HospitalInspections.org

Based on record review and interview the facility failed to provide supervisory and staff personnel for each nursing unit to ensure, when needed, the immediate availability of a registered nurse for bedside care of any patient for 2 of 4 hospital nursing units.

The findings include:

Review of Staffing for Intensive Care Unit dated 10/20/2019 for the 7:00PM - 7:00AM shift documented 1-House Supervisor, 1-Charge Nurse and 4-Staff Registered Nurses.

Review of Census for Intensive Care Unit dated 10/20/2019 for the 7:00PM - 7:00AM shift documented a census of 11 at the beginning of the shift.

Review of Final Nursing Station Census Report as of 10/20/2019 for the Intensive Care Unit documented 11 occupied beds.

Review of Assignment Sheet for Intensive Care Unit dated 10/20/2019 for 7:00PM - 7:00AM documented 1-Charge Nurse with 3 patients, 1-Staff Registered Nurse with 2 patients, 2-Staff Registered Nurses with 3 patients each and no Certified Nursing Assistant.

Review of Master Staffing Plan Nursing Services/Assignment of Nursing Care Policy Number 2-11-1-004 last revised 11/17 documented for the Intensive Care Unit Area the staff mix of 91% Registered Nurse and 9% Monitor Technician/Unit Secretary. Patient nurse ratio is maintained 2:1 or 3:1 with the exception of patient acuity requiring 1:1 nursing. For a census of 11, 6-Registered Nurses, 1-Monitor Tech/Unit Secretary (scheduled 3:00PM - 11:00PM) and no Nursing Assistant.

Review of Assignment Sheet for 2nd Floor Telemetry Unit dated 10/20/2019 for 7:00PM - 7:00AM documented 1-Charge Nurse (whom worked from 11:13PM - 7:19AM), 1-Unit Secretary, 1-Monitor Technician, 1-Staff Registered Nurse with 6 patients, 1-Staff Registered Nurse with 7 patients, 5-Staff Registered Nurses with 8 patients each and 4-Certified Nursing Assistants.

Review of Census for 2nd Floor Telemetry Unit dated 10/20/2019 for the 7:00PM - 7:00AM shift documented a census of 54 at the beginning of the shift.

Interview with Staff C on 11/20/2019 at 1:45 PM revealed that the monitor tech watches the monitor and also functions as unit secretary for simple tasks. Stated the monitor tech is scheduled until 11:00PM and the charge nurse takes over the duty to watch the monitor. Stated the patients are connected to individual monitors assigned to the intensive care unit bed and there are monitors placed at all 4 corners of the intensive care unit so that the nurses have access to see the rhythms while at the bedside and also at the nursing station.


Interview with the Chief Nursing Officer on 11/20/2019 at 12:13 PM revealed that staffing is reviewed with coordinators daily prior to the start of each shift. Stated the staffing for the evening shift is finalized by 5PM and the decision whether the charge nurse will take patients and if there will be no admissions is made for the 2nd and 4th floors based on staffing. Stated the house supervisor will be available for any additional nursing or patient care needs when made aware that the charge nurse will take patients.

Interview with Assistant Chief Nursing Officer on 11/21/2019 at 11:36 AM revealed that the 2nd Floor Telemetry Unit, 3rd Floor Surgical Stepdown and the 4th Floor Medical Surgical/Telemetry Unit may mix nursing staffing with the 4:1 ratio to maintain patient safety.

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