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!
