Staffing Ratios

[Tigerlily8]

Hi everyone,

I am relatively new to psychiatric nursing and for decades worked in critical care areas with a 1:2 nurse:patient ratio. I am now employed at a for-profit acute care psychiatric facility with a 1:15 nurse:patient ratio. The PICU does have a 1:12 ratio. Is this common in behavioral health? We are now opening a unit that accepts medically fragile geriatric unit. Right now the ratio is 1 RN : 15 Patients. My opinion is that we are dangerously understaffed. We have no CNA's, lifts and only a few hospital beds. What is the norm elsewhere?

[Davey Do]

I, too, work 12 hour weekend option MN in a geriatric psych unit with a for-profit facility. Wrongway Regional Medical Center (WRMC) psych division's staffing ratios have changed several times over the 16+ years I've been employed and is currently in the process of again making changes.

Due to numerous patient incidents and WRMC getting its wrists slapped by surveying and benefitting agencies, staffing ratios have improved over the years. I really only know the MN staffing ratios, but it does sound like your facility is dangerously understaffed, Tigerlily.

WRMC is in the process of assuring two RNs on each unit plus LPNs and techs. For example, the last shift I worked with a census of 15 patients, three being 1:1s, there were two RNs, two LPNs, a nurse extern, and two techs.

Currently, if there are 14 or less patients on geriatric psych with no 1:1s, MN staffing calls for one RN and another staff member, being an RN, LPN, nurse extern, or tech.

Day staffing, of course, calls for more.

[verene, MSN]

I float to 3 sub-acute units. Ratios are 1:14-16 depending on unit and census. When we have sub-acute patients with out significant medical commodities this is fine, with higher acuity - either medical or psychiatric - it can get very challenging at unsafe at time. If it is really bad we can get agency CNAs to help out, but usually everything vaguely medical falls on the RNs. We don't have hospital beds, lifts, or abilities to provide comprehensive medical care. We try to screen incoming referrals to prevent unsafe situations, but sometimes they still slip though, fortunately our providers have fairly low tolerance for sending out for medical acuity.

[umbdude, MSN, APRN]

1:12 for psych ICU is pretty unsafe, but unfortunately it's not uncommon. You only need 1 aggressive/violent patient to throw the entire unit into chaos. It's worth googling around to see if the facility has been on the news for patient deaths. My advice is to avoid places like that and ask whether there's a security team on site.

For-profit hospitals will throw nurses under the bus in an instant, so be sure you max out your personal malpractice insurance.

Good luck!

[DCubed]

2 hours ago, umbdude said:

1:12 for psych ICU is pretty unsafe, but unfortunately it's not uncommon. You only need 1 aggressive/violent patient to throw the entire unit into chaos. It's worth googling around to see if the facility has been on the news for patient deaths. My advice is to avoid places like that and ask whether there's a security team on site.

For-profit hospitals will throw nurses under the bus in an instant, so be sure you max out your personal malpractice insurance.

Good luck!

Reading posts like this freak me out and make me not want to be a nurse. Really scary stuff.

[umbdude, MSN, APRN]

13 hours ago, DCubed said:

Reading posts like this freak me out and make me not want to be a nurse. Really scary stuff.

There are decent places to work. It's just a matter of being selective and mindful about where you choose to work.

[SuburbsGirl]

The private psych facilities are terrible. All for profit. None of them care. The 4 I know are:

Strategic Behavioral Health

US Healthvest

Universal Health Services

Neuropsychiatric Hospitals

They are all terrible.

[lilRN16, ASN, BSN, RN]

I work for a private, not for profit crisis stabilization unit and our ratio is 1:4, state ratios are 1:6.

Is anyone in California like me?

[DAL2010]

My facility is a free-standing Psych hospital that is part of a large not-for-profit hospital family in Texas:

Mood Disorder Unit: RN 1:8, BHT 1:16

Detox Unit: RN 1:8, BHT 1:8

General Psych: RN 1:7, BHT 1:12

Psych ICU: RN 1:6, BHT 1:8 (more BHTs added when pt's highly acute)

Plus, we staff 2 Float BHTs each shift: 1 to help out Mood/Detox units and 1 to help out Gen Psych/PICU units.

[meeep, BSN, RN]

I work for a private, not for profit hospital on a locked, acute psych unit and our ratios are almost always 1:3. Sometimes we are 1:4 if we are short but have never gone higher than that. Mood disorders, geri/med psych, and our adolescent psych inpatient units have the same ratios. I just can't imagine how you would be able to safely care for 10-15 patients per 1 nurse ?

[Heylove, BSN, RN, EMT-B]

On 9/28/2019 at 4:12 PM, meeep said:

I work for a private, not for profit hospital on a locked, acute psych unit and our ratios are almost always 1:3. Sometimes we are 1:4 if we are short but have never gone higher than that. Mood disorders, geri/med psych, and our adolescent psych inpatient units have the same ratios. I just can't imagine how you would be able to safely care for 10-15 patients per 1 nurse ?

Oh my goodness! Sign me up!

I'm not bad mouthing my employer or our staffing, but your ratios are dreamy!

[meeep, BSN, RN]

We definitely know how spoiled we are. We are hiring! They provide relocation assistance as well.