PA Dept of Health proposed regs mandate 1:2 RN's in Critical Care, CCU, ICU, + NICU

  1. open comments solicited till 10/15/05 on sweeping pa doh regs:|#

    109.11. hospital staffing.

    a) the director of nursing shall be a member of the hospital medical staff and shall directly or by designation be a member of the hospital's patient safety committee.

    b) at least one registered nurse shall be on duty and physically present in each patient care unit during each shift.

    c) a sufficient number of registered nurses shall be on duty at all times to plan, assign, supervise and evaluate nursing care, to provide nursing care to patients who require the specialized skills of a registered nurse and to assure the health, safety and proper care of the patients.

    d) at least one registered nurse for every two patients shall be physically present in any critical care, intensive care, coronary care, neonatal intensive care unit at all times.

    e) a health care provider operating a hospital shall immediately report to the department any insufficiency in its nurse to patient coverage.

    f) a health care provider operating a hospital shall report its nurse to patient ratios for each patient care unit in its annual patient safety report to the department.

    g) nurses shall be assigned to patients in a manner that minimizes the risk of spreading infections and shall be commensurate with the qualifications of the nurse, the nursing needs of the patient, and the interdisciplinary care plan if applicable.

    hospital nursing plan and policies 109.20. written plan

    a) the director of nursing shall develop a written nursing plan that shall be available to all nursing personnel and all practitioners at the facility.

    b) the nursing plan shall:

    1) establish specific nurse staffing plans for each patient care unit using nationally recognized best practices and minimal nurse to patient ratios.

    2) delineate specific nursing policies and procedures to improve infection control and patient safety.

    3) indicate the relationship and lines of communication within nursing services and between nursing services, practitioners, and other divisions of the hospital.

    4) specify the duties of the on-duty nurse for each patient care unit.

    5) specify the duties of additional nursing personnel by specific title and position, for each patient care unit.

    from physician news:

    health department overhauls regulations their current form, the draft revisions would make some significant changes to health care facilities' regulatory requirements, including:

    - expanding the types of facilities requiring licensure to a newly-created category - "outpatient ambulatory health care facility" - which would include facilities providing imaging, pain management, rehabilitation, emergency and other services.

    - requiring a minimum nurse-to-patient ratio of 1:2 in four categories of critical care, and requiring facilities to report nurse staffing ratios for each patient care unit of a hospital or outpatient ambulatory health care facility.

    - requiring facilities annually to submit patient safety reports, to a identify a minimum of six safe practices to be implemented in the coming year, and to arrange for six hours of patient safety training for each health care practitioner, officer and director.

    - broadening the definition of hospital medical staff - which current regulations define as physician, dentist or podiatrist - to allow the medical staff to include other health care providers.

    - setting minimum charity care levels and limitations on collection practices by hospitals and outpatient ambulatory health care facilities, as well as requiring audited financial statements and reserving doh authority to audit and impose a plan for improved fiscal review of such facilities....

    Last edit by NRSKarenRN on Oct 8, '05
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    About NRSKarenRN, BSN, RN Moderator

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  3. by   pickledpepperRN

    how can you make it law?
    public pressure?

    anything we can do from out of state?
  4. by   oramar
    You know why this is really great. It lets all these managment people in all these institutions that have been pulling dirty short staffing trick on patients and nurses for years know that it is time to straighten up. I don't have time at the minute to read every word but the summary sounds pretty good. I will be back to read and think and maybe write a comment.
  5. by   Jolie
    One potential outcome of this proposal would be the renaming of units within hospitals. I managed a "NICU" in a community hospital in PA that was a small Level II unit. We rarely had a baby that warranted 2:1 staffing. Most of our babies were stable feeder/growers, IDMs or r/o sepsis babies that were easily handled in a 3:1 assignment.

    Rather than mandating staffing according to the unit in which the patient resides, it would make more sense to mandate staffing according to acuity. A vent baby or unstable new admit should be 1:1 or 2:1 based on their care needs, not based on the name of the unit to which they are admitted. Otherwise, NICUs all over the state will become "Special Care Nurseries" in order to avoid this requirement.
  6. by   Katnip
    What happens when you have critical boarders in the ER? They belong in ICU, but there are no beds. How will that supposedly work. As it is now, we can have up to two critical patients and two or more urgent or stable patients.

    Will it be mandated that the ER has to have the same ratio as ICU?
  7. by   lee1
    I don't know about you all but I have been a critical care nurse for more than 35 years in PA and NJ. I have never worked at a hospital where 3:1 in an ICU was a norm, it has always been 2:1 or 1:1 depending on acuity. Now, in a short pinch, yes I have taken care of 3 especially if they are tele waiting to transfer. SO, have the regs always been higher than 2:1 or has someone changed them say about 10 years ago as I suspect happened in NJ.

    Also, wherever I have worked the managers have been strong AACN supporters, so maybe that had something to do with it as the AACN as ALWAYS advocated 2:1, 1:1.
  8. by   lee1
    also another question. Who is it that tries to change the regs??? What power do they have. What organization do they initially belong to???
  9. by   Jessy_RN
    That is wonderful news.