Staffing Problems, Any ideas??

epg_pei · Dec 20, 2007

Our unit has 17 adult beds, 3 adolescent beds, and 3 assessment beds for ER docs use (ie overnight admission pending a psych consult). We are a locked unit, but also serve voluntary pts. No separate facilities for certified pts, everyone is behind the locked door. We are supposed to serve acute needs, but also end up getting chronic pts and addictions pts for short stays.

To serve these clients we have a charge nurse M-F 0730 to 1530. We have 4 "slots" which are generally filled by 2-3 other RNs and 1-2 LPNs, (licensed practical nurses, not psych nurses) depends on who's available or scheduled that day. These are 12 hour shifts from 0730 to 1930. We have an RN or LPN in a 12 hour shift from 1000 to 2200. No attendants on the unit on day shift, which I would prefer to see changed. A different RN is assigned to pass meds qid. An RN is co-assigned with an LPN to be responsible for vitals. A nurse is assigned to accompany pts (up to 5) for ECT MWF. An RN or LPN is assigned a day pt, we have up to 3 per day.

So the day shapes up like this: I come on for my day 12. I have 6 (or more depending on how many pts we are over capacity) pts assigned, but at 1000, I "lose" 2 pts to the evening nurse. Everyone else does the same, so we are about 4-5 per nurse plus day pt if assigned. I may do meds for the morning. Another nurse will do lunch, and so on. Once docs are on the floor, I attend consults when requested or if I feel I want to "listen in." I discharge any of my pts if ordered. Once that bed is open, I admit if a pt is received for admission. Oh yeah, at 1530, a lucky winner randomly chosen by the previous night staff, assumes charge nurse duties. :balloons:

Basically, the load is spread equitably, or as evenly as we can. Bad juju to have some doing little and others doing much. Every pt has a registered or licensed nurse. We cannot have an unlicensed staff assigned as primary care. It sounds, if I am correct in assuming your aides are not licensed, that you are understaffed for your census.

aloevera · Dec 24, 2007

I work on an adult psyche/chemical dependancy (dual diagnosis)

unit. We have 1-2 LPN's that pass meds and take off orders, depending on census. If we have usually about 40 pts, then we have 2 RN's to handle the pts. We split the charting. We handle discharges, admissions (could be from 0 to 6 a 12 hour shift) The CNA's handle

15 min. checks (we are a locked unit) meals, vitals, etc. They will inform RN if vitals not WNL. RN's do treatment plans with Dr. and

therapist q morning. One RN will do this while other at desk tending to pts. It seems to work well. We are busy usually unless cencus is low.

Hope this helps with your question.

Chaoticdreams33, MSN, RN · Dec 31, 2007

We staff RN's, MHW's (with 4 yr degree) and MHA's (with CNA). Each RN is in charge of everything for 5-7 patients on my shift. That includes meds, 1:1 assessments, treatment plans, education, charting, getting new orders as needed, admissions, and discharges, etc. MHW's do most of the groups, checks, vitals, fingersticks, and meals but do not currently have a patient assignment. That may be changing soon to increase the individual responsibility for each patient. Charge nurse has a pt assignment similar to the other RN's but the other nurses will take first admissions. In addition the charge RN has to handle the RN schedule and assignments, screen new admits and work with the admission process, room assignments for patients, code beeper for hospital, coordinate breaks for 1:1's.