Staffing issues and Regulations?? HELP!!!

bahamabread · Jun 10, 2006

So what you need help with?

RNforLongTime · Jun 10, 2006

I need to know whether or not staffing an ICU with ONE nurse with a pt on a vent is legal in PA? And also where do I find this information?

Home Health Columnist / Guide · Jun 10, 2006

There are no staffing regs in PA that i am aware of. If you have a nursing supervisor on in eve/nights, that is the person to call when patient going downhill.

Ted is often alone in NY with 2 patients in ICU. Very common is smaller places unfortunately.

I was night RN on telemetry--me and 12 patients (most were walky/talky in 1980's), only got aide if vented pt on unit, so feel your pain and license concern.

State Board of health is place to check regs--will look for you.

Know NJ has regs 1-2 pt's/RN, 2 RN must be in unit.

dorimar, BSN, RN · Jun 10, 2006

Beg to differ. You have a right to refuse that assignment weather the state of Pennsylvainia has staffing guidelines or not. That is extremely unsafe. When your patient is flipping out all of a sudden and trying to climb out of bed & injures you, who is there to protect the patient? When he goes into vfib, hmm?? guess you have to delay defibrillation for the operator to answer you call for the code. Who's going to order your stat abg's while your bagging the patient who's sats are suddenly dropping? All these things are common occurrances in ICU. While I don't know the staffing regulations in Pennsylvania, I do know that you can be held accountable for the assignment you accept, and that if harm comes to a patient due to acceptting an unsafe assignment, you can be held accountable for acceppting said assignment. Nursing sucks.

RNforLongTime · Jun 10, 2006

Right now, there's nothing I can do about it. But I WILL be looking into things a bit further. And if ER calls with an admission, I AM calling the second RN in.

Thankfully, this pt is stable and calm. I can give ativan q 15min if needed. There's a code blue button on the back of the wall that alerts the operator of a code blue.

Nursing DOES suck sometimes and this hospital is all about the almighty dollar, pt safety be damned!

Home Health Columnist / Guide · Jun 10, 2006

pa regs 20 years behind today standards, imho. see article below as they are trying to mandate ratios for some units in updated regs which must be approved by legislators..... email them your story/concerns.

hospital regulations

to view pennsylvania state licensure regulations for hospitals, click here.

109.4. professional nursing staff.

a sufficient number of registered professional nurses shall be on duty at all times to plan, assign, supervise, and evaluate nursing care as well as to give patients such nursing care as requires the judgment and specialized skills of a registered nurse. a graduate nurse, or graduate practical nurse, providing care shall be under the supervision of a registered nurse.

109.5. auxiliary nursing staff.

109.6. staffing schedules.

(a) there shall be staffing schedules reflecting actual nursing personnel required for the hospital and for each patient unit, including but not limited to the surgical and obstetrical suites, the outpatient unit, special care units, and the emergency service unit. staffing patterns should reflect consideration of nursing goals, standards of nursing practice, and the needs of the patients.

(b) staffing schedules shall accomplish the following:

(1) staffing patterns which reflect the quality and quantity of various categories of nursing personnel necessary to carry out the nursing care program.

(2) assignment of personnel in a manner which minimizes the risk or cross-infections.

(3) the patient care assignment is commensurate with the qualifications of each nursing staff member, the identified nursing needs of the patient, and the prescribed medical regimen. © schedules which contain an indication of personnel attendance by date, service unit, and time of actual attendance shall be kept on file for a minimum of one year.

109.7. nursing staff qualifications.

133.2. types of special care units.

133.4. organization and staffing.

special care units shall be organized so as to function effectively and shall be integrated with other departments or services of the hospital.

133.6. special care unit nursing service.

(a) when a special care unit is occupied, specialized nursing services shall be provided to ensure medically appropriate and effective patient care.

(b) nursing services shall be provided in accordance with chapter 109 (relating to nursing services), as well as the following:

(1) at no time may the occupied unit be without a registered professional nurse. other registered nurses and health care personnel may serve as assistant or backup personnel under the direct supervision of a qualified special care unit nurse.

(2) when a special care unit is occupied, the professional nurse on each tour of duty shall be responsible for the nursing care in the unit. the nurse so assigned shall be qualified by training and experience and shall have demonstrated appropriate competence.

133.31. policies and procedures.

compare to nj regs:

njac title 8 hospital licensing standards chapter 43g

http://www.state.nj.us/health/rules/..._hoslicstd.pdf

n.j.a.c. 8:43g-7.5(b) states, "for patients who remain in the cardiovascular surgical intensive care service or recovery room beyond the initial period of stabilization, there shall be at least a ratio of two registered professional nurses to three such patients."

jersey shore university medical center $35,000 fine assessed due to staffing violation after review of staffing sheets

http://www.state.nj.us/health/hcsa/hospfines/jers060605_03.pdf

they paid the fine too!

--

article: health department overhauls regulations

http://www.physiciansnews.com/cover/1005.html

**canoehead, BSN, RN** · Jun 10, 2006

I worked as supervisor in a small hospital like this. The ICU had a cordless phone that the RN could carry around in her pocket, plus they were encouraged to hit the code button if they needed help and couldn't leave the room. The OB unit also had a panic button that rang in the ER and the Sherriff's office to get a different kind of help in a hurry.

Not ideal, but made things a little easier.

TennRN2004 · Jun 10, 2006

I need to know whether or not staffing an ICU with ONE nurse with a pt on a vent is legal in PA? And also where do I find this information?

What do you do if you have to go to the bathroom? I guess you have to hold it for 12 hours until you get home, so no lunch break either. I personally would not feel comfortable calling even my nursing supervisor to relieve me for a minute while I went to the bathroom or heated up my lunch. One, that's not their job, two, if you're not a unit nurse that patient could be showing signs of trending down hill and supervisor may not recognize it in a timely manner. No offense to my supervisors, but if you haven't done bedside nursing in some years, it's not safe to leave the patient on a vent in the ICU with a supervisor in my oppinion.

NICU_3_RN · Sep 8, 2006

I am at work right now all alone with ONE pt who is a full code and on a vent via tracheostomy? I work in PA. Is this legal? Apparently the facility where I work does this ALL the time! I don't even have a aide to help out. The other RN went home on call from 7-11pm. There's a nurse supposedly coming in at 11pm and she's supposed to float but refuses to do so. And I am Not gonna float since I've been here since 7pm and am the full time staff where as this other girl is PRN staff.
Where can I find out if this is legal or not? Would it be a Dept of Health reg or a Board of Nursing regulation? Thanks!

Maybe this will be the unpopular opinion - but if you're so concerned about your one patient in the ICU by yourself - how do you have time to mess around online? Although, i believe that one nurse should never be left alone on a unit, for emergency reasons, you probably shouldn't be in an online forum while it's happening.

I did leave a job once due to unsafe staffing conditions, and recommend anyone else do the same. It's not worth your license.

But if something did happen, and someone found out you were online while it did, youd be so amazingly liable, regardless of staffing conditions.