Safe staffing levels

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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.

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.

We're allowed to ask our admissions department for 15 minutes to get things settled and finish up whatever we need to quickly. If we're swamped we usually let them know the situation and tell them they can bring the admission to the floor but to let them know they may have to wait a little until someone can do the admission. This doesn't happen frequently. It also helps that admissions staff also help out on the floors sometimes so they know how crazy it can get.

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Specializes in Med/Surg, Behavioral Health.

We have a 16 bed unit, and if we are "full" (12-16 patients) we can have the following staff:

Days: 3 nurses, two techs, 1 secretary, + ancillary staff (case managers, OT, SW)

Eves: 3 nurses, two techs, 1 secretary

Nights: 2 nurses, two techs

That is ideal staffing of course. Due to many, many, many reasons ... we often find ourselves with two nurses and one tech. :no:

As for admissions, the emergency room is always pushing too (sometimes pushing to go OVER census if we have scheduled discharges the next day). We have a policy that there has to be AT LEAST 45 minutes between admissions. And NO change of shift admissions - since techs and RNs are in report during that time, usually nobody is around to see the patient. Which is not a good thing!

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Census on adult/gero unit "full" is 18-22 and if we have 16 or less patients only get 1 tech with myself. Sometimes its a busy week with high acuity patients and census over 18+ and supposed to get 2 techs but it doesn't always happen. Mgmt. doesn't lose any sleep over me running around like chicken little like the sky is falling they don't seem too bothered if there are high acuity patients, falls, agitated patients, 1:1 monitoring orders, gero's confused, fragile, admissions with just me and 1 cna...well maybe they do care but they don't show it or show appreciation to their employees.

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I've decided to take another position due to staffing levels. I'm excited and sad all at the same time. Psych nursing is my love...but I can't put safety by the wayside. I've taken a position at a health department, so I'm excited as this is something totally new!

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Congrats! My advice to you was going to be if it feels unsafe, get out of there! I think it is hard to compare across the board state to state and hospital to hospital however your gut knows when something isn't right and it's your license. Good luck with your new opportunity:)

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Thank you macfar28! I have learned to trust my gut while working in psych. And it was telling me that something bad could very well happen. I hope that nothing happens to the staff or patients, but I feel it's only a matter of time. I just want everyone to be safe and for the patients to feel safe. The patients would make comments all the time about the low staffing.

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We're 1:8 with RN's & 1:6 with B.H. Specialists.

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Specializes in Psychiatric, Addiction, Geri-psych.

Working night shift, we are constantly understaffed. 1 unit has up to 20 patients with 1 nurse, 1 med nurse, and 2 techs. The med nurse leaves early though. That leaves me 20 patients to complete paper charting on including detox patients that need Q4 assessments, tons of needy patients that need prns, not to mention having to complete 2 sets of q15 rounds and at least 1 set of environmental rounds. Plus no med nurse for 6am meds so I have to do those and the morning accu-checks. That on top of physician orders, new admits and 24 hour chart audits, not to mention codes called and sending patients out to the er (when necessary)..some nights are better than others! But no...I don't always feel its safe.

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Geez. After reading this thread I realize how unsafe my unit is. Ive had up to 38 patients on my child & adol unit.. with me as the only nurse. I am the only nurse at all times. No med nurse to assist. 2 techs only unless we get a 1:1.

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Can anyone provide any national or regional staffing "benchmarks" for psychiatric units?

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Heart of Glass, get out of there. That is some scary staffing. I work 3rd shift at the state hospital. The staffing level here is better than a lot of the levels mentioned in other posts. Still, we have very acute patients that wouldn't be kept for long in private facilities. We have a very large forensics population as well as civic pts, geriatrics and adolescents. I happen to work in a dual dx unit; substance abuse/MI. We have 20 pts with 1 RN & 1 LPT on at night. We frequently get pulled to other units to cover. Some of the other units are really understaffed in my opinion. You worked hard for that license. Don't lose it to admin's bottom line. If something goes bad on your shift, they won't hesitate to hang you out to dry. Their main goal is to look good and make the big bucks; this is diametrically opposed to what our goal as RNs is. Be careful and be safe.

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