Practicum Project Final Report

Improving the Staffing Structure at an Acute Inpatient Psychiatric Facility

Problem Statement: Individuals admitted for acute inpatient psychiatric care are among the sickest and most vulnerable of the mentally ill and often have one or more medical comorbidities that compound their needs (Delaney et al., 2020). Organizations that provide acute psychiatric inpatient care are tasked with creating and maintaining a safe, patient-centered, culturally supportive, trauma-informed, and recovery-focused environment. The nursing staffing structure within an acute inpatient setting plays a crucial role in fostering a culture of learning that supports and maintains safe, efficient, high-quality care (Normand, 2014; Moreno et al., 2022; Triplett et al., 2017). Conversely, staffing structures that are not based on the needs of the patient population and that have low RN ratios can decrease compliance with quality measures, including increased adverse events (Staggs, 2015; Thériault et al., 2019). Goals and Methods: This project was aimed at creating a staffing structure that provides optimal nursing leadership to support compliance with quality measures and foster a learning culture within a small acute inpatient psychiatric facility. A nurse manager and milieu manager role were added to the staffing structure and RN presence was increased on day and evening shift. Results: Early indicators demonstrate improved compliance with identified quality measures of nursing documentation and mandatory training rates. Implications and Recommendations: This information can prove valuable to other acute inpatient psychiatric facilities seeking to improve patient and staff outcomes. Continued tracking of quality measures is recommended to determine long term impact of this staffing structure model and to identify any confounding variables. Keywords: psychiatric nursing, staffing psychiatric units, psychiatric nursing quality

The presentation of the outcomes of the project to improve the nursing staffing structure at Pocasset Mental Health Center was very well-received. Participants were enthusiastic about the plan and impressed by the outcomes. The audience included the Department of Mental Health (DMH) Area Director, the Site Director, both leaders of the DMH Office of Inpatient Management (OIM) several Directors of Nursing, the Area Learning and Development Director, and the Area Nurse Educator, as well as site leadership and nursing staff, among others. A robust question and answer session followed the presentation.

The DMH Area Director was very interested in the use of the Milieu Manager and many shared this interest. Many of the attendees expressed that the Culture of Learning concept is well-aligned with the mission and vision of DMH. The participants from the Staff Development team offered support in creating the Milieu Manager training and agreed that the best time to roll out this new assignment would be at the same time as the new de-escalation model (MANDT) expected to begin in the next two months.

Danielle Sullivan, MSN, RN, Director of Nursing, Pocasset Mental Health Center