as one could housing them on one unit anyway), and a third one to tend to the unit as a whole. If we had an abundance of children or adolescents, we'd get an extra tech so two techs could be assigned to that population.

Nursing, on the other hand...usually 2 nurses. Not always. If the census was below 16, they'd tend to shortchange us in the nursing department.

This isn't in CA, BTW.

mare4322 · Mar 20, 2013

I am also concerned about the staffing ratio. I am the charge nurse 3 days a week 12 hr shifts of a 26 bed psych unit We are allowed me, a med nurse, and 2 MHTs for a census over 19. When the census drops to 19 they send 1 of the MHTs to another unit or home. On the unit there is Adult Psych, Chemical Dependency, and a Womans Program. We are supposed to keep the men on one end of the unit and the women on the other end. There are 2 nurses stations and a long hall seperating them. One MHT is to stay on the Womens end and the other stays on the mens end. I am housed on the mens end along with the med nurse. We very seldom have a male MHT. Yesterday we discharged 6, admitted 4 new patients and had one transfer from another unit. This all took place from 3p-7p for me and 2 more pts. were admitted after I left. Administration learns who is to be discharged and begins pushing us to get the pts out so they can fill the bed. The admitting office or Care Center as they are called will send patients to us back to back. It gets so overwhelming, yesterday I refused to accept an admission at the time they wanted to send the pt. I was swamped I had just gotten 2 new patients. I was still working on discharges, answering phones, taking off orders, tending to doctors, not to mention pt needs and issues.

OUESTION: I've been told by the care center that I can't refuse to take a patient, that whenever they call I am to take report and take the patient. I know I can (since we have 26 beds) refuse to take any patients over 26. And to clarify I am not saying that I won't take the pt. at all, I am just saying "I'm swamped, I can't handle another pt right now. "Give me 20-30 minutes to take care of the patients you just sent me."

Please advise.

alb402 · Mar 20, 2013

I didn't work C&A routinely, but when I've been floated there, I've always had a minimum of 3 techs regardless of census: one to round on the children, another on the adolescents (we kept the two populations as separate as possible...as far as one could housing them on one unit anyway), and a third one to tend to the unit as a whole. If we had an abundance of children or adolescents, we'd get an extra tech so two techs could be assigned to that population.
Nursing, on the other hand...usually 2 nurses. Not always. If the census was below 16, they'd tend to shortchange us in the nursing department.
This isn't in CA, BTW.

What state are you in?

I guess I should be grateful as it sounds many other places are staffed a lot worse than we are. But working with kids (and their families) I want to provide the best care possible and not have to worry about liability issues (e.g. Teens having sex on the unit, fights, etc.). It seems whenever something happens it comes back on us, but we're doing the best we can with what we've got. Constantly having to tell kids we can't help them at that moment because there's a million other things going on isn't acceptable to me. I am grateful that we always have 2 nurses though. Between admissions, discharges, medication, orders, and talking with doctors and families, doing that alone would drive anyone crazy themselves.