HospitalInspections.org

Based on observation, record review and interview, the hospital failed to ensure it had an adequate number of RNs to provide nursing care to all patients. The hospital failed to have supervisory staff for each nursing unit to ensure the immediate availability of an RN as evidenced by the absence of a designated RN in the Adolescent Psychiatric Unit.
Findings:

Review of the hospital's policy NSG-06, revised 09/01/22, titled Staffing Plan revealed, in part, the following Procedure:
...A registered nurse is physically present and immediately available at all times when a patient is present on the unit. As used in this policy, "immediately available" requires the registered nurse to be physically present in the patient common area, nursing station, lounge area adjacent to the nursing station, or in other areas in which the overhead paging system is audible.
...The facility will be staffed with a minimum of 2 nursing staff, one of which is a RN with one additional direct patient care staff (LPN/LVN, MHT, CNA), to maintain a therapeutic milieu and a safe environment.

Review of the hospital's staffing grid revealed the following staffing plan for the Adolescent Unit with 14 licensed beds: RN - 24 hours.
On 10/01/2024 at 1:30p.m., review of the grid and interview with S1Administrator and S2Clinical Director confirmed that an RN should be present in the unit 24 hours per day, one on each shift.

On 09/30/2024 at 11:15 a.m., a tour of the Adolescent Unit and interview with S3LPN confirmed the current census of 12 patients. She stated the staff included 2 LPNs and 4 MHTs. She confirmed there was no RN assigned to the unit. She further confirmed that 1 patient was on a one-to-one level of observation, 2 patients on line of sight level of observation, and the remaining 9 patients were on an every 15 minutes level of observation.

On 10/01/24 at 2:40 p.m., an interview with S4DON confirmed that he had scheduled an RN for the Adolescent Unit on the 09/30/2024 day shift, but that RN had called in for her shift. He confirmed that he did not replace the RN with another RN, but staffed with a second LPN instead. He further confirmed there were other available RNs available in the hospital that could have been assigned to the unit for that shift until they could find a replacement. Instead, he stated the plan was for an RN charge nurse who was assigned to another unit to leave her unit in order to come to the Adolescent Unit for any tasks or duties required to be performed by an RN.