Staffing on Inpatient Unit

[swimrn1]

I work as an RN on an 30-bed inpatient psychiatric unit. We are in the process of changing from functional nursing to team nursing. We have a charge nurse and 3 team nurses (who care for 10 patients each). Team nurse responsibilities include assessment, medications, admissions, discharges, making rounds with the doctors, signing out orders for our patients (we still do paper charting, and it can be extremely difficult to make sure all of the orders are signed out before someone takes the chart out of the nurse's station), showering patients with poor hygiene, restraint paperwork (if the occasion arises), etc. When our unit is full, we have 4 mental health counselors to monitor the hallways, redirect patients, do rounds, etc. All of our patients can be described as medium or high acuity.

Each step in this transition has required some adjustment, which so far has been manageable. However, this week marked the beginning of the team nurses being totally responsible for every nursing aspect of the patients' care. Our team leader (who is usually charge) refuses to help us with any task-even if she is not busy. We are able to manage quite well when anyone besides the team leader is charge; we have good teamwork, and we help each other out whenever possible. But we all feel very overwhelmed by the expectation of knowing and doing everything for 10 acute patients. We don't feel that it is an appropriate load to manage safely/to the expectations of our manager.

The only thing I have to compare to was on the medical units in nursing school, where the nurse to patient ratio was usually 1:5. Obviously, psych is going to be different-on my unit our patients are pretty much medically stable.

For anyone else working on a psych unit that uses team nursing- what is your nurse to patient ratio? Any advice on how to manage this patient load? Any research articles about staffing on psych units would be a plus :) Thank you!

[chevyv, BSN, RN]

Can't help much. I have 22 pts on my unit and am the only RN. We don't get many discharges or admits though. Pretty steady for me.

[kiwipsychnurse]

You will love this. Day shift 8 nurses 15 patients. Afternoons 5 to 15 and nights 3 to 15. I think these are the best ratios in the world. Forensic psych hospital, Auckland, New Zealand.

[IdrilRN, BSN, RN]

My unit is 14 beds, on rare occasion we take a 15th.

On days and eve's the nurses can have up to five patients each, there are three nurses, 2 and a charge, who also takes patients. They also have one mental health tech, who also is an LNA, if we have above 10 patients. They do the checks, vital signs, manage the meals, help with groups as needed. At night we can have up to seven patients. There are two nurses and a tech if we are above 10. But no matter how many patients we always have two nurses. I once had two patients.

We are a short term crisis stabelization unit. The usual stay is 1-2 weeks. Some times we have people for longer, up to three months but that is usually a placement issue.

So anyway, if I am busy or my fellow nurse is busy, we help each other out. If someone wants a medication and I am busy then my partner will give them something. The only time this does not happen if our patient has serious med seeking or other malupulative/staff splitting behaviors then the can only go to their nurse for meds etc.

When I was at the state hospital there was the charge RN, the tx nurse and the med nurse and a slew of psych techs. Who were fantastic, a lot had degrees in psychology. Pretty much all of them had gone to the psych tech school the hospital sponsered. The people would come to the window for their medications. If I was on break then the charge nurse would be in charge of the medications and give them. The average amount of patients were 25-30.

[Meriwhen, ASN, BSN, MSN, RN]

You will love this. Day shift 8 nurses 15 patients. Afternoons 5 to 15 and nights 3 to 15. I think these are the best ratios in the world. Forensic psych hospital, Auckland, New Zealand.

That settles it, I'm emigrating to NZ!

Our nurse-patient ratio goes from 1:8 to 1:12. Unfortunately, it's often closer to 1:12 than 1:8. There's at least 2 techs. If it's all regular unit staff we do team nursing pretty well and help each other out. The problems arise when we have floating staff who don't want to be on the unit and/or don't want to do anything more than they have to.

[marshmallowstar, BSN, RN]

The psych center I use to work at had staff ratios (nurse plus mental health techs) not nurse ratios

Children's 1:4 22 bed unit 1 RN sometimes an RN and LPN

Adol 1:7 24 beds 2 RNs

Mood disorder adult 1:7 25 beds 1 RN sometimes 2 RNs

Psychotic adult 1:4 15 beds 1 RN

We also had a 20 bed adol rtf on grounds they were 1:8 with 1 sometimes 2 LPNs

Since I've left the RTF has closed and they converted the beds to more adult beds.

I'm starting at a corrections psych unit in a couple of weeks they are 15 beds 1 RN, 1 LPN and 3 MHTs

[Yosemite, RN, ASN, EMT-I]

I've worked 2 psych units, one private for-profit and one county. Examples: night shift, 18 clients, me (R.N.) and ONE non-licenced staff to do admissions, medication passes, redirecting clients, inventory of admissions' belongings, Q 15 minute saftey checks, chart audits, potential pre-admission assessments, house supervisor, unannounced fire alarm inspections, seclusion and restraints (got help from other untis for this). When the unlicensed staff took lunch, I was alone.

Day shift: Myself, usually a L.V.N. or L.P.T., 2 non-licensed staff. Up to 8 admissions (the record), up to 6 discharges, charting on at least half of the clients (14), "taking off" orders, serving legal paperwork and advising clients of their rights, answering phones (never ENDING, seeminly), covering breaks for the other staff, trying to hide the fact I had no time to take breaks OR lunch 99% of the time (and not get caught by aministration), trying to not ask for help of administration (who insists I ask for help when I need it, but never has the time to help or only has the ability to socialize with staff while doing so, tying up even MORE rescources!).

Rinse, repeat until injuries from clients make it too difficult to continue working in that environment then TRY to get another nursing job.

[Whispera, MSN, RN]

I worked as the only (I repeat, only) staff member, on an evening shift, on a psych unit with up to 12 patients. It was not a good situation at all...

[ccoombs]

I work on the acute male admission unit at a state hospital, and on a typical day we have a census in the teens, but I have seen it creep into the twenties, and have one RN, one LPN, and 4 or 5 Techs, depending on the census and levels of observation. Also some days we will have an additional LPN to handle order processing, coverage during breaks, etc for our unit and the adjoining unit. Usually the unit feels well staffed, but some days you could use an entire army.

[kimish]

I have extensive Psychiatric Nursing Experience: the first at State Hospital, 1 RN, 1 Med Nurse (usually LPN), and 5 techs to 40 patients. When the hospital starting shutting down, I was asked to be RN on 2 Units....then the whole building (the rest of staff remained stable). When they asked me to do the building across the road, I had to give notice. I went to Travel Psych RN, and worked Adult Acute in County Hospital - we had 27 patients on Unit. There were 4 RN sometimes 2 techs. We did total care with our 6-8 patients. Private Psych Facilty - 30 patients and 4 RN and we had 1 Tech. Did total care - 7-9 pts. County Facility - Free Standing Hospital, about 40 patients. 5 RN and 2 techs, we did total care. In every case, our charge nurse took patients. We all did admissions/discharges and Meds. Most important: I would never take a job I was the only staff member. Never. You must have support immediately if there is a problem. Someone to yell help to. Someone to make a emergency call. Never be alone. Not even to cover for breaks. Insist on back up. For your safety, for your patients safety.

[MollNick]

I have been on unit dayshift, 1RN (me), 1 LVN (meds), and 1 tech for 21 patients in adult intensive care unit.

[vikkirn]

ughhhh