Nurse to patient ratio on an inpatient psychiatry unit

By Timberly Klinestiver posted 01-14-2020 12:01 PM

  
​Hello,
I am a clinical nurse manager of an 30 bed inpatient psychiatry unit. I am curious to see what other units nurse to patient ratio's.
Thank you
Timberly MSN,RN-BC
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18 days ago

I work at a psychiatric facility that has aseveral units.A pediatric unit,an adult unit,and 2 acute units. The staffing is always short. My unit has combined to Max 42 patients with 3 nurses, continuous discharges and admissions. When it is staffed appropriately, there are 5  PTC's. One to stay in the day room, 2 to do 15 minute checks, one to stay with the close observation rooms, and one for admissions. In reality we are lucky to have 4,and usually 3.The acute units have one nurse and 3  PCT's. When there is an episode that needs several people to secure a patient,there is an mediate response from staff.I love that about our nurses and PCT's.But we have had several PCT's leave due to low pay and high stress. In my opinion it can be an unsafe ratio when it is often understaffed. I have been at a facility that had a suicide, and I believe 15 minute checks are the most important aspect of care. In reality it is not, and the direct care givers try to juggle everything and keep patients safe. I love my job, my co -workers, and working with the patients. Right now nurses are working others units as well as patient care technition. I am curious if this is the normal staffing and ratio in other facilities.

22 days ago

​Thanks for your response David. I am curious about who takes the client to appointments since you have just 1 CNA in the unit. Secondly if any of your client becomes agitated/aggressive and has to be on 1:1 monitoring, how do you handle that? 

While inpatient, outpatient appointments are canceled (like clinic appointments) and re-scheduled for after discharge.  If a patient has an off-unit procedure like an x-ray, our staff transport them based on their acuity.  If a low-acuity (calm, cooperative) patient has ECT, for example, our CNA will drop them off on that hospital unit and then our nurse will pick them up after - either way, the transporting staff member is only gone for maybe 10 minutes.  For a higher acuity patient, our staff will stay with them throughout and security will also likely be present throughout (like if someone needs an x-ray after punching a wall).  This takes longer and is more strain, but also doesn't happen often.

For episodes of acute aggression, we use seclusion/restraint chair/chemical restraint depending on the situation (if all attempts at de-escalation fail).  Generally we pull help from other parts of our behavioral health building - so a nurse might flex over briefly from the adult open unit to help on the adult secure unit until the crisis situation is managed.  Only if it seems a patient is going to be an ongoing violence risk will we overstaff the unit while we work on sending them to a higher level of care, which can take an aggravating amount of time sometimes.  Our hospital has a float pool to cover staffing shortages, and they commonly cover 1:1s.  Actually, ideally, a float pool person who is oriented to us will work the floor and our staff will cover the 1:1 since we specialize in this patient population.

It's more common to have a patient be a 1:1 for being a falls risk or for being intrusive with peers and unresponsive to redirection (like, say, a hypersexual manic person or an attention-seeking borderline IQ group home type).

01-24-2020 01:51 AM

Thanks for your response David. I am curious about who takes the client to appointments since you have just 1 CNA in the unit. Secondly if any of your client becomes agitated/aggressive and has to be on 1:1 monitoring, how do you handle that?

01-22-2020 05:02 AM

I work on a 30 bed unit also.

Our adolescent unit has 8 beds and when full is staffed with 2 RNs.  We also have a CNA from 7a-11p.

Our adult open unit has 14 beds and when full is staffed with 3 RNs from 7a-11p, 2 RNs from 11p-7a, and 1 CNA 24/7.

Our adult secure unit is 8 beds and is staffed with 2 RNs and 1 CNA 24/7.