Issue link: https://nnumagazine.uberflip.com/i/117852
Title 22 Section 70217, Mandated Minimum Numerical Nurse-to-Patient Ratios by Unit Type Section 70217 (a). Nursing Service Staff 1. The licensed nurse-to-patient ratio in a critical care unit* shall be 1:2 or fewer at all times. ���Critical care unit��� means a nursing unit of a general acute-care hospital which provides one of the following services: an intensive care service, a burn center, a coronary care service, and acute respiratory service, or an intensive care newborn nursery service. DHS/FSOR: Critical care unit means a unit that is established to safeguard and protect patients whose severity of medical conditions requires continuous monitoring and complex intervention by licensed nurses. ���Intensive care newborn nursery service��� was added to the list of critical care units to clarify that it is included as a critical care unit. It is DHS��� intent that the phrases ���intensive care units��� and ���critical care units��� may be used interchangeably. Intensive care units are mandated to have a minimum nurse-to-patient ratio, of 1:2 or fewer, at all times. The 1:2 ratio standard has become the minimum ratio for critical care units, with many patients in those units requiring staf���ng at 1:1 and even 2:1. 2. The surgical service operating room shall have at least one registered nurse assigned to the duties of the circulating nurse and a minimum of one additional person serving as scrub assistant for each patient-occupied operating room. The scrub assistant may be a licensed nurse, and operating room technician, or other person who has demonstrated current competence to the hospital as a scrub assistant, but shall not be a physician or other licensed health professional who is assisting in the performance of surgery. DHS/FSOR: This provision makes explicit the requirement for a registered nurse (RN) to function as the circulating assistant in the surgical service operating room. The most critical period of care for surgical patients occurs in the operating room. The instability inherent in the patients��� condition while undergoing surgery necessitates the registered nurse���s level of skill for ongoing assessment and evaluation, while assisting the surgical team. The ongoing assessment includes minute-by-minute vigilance and availability for immediate response to emergent patient changes on the part of the circulating registered nurse. 3. The licensed nurse-to-patient ratio in a labor and delivery suite of the perinatal service shall be 1:2 or fewer active labor patients at all times. When a licensed nurse is caring for antepartum patients who are not in active labor, the licensed nurse-to-patient ratio shall be 1:4 or fewer at all times. DHS/FSOR: This is based on the patients��� need for critical care during the end of labor and through the delivery process. The 1:2 ratios conform to the ratios for the other critical care units in the hospital. 4. The licensed nurse-to-patient ratio in a postpartum area of the perinatal service shall be 1:4 mother-baby couplets or fewer at all times. In the event of multiple births, the total number of mothers plus infants assigned to a single licensed nurse 26 N AT I O N A L N U R S E shall never exceed eight. For postpartum areas in which the licensed nurse���s assignment consists of mothers only, the licensed nurse-to-patient ratio shall be 1:6 or fewer at all times. DHS/FSOR: In ���Guidelines for Perinatal Care,��� both the American College of Obstetricians and Gynecologists and the American Academy of Pediatrics, (representing the specialty���s physicians, recommend a nurse-to-patient ratio of 1:6 for postpartum patients without complications and 1:4 for normal mother-newborn couplet care. The Association of Women���s Health, Obstertric, and Neonatal Nurses, representing the specialty���s nurses, agrees that those are the appropriate ratios. 5. The licensed nurse-to-patient ratio in a combined labor/delivery/postpartum area of the perinatal service shall be 1:3 or fewer at all times the licensed nurse is caring for a patient combination of one woman in active labor and a postpartum mother and infant. The licensed nurse-to-patient ratio for nurses caring for women in active labor only, antepartum patients who are not in active labor only, post-partum women only, or mother baby couplets only shall be the same ratios as stated in subsection (3) and (4) above for those categories of patients. DHS/FSOR: In a combined labor/delivery/postpartum area of the perinatal service, the minimum nurse-to-patient ratio is to be 1:2 or fewer at all times when a nurse is caring exclusively for women in active labor. 6. The licensed nurse-to-patient ratio in a pediatric unit shall be 1:4 or fewer at all times. DHS/FSOR: The word ���unit��� was added because current regulations differentiate between the pediatric service and the pediatric unit. Other hospitals which admit pediatric patients but do not have pediatric units would admit the pediatric patients to a mixed unit, and that ratio, in concert with the patient classi���cation system (PCS) would dictate the appropriate staf���ng level. 7. The licensed nurse-to-patient ratio in the post-anesthesia recovery unit of the anesthesia service shall be 1:2 or fewer at all times, regardless of the type of anesthesia the patient received. DHS/FSOR: DHS concurs with the California Society of Anesthesiologists which wrote, ���The CSA supports the proposed DHS nurse-to-patient ratio of 1:2 or fewer for patients in the post-anesthesia recovery unit. The most critical phase for a patient recovering from anesthesia, whether it is general, regional, or intravenous, is the immediate period following surgery and anesthesia, before they are transitioned to an inpatient setting or discharged to a lower level of care.��� 8. In a hospital providing basic emergency medical services or comprehensive emergency medical services, the licensed nurse-to-patient ratio in an emergency department shall be 1:4 or fewer at all times that patients are receiving treatment. There shall be no fewer than two licensed nurses present. DHS/FSOR: At least one of the licensed nurses shall be a registered W W W. N A T I O N A L N U R S E S U N I T E D . O R G NOVEMBER 2012