HospitalInspections.org

Based on observation, interview and record review, the facility failed to ensure a sufficient number of registered nurses (RN's), patient care technicians (PCT's) and unit secretaries (US's) from 12/25/2024-01/08/2025 on the Progressive care unit (PCU) to provide patient care.

This deficient practice had the likelihood to cause harm to all patients on the PCU unit.

Findings include:

During an observation on 01/08/2025 after 10:48 a.m., a unit secretary was not observed at the nurse's station. Staff nurses were observed answering the call light at the nurses station in between taking care of their patients. Observation of the staffing board behind the nurses' station revealed there was a patient census of 14. There was documentation that there were 5 nurses, 1 tech, 0-unit secretary and 1 sitter. The sitter listed was the unit secretary.

During confidential interview the following was stated about staffing;

The unit secretary for the day shift was the "sitter for a 1:1 patient."

When asked about titration audits it was stated "So short staffed the haven't been doing that. Were short especially on the night shift."

"On nights there are two nurses out on FMLA "and the agreement "expired for contracted staff." To try to control the census on the unit they "block rooms, hold patients in ER or transfer to ICU."

"Last two nights we have been short."

Staffing is the "biggest struggle, they look at numbers and not the acuity."

Examples of the high acuity patients on the unit were "heavier care, assist with feeding, can't turn themselves, total care patients, cardiac drips, heparin drips or if they have a pressor" medication.


Review of staffing "Progressive Care Unit STAFFING GUIDELINES" for fiscal year 2024 allowed for a 12-hour charge nurse on both shifts regardless of the census.

Review of the current staffing "Progressive Care Unit STAFFING GUIDELINES", for fiscal year 2025 revealed there was no allowance a charge nurse on the 12-hour day shift until the patient census reached 25. Review of the form revealed a director listed for 5.7 hours during the 12-hour day shift instead.

During an interview on 01/08/2025 after 2:48 p.m., Staff #9 (House supervisor) said some of the director's duties was to help on the floor, take patients, staffing and payroll. Staff #5 (Chief nursing officer) said that each unit would have a director now. Staff #5 (Chief nursing officer) confirmed the charge nurses for the days shift on the PCU unit had been removed from the staffing guideline.

Review of staffing "Progressive Care Unit STAFFING GUIDELINES", untitled daily staffing unit forms, and the house supervisor reports revealed the following:

01/07/2025-On the 7 pm-7am shift there was a census of 14 patients. The staffing guideline allowed for 5 Registered nurses (RN), but the unit was staffed with 4 RNs.

01/06/2025- On the 7 am-7 pm shift there was a census of 18 patients. The staffing guideline allowed for a unit secretary for 12 hours. Staff #10 (Registered nurse) said the unit secretary works Monday-Friday for 8 hours a day. No explanation was provided for the other 4 hours coverage for a unit secretary.

On the 7 pm-7am shift there was a census of 16 patients. The staffing guideline allowed for 5 Registered nurses (RN), but the unit was staffed with 4 RN's.

01/04/2025- On the 7 pm-7am shift there was a census of 18 patients. The staffing guideline allowed for 6 Registered nurses (RN), but the unit was staffed with 5 RN's.

01/03/2025- On the 7 pm-7am shift there was a census of 14 patients. The staffing guideline allowed for 5 Registered nurses (RN), but the unit was staffed with 4 RN's.

01/01/2025- On the 7 am-7 pm shift there was a census of 20 patients. The staffing guideline allowed for 5 Registered nurses (RN), 1 patient care technician (PCT) and 1 unit secretary. The facility had 6 RN's and 1 unit secretary. There was not a PCT on duty.

12/31/2024- On the 7 pm-7am shift there was a census of 20 patients. The staffing guideline allowed for 6 Registered nurses (RN) and 2 patient care technicians (PCT), there was only 6 RN's on duty.

12/29/2024 On the 7 am-7 pm shift there was a census of 18 patients. The staffing guideline allowed for 5 Registered nurses (RN) and 1 unit secretary. The facility had 5 RN's and 1 PCT on duty. There was no unit secretary on duty.

12/28/2024 On the 7 am-7 pm shift there was a census of 18 patients. The staffing guideline allowed for 5 Registered nurses (RN), 1 patient care technician (PCT) and 1 unit secretary. The facility had 5 RN's and 1 PCT. There was no unit secretary on duty.

On the 7 pm-7am shift there was a census of 18 patients. The staffing guideline allowed for 6 Registered nurses (RN). There were 5 RN's and 1 patient care technicians (PCT) on duty.

12/27/2024- On the 7 pm-7am shift there was a census of 19 patients. The staffing guideline allowed for 6 Registered nurses (RN), but there was only 5 RN's on duty.

During an interview on 01/09/2025 after 12:30 p.m., Staff #10 (Registered nurse) and Staff #1 (Director of Patient Care) confirmed the staffing forms, census and numbers of staff.



Review of the facility's policy and procedure titled "Nurse Staffing Plan-Nursing Services (TX Markets)" dated February 2024 revealed the following:

"..DEFINITION(S)
Nurse Staffing Plan- written plan used as a guide for effective staffing including the number, competency, and skill mix of staff in relation to the provision of needed care and treatment. The nurse staffing plan includes staffing grids that include minimum staffing levels for individual units, and a method to adjust staffing and a contingency plan when patient care needs unexpectedly exceed staff resources that are applicable hospital-wide.."

"..POLICY
A. The Texas Market will provide patient care through appropriate use of qualified and skilled personnel and therefore will adopt, implement, and enforce nurse staffing grids that are based on the needs of each patient care unit, each shift, and on evidence related to patient care needs ..."