Staffing ratios

[MOnurse33]

The facility I work in takes 18-64 year olds and we have a max limit of 22 patients. When I first began working here there on day shift there were 3 nurses and 2 CNAs, nights was 3 nurses and 1 CNA (one nurse would drop down and help with 15 minute rounds after meds). We have been short staffed for 2 months and administration is now saying we will drop to 2:22 ratio for nursing. There will be 2 CNAs.
Some days our acuity is high and 2:16 is extreme. Most staff at our facility is already talking about leaving because of the lack of nursing staff that is going to be available. With violent codes and high acuity we all feel like it is unsafe for staff and other patients. 
 

So my questions are:

What are your staging ratios? What program or what’s in place for patients that are being violent? Does your facility use restraints? 

[MicheA]

At my hospital, we have a bunch of psych units. On my unit we have 20 beds, there are 3 RNs 4CNAs on days, 3RNs 3CNAs on eves and 1RN 2CNAs on overnights. If we have a patient in restraints(which is an automatic 1:1) or on 1:1s for safety we staff up and add another CNA. If someone goes on 1:1s for whatever reason during a shift, we are usually stuck and cover that from the compliment. We have a security team, and an on call psych doc, to help with restraints, but on my unit they are pretty rare (except when they aren't). We more often do 1:1s, and mostly to stop self injury rather than violence.  Other units have different staffing ratios and different acuity, but for the most part it is pretty safe, even with high ratios. 

[mom35]

1 to 20 to 40 pts with an lvn to pass meds, an between 4 to 6 pnas.

[jonnysangel777, LPN, LVN]

the facility I just left is an acute 16 bed facility. they are always short staffed. day shift 1 licensed psych tech (lpt) or 1 lvn and 1 CNA and that was OK on day shift. that happens every weekend. lots of call offs and overtime by only a couple staff who would stay or come in because most staff refused to work weekends so every weekend they are short. Sometimes you would get lucky and 2 licensed staff and 2 cnas. then on eve shift same thing, and noc shift it was 2-3 licensed staff and 1-2 CNA. the don would never ever cover and said they did their time on the floor so they would rather be short staffed then cover. so there have been times where noc had 1 licensed staff and 1 CNA. pt acuity doesn't matter, 1:1's, you would still have 1 licenses and 1 CNA and they would take turns doing the 15 min rounds and doing 1:1 and the license would also have to pass meds and chart and deal with any other issues that come up. it was sooooooooooooooooooooo unsafe. staff weren't even properly trained, the person who did the training wasn't even licensed to do the training and took short cuts with the training so no one new how to descalate and staff put hands on illegally and put patients in seclusion illegally. it is a mess. rounds aren't done, they are faked. It's an accident/lawsuit waiting to happen. no over sight by don or administration whatsoever and short staffing on top of untrained staff has led to not only staff injuries but also patient injuries. don't forget the extremely high turnover rate of all staff.

[JenRN119]

I was never given a staffing ratio, but was surprised when I started that there is often one nurse per unit. The most patients I've had was 24 or 25, these are adolescents. I really liked this job when I started, but I'm finding it very overwhelming now. Is this normal for psychiatric nursing? I would like to stay in this specialty, but I don't want to work with ratios like this.