Hello everyone,

I am currently working on a "Quality Improvement Project" as a part of my senior leadership class. We have to find a problem or situation that can be improved, research about it, come up with an idea, and then present said idea to the floor/peers/professors. I am having a very difficult time doing this because I am on a very low census pediatrics unit (2-3 patients/day) that has only one nurse on the floor at a time. Finding something that was a "problem" or needed improving is nearly impossible. The one HUGE thing I can think of is dealing with HIPAA and patient safety. Here's the question:

Is there a standard/regulation/law out there that states the MINIMUM amount of professional nursing staff (RN, BSN, MSN, etc) required to be working on one floor at a time?

The main problem that I have seen is that the nurse's station is COMPLETELY left unattended if the nurse goes into a patient's room, and I know that HIPAA states that you need to have patient records, information, etc stored in an area where a staff member who does not need this info i.e. house keeper, maintenance cannot reach it without some form of resistance. Another problem is that me as a male could get into trouble with a female pediatric patient. For example, I am caring for 15 y/o Suzi without any form of supervision during a private procedure (Inserting a catheter). Suzi is then able to say I may have sexually abused her or done something inappropriate. Then it's my word against hers. Another situation that may happen is code situations. If there is only 1 RN on the floor and the nearest RN is down a long hallway, then double doors, then another pair of double doors, and a long hallway (You get the point) and a patient codes the nearest nurse will take a long time to reach the patient. These are all dangerous situations especially in a hospital, but I am finding it difficult to find research/information on this. HELP ME PLEASE!!!!

Wait. Your AN name says "nurse"? This sounds like a school question?

I liked the name, but I graduate in 51 days and will take my boards soon after that. So yes this is a school question regarding my senior leadership class and the project I have to do for it.

The issues you raise are good ones. For that reason we staff 2 nurses (or 1 nurse and 1 CNA) on peds at all times. I don't know the regs on this though.

I liked the name, but I graduate in 51 days and will take my boards soon after that. So yes this is a school question regarding my senior leadership class and the project I have to do for it.

I think the post questioning your username is alluding to the fact that this board's terms of service do not allow anyone to infer/allude to a licensed nurse title unless they have actually been licensed as such.

Not to mention that a nursing student should been educated as to the inappropriateness of that.

And put it under homework assistance/student/school type forums.

There are no stated staffing levels in the regulations. For example in an acute access hospital you can have a skeleton crew of 1 nurse in the hospital. And even on a well staffed unit there may be no nurses at the desk to keep people away from charts. However if someone is found looking through charts they can be escorted out of the building. The deal with being the only male nurse on a floor is no different then being the only female nurse on a floor. Female nurses must insert catheters in male patients and visa versa. Granted it does help to have another person in there to help cover your orifice. Both of those points are valid. As long as there is a way to alert a code team from inside the room that problem shouldn't be too big of in issue... Have a great day!

The question is why don't we ban together and set precedences on minimum pt/nurse ratios as well as taking into consideration the amount of care needed for each pt and could their health deteriorate quickly because in my state I have not found the pt /nurse ratio including other mitigating factors

The question is why don't we ban together and set precedences on minimum pt/nurse ratios as well as taking into consideration the amount of care needed for each pt and could their health deteriorate quickly because in my state I have not found the pt /nurse ratio including other mitigating factors

Good luck. One of the major hospitals in my state is working on this right now. The nurses are unionized and the currect contract finished last September. Since then, the nurses have been trying to negotiate a new contract and one of the stipulations is that they want minimum staffing ratios in the contract. The hospital is refusing to put in this language, stating that staffing ratios need to be flexible based on reimbursement and other changes in healthcare. The nurses and hospital management have been debating this for months now. There has already been one 3 day strike and another one will probably happen soon. (btw, the current staffing is usually 5-6 patient per nurse on days).

That's probably the biggest reason there are no mandated staffing ratios. The bottom line is more important than patient safety.

I also work on a small pediatric unit, we have 7 available beds. We can have 6 pts and still be staffed with 1 nurse! There should def be minimum staffing laws. I believe there should at least be 1 nurse and 1 cna on the floor even with 2 pts. Here is a problem for your paper. I had to call a Rapid response on a patient all i had was the pulse ox machine built in the wall to hook him up to. the RR team was mad that the crash cart wasn't there and set up when they got there. The first thing they teach you is to not leave your patient so I was supposed to leave the room run all the way down the hall to get the cart (BTW the pt was breathing and had a pulse he just wouldn't wake up)

I also work on a small pediatric unit, we have 7 available beds. We can have 6 pts and still be staffed with 1 nurse! There should def be minimum staffing laws. I believe there should at least be 1 nurse and 1 cna on the floor even with 2 pts. Here is a problem for your paper. I had to call a Rapid response on a patient all i had was the pulse ox machine built in the wall to hook him up to. the RR team was mad that the crash cart wasn't there and set up when they got there. The first thing they teach you is to not leave your patient so I was supposed to leave the room run all the way down the hall to get the cart (BTW the pt was breathing and had a pulse he just wouldn't wake up)

Perhaps informing the parents that their child is safer in a day care center with mandatory staffing ratios, (with the punishment closing down the day care if staffing falls below the required levels), than in a pediatric unit of a hospital. Sad, isn't it?

When my kids were little, and using day care, I chatted with the owners on several occasions. I learned alot about how day cares are staffed, and the punishments if they don't meet requirements 100% of the time.

The owner would sub for a teacher if they were had a call-in, so they would always be adequately staffed! Imagine that?

JMHO AND MY NY $0.02.

Lindarn, RN, BSN, CCRN

Someplace in the PACNW