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THREE CROSSES REGIONAL HOSPITAL LLC 2560 SAMARITAN DRIVE LAS CRUCES, NM 88001 July 16, 2021
VIOLATION: PATIENT CARE ASSIGMENTS Tag No: A0397
Based on observation and interviews, the facility failed to ensure appropriate assignment of nursing personnel to provide intermittent care (care/supervision provided in the event that the primary nurse must depart from the patient care area). This failed practice is likely to lead to inappropriate care assignments and an increased risk of adverse events.

The findings are:
A. On 07/08/2021 at 1:15 pm, observation of facility's inpatient care area revealed only 2 nurses on duty as primary bedside nurses, S (staff) 20 (Registered Nurse, ICU) and 21 (Registered Nurse, Medical-Surgical).

B. On 07/08/2021 at 1:30 pm, interview with S17 (Registered Nurse, Emergency Department) confirmed that they do float (work in a different unit) to the ICU. S17 indicated that the staffing breakdown on the inpatient floor is 1 medical-surgical nurse and 1 ICU nurse due to the low census of patients. "At most, there will be 3 medical patients and 1 intensive care patient." When asked about how the ICU nurse is able to step off the floor, if needed, S17 stated "The medical surgical nurse would have to watch the ICU patient. That's not safe at all cause I would want to have another ICU nurse watch my patient if I want to eat or have to leave the floor." In regard to taking on ICU tasks and training, S17 indicated "during my orientation they [facility] didn't go over much ICU equipment and I wouldn't feel that comfortable going up there [ICU]."

C. On 07/08/2021 at 1:45 pm, interview with S20 (Registered Nurse, ICU) revealed that the process for if they need to step off the floor is to have the medical-surgical nurse watch their critical care assignment. When asked about safety concerns, S20 replied "I don't feel it's safe to have a medical nurse watch my patient. We have a critical care director but they've never watched my patients."

D. On 07/08/2021 at 2:00 pm, interview with S21 (Registered Nurse, Medical-Surgical) revealed that they assist ICU nurses, but must remain in their scope of practice (limitations imposed on one's nursing practice). S21 reported that if they had to watch an ICU patient they would refuse stating "I cannot watch an ICU patient, that would be an inappropriate task." and indicated that the director of critical care would have to watch the patient, if needed.

E. On 07/08/2021 at 2:15 pm, interview with S22 (Director of Medical-Surgical Services) revealed that on night shift, the staffing is 1 medical surgical nurse and 1 ICU nurse. When the ICU nurse must step off the patient care area, S22 reported that the accepted process is to have the medical surgical nurse be accompanied by an Emergency Department paramedic. S22 highlighted that there have been no reported concerns regarding ICU patients being watched by medical surgical nurses and that medical surgical nurses never assume full responsibility for the ICU patient.

F. On 07/08/2021 at 2:30 pm, interview with S15 (Director of Critical Care Services) reported that expected interruptions (lunch breaks and bathroom breaks) depend on staffing between the ICU and Emergency Department. If an ICU nurse needs to step off the floor, an Emergency Department nurse will come to the floor to relieve them. "There's 2 nurses in the emergency room , so one can go up and let the ICU nurse have a lunch." S15 confirmed that should the Emergency Department nurse depart to cover the ICU nurse, there would be only 1 nurse in the Emergency Department.