HospitalInspections.org

Based on interview and record review it was determined that the facility failed to ensure minimum staffing levels according to the facility staffing grids as evidenced by: 1) an insufficient number of Registered Nurses (RNs) in two (Cardiac Surgical Unit [CSU] and Medical Intensive Care Unit [MICU]) of three Intensive Care Units (ICUs) on 5 of 5 sampled days.

Findings included:
1. A review of the hospital's staffing grid revealed the following RN to patient staffing standards or ratios for the MICU and CSU:
13 Patients = 7 RNs (registered nurses) and 1 charge nurse without patients.
15 Patients = 8 RNs and 1 charge nurse without patient assignment.
16 patients = 8 RNs and 1 charge nurse without patient assignment.
17 patients = 9 RNs and 1 charge nurse without patient assignment.
18 patients = 9 RNs and 1 charge nurse without patient assignment.
19 patients = 10 RNs and 1 charge nurse without patient assignment.
20 patients = 10 RNs and 1 charge nurse without patient assignment.
21 patients = 10 RNs and 1 charge nurse without patient assignment.

2. A review of staffing assignment sheets on the 7:00 PM to 7:00 AM shift on the MICU and CSU, documentation related to the assignments, and review of the hospital staffing grid, which provides RN to patient staffing ratios revealed the following staffing shortages:
- A review of the MICU staffing assignment sheet on 08/01/2022 revealed 21 patients were on the unit at 7:00 PM. 7 nurses and 1 charge nurse were on the unit. This was a shortage of 3 nurses.
- A review of the CSU staffing assignment sheet on 08/01/2022 revealed 19 patients were on the unit at 7:00 PM. 8 nurses and 1 charge nurse were on the unit. This was a shortage of 2 nurses.
- A review of the MICU staffing assignment sheet on 08/06/2022 revealed 20 patients were on the unit at 7:00 PM. 8 nurses and 1 charge nurse were on the unit. This was a shortage of 2 nurses.
- A review of the CSU staffing assignment sheet on 08/06/2022 revealed 17 patients were on the unit at 7:00 PM. 8 nurses and no charge nurse were on the unit. This was a shortage of 1 nurse and 1 charge nurse.
- A review of the MICU staffing assignment sheet on 08/07/2022 revealed 16 patients were on the unit at 7:00 PM, 3 patients were admitted prior to 10:05PM, bringing the total to 19 patients. 6 nurses and 1 charge nurse were on the unit. This was a shortage of 4 nurses.
- A review of the CSU staffing assignment sheet on 08/07/2022 revealed 15 patients were on the unit at 7:00 PM. 7 nurses and 1 charge nurse were on the unit. This was a shortage of 1 nurse.
- A review of the MICU staffing assignment sheet on 08/12/2022 revealed 19 patients were on the unit at 7:00 PM. 7 nurses and 1 charge nurse were on the unit. This was a shortage of 3 nurses.
- A review of the CSU staffing assignment sheet on 08/12/2022 revealed 13 patients were on the unit at 7:00 PM. 6 nurses and 1 charge nurse were on the unit. This was a shortage of 1 nurse.
- A review of the MICU staffing assignment sheet on 08/13/2022 revealed 21 patients were on the unit at 7:00 PM. 7 nurses and 1 charge nurse were on the unit. This was a shortage of 3 nurses.
- A review of the CSU staffing assignment sheet on 08/13 /2022 revealed 15 patients were on the unit at 7:00 PM. 7 nurses and 1 charge nurse were on the unit. This was a shortage of 1 nurse.

3. On 8/15/22 at 1:00 PM an interview was conducted with the Director of ICU disclosed that they admit ED (Emergency Department) patients to the ICU when PCU (Progressive Care Unit-a unit in the hospital that accepts less critical patients) bed not available. The ratio in the ICU's is one nurse to two patients.

4. An interview was conducted with RN R at 1:13 PM on 8/15/22 revealed they care for up to three ICU patients, that is now the normal staffing. She also disclosed that she does not feel safe with the number of patients per nurse.

5. On 8/15/22 at 1:39 PM an interview was conducted with RN T. RN T said some days are challenging with three critical ICU patients, and four PCU patients in an ICU setting. It's daily now, that they have three to four.

6. On 8/16 22 at 7:21 PM an interview conducted with RN L who disclosed she usually has three to four patients in the ICU, she revealed notification were made to the manager asking for assistance with the reply they do not have another staff member to send to ICU.

7. Interview with Staff FF on 08/16/2022 at 1:10 PM revealed that chronic nursing shortages has resulted in dangerous levels for patient care. The nurses in ICU are assigned three critical patients at times four critically ill patients.

8. Interview with the Director of Quality on 08/15/2022 at 10:54 AM revealed the facility was aware of the critical staff shortages issues within the facility since January 2022. They developed a task force to maintain the one to two ratio in the unit. Nursing staffing deficits remain.