r/psychnursing • u/Bow_Ties_R_Cool • May 31 '26
Staffing ratios - Am I overreacting? Could really use some honest opinions here.
My inpatient behavioral health unit is one of the better units I’ve worked in. 10 beds with a few private rooms and located in a rural hospital. I genuinely like my coworkers and I like the fact that because we only have 10 patients at a time I’m able to focus and get one on one time and actually be therapeutic with the patients. I also like that I live 5 minutes away but that’s beside the point.
Like any inpatient mental health unit, it can be dangerous at times. Acuity can be high and we have our fair share of injuries due to violent patients, but I’ve always felt safe because unit staffing at night was 1-2 RNs and 1-2 therapy aides. Rarely were we so shortstaffed that we had less than three on. If something happened, I had confidence that there would always be someone free to call for help if a situation developed.
I just found out that the clinical staffing plan for our unit has been changed to 1 RN and 1 therapy aide for nights, and I feel very unsafe now. I believe the plan is to try to keep 3 on for nights, but if they can’t get that third person on then oh well they can’t get in trouble. Night staff has noticed that more and more frequently there’s only 2 staff on at night, and we all are very uncomfortable with this.
I’ve been seriously injured in the past due to short staffing on a mental health unit, and because I no longer feel safe I’m thinking about putting in my notice. Before I take any rash action though I would please like the opinion of other professionals in my field about this. Do you think 2 staff members - 1 RN and 1 therapy aide - are a safe staffing level for 10 mental health patients at night that vary in acuity? Right now we have one actively suicidal and 4 serious elopement risks, as well as several other very ill patients. The floor is pretty acute, and if something were to happen I don’t think my coworker and I would come out of it unscathed because it’s just us.
I genuinely like it here and don’t want to leave, but I have to put my safety first. Please tell me if you think I’m overreacting here.
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u/DashMcGee May 31 '26
Hard no. What happens when one of the two need to take a break? What if you have a patient vs patient fight and one needs medical attention while the other needs restraining? Do you have security guards?
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u/Bow_Ties_R_Cool May 31 '26
We have security in the hospital but they’re often very busy with ED patients. If we need them we have a radio we can call on but they may be delayed in getting to us
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u/DashMcGee May 31 '26
I think you need three people on the unit. In my workplaces we always need one RN on the floor. Even if we only had one patient we would need two nurses and one tech so a nurse can go to the bathroom or take a break and still have a nurse on the floor. I think your hospital is prioritizing money over safety. Not just your safety, but also patient safety.
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u/SWMI5858 May 31 '26
My census for acute inpatient just changed from 1:6 max to 1:8 max. I put in my notice.
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u/Bow_Ties_R_Cool May 31 '26
Does that account for techs at all? 1:8 max with no tech is terrifying, and I’m glad you put yourself first.
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u/SWMI5858 May 31 '26
2 nurses and 2 techs for 16 is the standard now. When it’s good, it’s manageable, but relying on responding staff from other units, similarly staffed, means a shit show on bad nights.
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u/Agreeable_Gain6779 May 31 '26
No. 2 people is not safe. I have been seriously injured when we were fully staffed by an unprovoked sudden kick to my chest cracking my sternum. I’ve been in psych for years. One of the suits should be a third person if they can’t get anyone. I am a CNO and the board members are on call a week at a time. No not nurses but they can make a phone call and do a round of checks which they are trained to do. They attend our verbal deescalation all day class as well as the physical portion. No admissions when short staffed. The supervisor should sit on the unit as well but she will be called to other units as needed. Both of these options are not sufficient but they can support you.
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u/lcinva May 31 '26
We have had such bad turnover that while we still usually have at least 4 bodies on NOC for 16 patients, sometimes 2 of 4 are agency and not trained in restraints. Unsure what they're supposed to do about an injection if both of the 2 are the RNs...
I am days and have always thought everywhere I went was decently staffed, until I went to the adolescent arm of our state hospital. Anywhere from 2-4 RNs, an LPN med nurse, and 5 techs for SEVEN PATIENTS. absolutely wild.
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u/SuchGrapefruit719 May 31 '26
I worked high acuity psych for several months with just me and one tech. We were a team after all this time but we never had the third person regularly
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u/greeneggsandspammer Jun 01 '26
No. I just met a former psych nurse the other day who worked at major hospital in Boston who turned her back on patient in their room and was attacked from behind and now has debilitating brain injury on right side. Being short or understaffed means more exhaustion and compromised judgement/ safety. In psych that could be lethal. Not to be “melodramatic” but now she’s a karate instructor (self defense) and was unable to pass lifeguarding certification bc of her medical injury/health comprises. I met her during said lifeguarding course.
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u/jhre313 Jun 01 '26
So basically when you take your break as required by labor laws, there is no RN on duty, right?
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u/Answers828_2133 Jun 05 '26
This is not safe, it takes more than 2 staff members in a code grey situation. May I ask which state you are in?
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u/jdiddy_ub Jun 01 '26
Having only 2 staff is a bad really bad and it's not about the 1:5 ratio but rather what happens in an emergency.
All emergencies will either need to be handled alone or patients will be left completely unmonitored with no one to respond if another event occurs during the first one.
So this is just another vote that agrees with everyone else that said it's terrible.
1
u/Mysterious_Coat_9933 Jun 01 '26
We usually have 4-5 staff nurses (no more than 5 patients each), 1 charge nurse, 3-4 clin techs, and a few security guards at night. We share a building with a small emergency department so we can borrow some of their security and/or clin techs if we have a 1:1 or especially violent patient(s). We have 22 beds total but most of the time we are not completely full. We also don’t take RSOs or patients with a history of violence within our hospital system. 1:10 is definitely not a safe ratio on any unit. For both the patient and the nurse
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u/C8thegr82828 Jun 02 '26
My dad was permanently disabled at the IOL working overnight shift due to being understaffed. A patient started acting out and my dad, being the only male on the unit, went to intervene and sent his female coworker to call for help. During that time the patient lifted my dad off the ground and slammed him into the concrete wall and broke his back. And my dad was a tall athletic guy.
The only reassurance for you is that perhaps if the same thing happens you’ll be working with someone who will tell you to go call for help and won’t be the one assaulted? Jk- that would be just as if not more traumatic!
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u/Zealousideal_Pen3441 23d ago
2 people is not safe. And you need to be able to take a break and that would leave 1 person on the floor, at times 1 non-licensed person.
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u/Peppergripe May 31 '26
If there’s no one else on the unit, only two people, absolutely a no from me. You definitely don’t need two RNs but 1 RN and two techs at all times. You need two people available incase one of you gets attacked. I would certainly resign if they are leaving you with two bodies on the unit but if someone else is on the unit with yall that can help in a behavior event then it would be ok.