Safety/Staffing Question

[Morena77]

I'm fairly new to this site and not sure if this is in the right place, but didn't know where else to post. I am a RN currently working on a substance abuse unit of a for-profit hospital. My co-workers and I are being asked to "flex" hours (not work an entire shift and use vacation time to make up for hours lost) when our census is low. I have been a nurse manager at other places so I understand budgets and the need to make a profit. Lately though there are times when we are being asked to work the unit by ourselves (one nurse, no CNA, pt care tech, nobody else). We ALL feel that this is a HUGE safety risk. Our patients are sometimes still under the influence of drugs/alcohol, and a lot of times have underlying psych issues (bipolar, schizophrenia, etc.). We are NOT a psych/lockdown unit. Several of us have gone to our direct supervisor as well as administration but no one else sees this as a possible threat to our safety, they are just looking at budget/numbers. We are in a fairly isolated area of our hospital and the only patient care area on our entire floor. We don't carry 2-way radios or other communication devices on our persons, except maybe our own personal cell phones. Does anyone else work on a unit where they are sometimes the ONLY staff on the unit with patients? Does anyone know who else we could talk to regarding this? Or is this completely normal at other facilities/detox units?

[Meriwhen, ASN, BSN, MSN, RN]

An unfortunate misconception about a CD/detox unit, especially one located in a psych hospital, is that because most of our patients are not actively psychotic, they must be a lower acuity and so all that staff just isn't needed.

What the powers that be fail to realize that when it comes to detox, our patients have a higher medical acuity than the average psychiatric patient. Sure, we're not as likely to have a code for violence, but we'll be the ones with the patients seizing or crashing and we need to call the Code Blues.

If you are in California, your ratio should be 6:1 or thereabouts come hell or high water.

Otherwise, I would say a safe ratio would be 2 staff (1 RN, 1 RN/LVN/tech) for every 8 patients. Even then that would also depend on who you have detoxing off of what. 8 patients who are having mild detoxes are far easier to manage than only 4 patients but all with very bad detoxes.

But you said the key phrase: FOR PROFIT. Hospitals that are for-profit are going to get by with as little staffing as they can so they can maximize their returns. They only care about adequate staffing when regulatory agencies come around to visit. I also used to work for such a facility, and I don't plan to work for another one again if I can ever help it.

[Whispera, MSN, RN]

During one of my first jobs as a psych nurse, I worked a combination psych/CD unit. I was often the only staff person present for up to 12 patients. Most of the time my safety wasn't at risk. It was very difficult to get things done, since I was the only person there to do everything.

While my safety wasn't at risk, the safety of the patients could more easily be at risk. I couldn't be everywhere to see everything all the time. What if someone started seizing and no one told me or I didn't see it due to being busy with something else. What if someone tried to kill himself? How would I get help even if I found the person in time?

This is such a safety risk for your patients if not for yourself. I hope you can get people-in-charge to listen.

[TriciaJ, RN]

They will push the envelope. I think it's extremely unsafe to have just 1 person for any number of patients. Has your hospital had a JCAHO visit lately? Who else are they beholden to? Do you have a union? Time to figure out what cages to rattle. Meanwhile, ask your supervisor if there's an updated protocol for a 1 person code, seizure, violent incident, etc. When your coworkers get together for useless complaining, see if you can get them to help you brainstorm and figure out who all to call.

Another thing, keep your liability premiums paid up. Inevitably something bad will happen and your hospital will find ways to point fingers at the poor nurse who just happened to be on duty. When you've done all you can think of, and they still don't take anyone's safety seriously, time to bail. Good luck.