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Based on observation, interview, and record review, the hospital failed to ensure adequate staffing levels for the Emergency Department (ED) South for 19 of 19 sampled patients (Patient 1, Patient 2, Patient 3, Patient 4, Patient 5, Patient 6, Patient 7, Patient 8, Patient 9, Patient 10, Patient 11, Patient 12, Patient 13, Patient 14, Patient 15, Patient 16, Patient 17, Patient 18 and Patient 19). This failure resulted in state mandated staffing ratios not being met and had the potential for unmet care needs.

Findings:

During an interview on 2/18/25 at 1:50 p.m. with Regulatory Specialist (RS), RS stated the hospital does not have a nurse staffing policy and procedure but follows Title 22 (sets of regulations for health care facilities licensed by the state) for staffing and nurse ratios.

During an observation on 2/19/25 at 9:30 a.m. in ED South, multiple recliners in a bay on the east side of ED South were filled with patients, patients were seated in three recliners around the nurse's station, and three bays on the north side of the department had patients.

During an interview on 2/19/25 at 90:35 a.m. with Shift Lead Registered Nurse (SLRN) 1, SLRN 1 stated she is the only RN for twenty patients in beds, recliners, and rooms. SLRN 1 stated there is one Quick Look RN (assesses patients' acuity when entering the ED to determine how quickly the patient needs to be seen) but she is not assigned patients, and one triage RN who is not assigned patients but can help is she is not busy, and one licensed vocational nurse (LVN). SLRN 1 stated one RN came briefly from ED North but was called back to ED North. SLRN 1 stated her shift started at 7 a.m. and there were 13 patients in ED South at that time. SLRN 1 stated she thinks the nurse-to-patient ratio for the ED is 1:4 (one nurse for four patients).

During an interview on 2/19/25 at 9:50 a.m. with Emergency Department Director (EDD), EDD stated, "The census is the ED is fluid" but gave no response as to why the float nurse did not stay in ED south or what other measures were taken.

During a concurrent interview and record review on 2/19/25 at 10:12 a.m. with Emergency Department Nurse Manager (EDNM), EDNM stated nurses assigned as the Quick Look nurse are always at the entrance to the ED and the Quick Look nurse is not assigned patients. EDNM stated the ED Triage Nurse's main duty was to input medical histories of patients and can help with patient related tasks when not busy, but are not assigned patients. Print out of patients in ED South from 7 a.m. to 9:35 a.m. and corresponding "ED Activity Log" reviewed.

During an interview on 2/19/25 at 12:15 p.m. with Patient Care Executive (PCE), PCE stated it was her expectation that frontline staff be comfortable in reporting staffing concerns and for managers and directors to help with patient care as needed.

During a review of Title 22 Code of Regulation Division 5 §70217 Nursing Service Staff a. (8) "In a hospital providing basic emergency medical services or comprehensive emergency medical services, the licensed nurse-to-patient ratio in an emergency department shall be 1:4 or fewer at all times that patients are receiving treatment. There shall be no fewer than two licensed nurses physically present in the emergency department when a patient is present.
At least one of the licensed nurses shall be a registered nurse assigned to triage patients. The registered nurse assigned to triage patients shall be immediately available at all times to triage patients when they arrive in the emergency department. When there are no patients needing triage, the registered nurse may assist by performing other nursing tasks. The registered nurse assigned to triage patients shall not be counted in the licensed nurse-to-patient ratio."