Fix Untenable Staffing Ratios at Huntsman Mental Health Institute

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Why are we petitioning for better staffing levels at Huntsman Mental Health Institute?


The University of Utah’s PROMISE Standards require that staff “speak up and report safety concerns with a focus on improvement, not blaming.” [1] Accordingly, we, a super majority of nursing staff, are petitioning the administration of Huntsman Mental Health Institute to address inadequate staffing ratios for the following reasons:

Assistance with ADL Care

The alarming inadequacy of our staffing levels is severely compromising our ability to provide even the most basic patient care, let alone the comprehensive, compassionate care that our patients deserve and the organization expects. These staffing ratios also lead to insufficient ADL care for our patients. Essential tasks such as feeding, bathing, and toileting are either delayed or neglected, which not only undermines the dignity of our patients but also poses serious health risks, both to patients and staff. Research shows that having more experienced, veteran nursing staff on the floor is associated with improved ADL completion and fewer patient falls. [2] The inability to meet patient needs is not due to negligence or laziness on the part of the staff but is a direct consequence of having too few hands to manage too many needs. [3]

Patient Safety

Patient safety is another critical area that is being jeopardized by our unsafe staffing ratios. With insufficient staff to monitor patients adequately, the risk of accidents, self-harm, or harm to others increases exponentially. On some units, staff assigned to safety checks have been additionally assigned to take vitals or lead groups, a direct violation of  HMHI’s policy on visual safety checks. [4] We cannot maintain constant vigilance over all patients, which is a fundamental requirement in a mental health setting. This oversight could lead to catastrophic consequences that are entirely preventable with proper staffing. A study in The Lancet found that improvements of even one patient per nurse in the ratio relates to inproved outcomes in patient mortality, readmissions, and total length of stay. [5] If we truly want to provide the best possible care to our patients, improving the ratio of staff to patients is absolutely essential. 

Staff Burnout and Staff’s Physical and Mental Wellbeing

The relentless pace and overwhelming workload are detrimental to staff’s mental and physical wellbeing. The lack of sufficient breaks, including basic necessities such as bathroom and lunch breaks, exacerbate this issue. Our schedules are packed with back-to-back assignments, leaving no room for respite or recovery. Many techs are not able to take their legally required 15 and 30 minute breaks and are often admonished by managers for eating in patient care areas while trying to maintain adequate unit supervision. This relentless cycle of work without adequate rest periods is not only detrimental to our physical and mental health but also diminishes our capacity to provide quality care. [6] Staff are regularly injured by patients at HMHI. The number of staff sent to the Emergency Department, unable to work due to injury, or who have left HMHI after being injured is too high. Our staff provides vital care to some of the most vulnerable populations in our region, and deserves to be protected and supported as we do this dangerous, lifesaving work. 

Lack of Rapport and Continuity of Care

Building rapport with patients is a cornerstone of effective mental health care. [7] Unfortunately, the current staffing situation makes it nearly impossible to establish and maintain meaningful connections with our patients. The constant rotation of staff and the high workload prevent us from spending the necessary time to understand and address each patient’s unique needs. This lack of continuity and personal connection hampers our therapeutic efforts and undermines patient trust and engagement. [8]

Managerial Responsibility and Advocacy

It is deeply concerning that these issues persist under your management. The failure to advocate for safe staffing ratios not only compromises patient care but also reflects a lack of support for your team. Your role as an administrator includes ensuring that the working conditions are safe and conducive to high-quality care. Allowing these unsafe staffing ratios to continue indicates a disregard for both patient welfare and staff well-being.

Immediate action is required to address these issues to prevent further deterioration of patient care and staff morale. We urge you to improve your advocacy for our staff and patients.

Sincerely,

The Nursing Staff of Huntsman Mental Health Institute

  1.  Promise Standards | University of Utah Health. (2023, January 17). https://healthcare.utah.edu/documents/promise-standards

  2.  Tonkikh, O., Zisberg, A., & Shadmi, E. (2021). The role of nurse staffing in the performance of function-preserving processes during acute hospitalization: A cross-sectional study. International Journal of Nursing Studies, 121, 103999. https://doi.org/10.1016/j.ijnurstu.2021.103999

  3.  Wilson, M., Riedy, S. M., Himmel, M., English, A., Burton, J., Albritton, S., Johnson, K., Morgan, P., & Van Dongen, H. P. A. (2018). Sleep quality, sleepiness and the influence of workplace breaks: A cross-sectional survey of health-care workers in two US hospitals. Chronobiology International, 35(6), 849–852. https://doi.org/10.1080/07420528.2018.1466791

  4. Policy Record. (n.d.). Retrieved September 24, 2024, from https://pulse.utah.edu/policies/Lists/Policies/DispForm.aspx?id=1384

  5.  McHugh, M. D., Aiken, L. H., Sloane, D. M., Windsor, C., Douglas, C., & Yates, P. (2021). Effects of nurse-to-patient ratio legislation on nurse staffing and patient mortality, readmissions, and length of stay: A prospective study in a panel of hospitals. The Lancet, 397(10288), 1905–1913. https://doi.org/10.1016/S0140-6736(21)00768-6

  6.  O’Connor, K., Neff, D. M., & Pitman, S. (2018). Burnout in mental health professionals: A systematic review and meta-analysis of prevalence and determinants. European Psychiatry, 53, 74–99. https://doi.org/10.1016/j.eurpsy.2018.06.003

  7.  Joe, G. W., Simpson, D. D., Dansereau, D. F., & Rowan-Szal, G. A. (2001). Relationships Between Counseling Rapport and Drug Abuse Treatment Outcomes. Psychiatric Services, 52(9), 1223–1229. https://doi.org/10.1176/appi.ps.52.9.1223

  8.  Puntis, S., Rugkåsa, J., Forrest, A., Mitchell, A., & Burns, T. (2015). Associations Between Continuity of Care and Patient Outcomes in Mental Health Care: A Systematic Review. Psychiatric Services, 66(4), 354–363. https://doi.org/10.1176/appi.ps.201400178