Issue link: https://nnumagazine.uberflip.com/i/117852
nurse assigned to triage patients when they arrive in the emergency department. When there are no patients needing triage, the registered nurse may assist by performing other nursing tasks. The registered nurse assigned to triage patients shall not be counted in the licensed nurse-to-patient ratio. When licensed nursing staff are attending critical care patients in the emergency department, the licensed nurse-topatient ratio shall be 1:2 or fewer at all times. 9. The licensed nurse-to-patient ratio in a step-down unit shall be 1:3 or fewer at all times. A ���step-down unit��� is de���ned as a unit which is organized, operated, and maintained to provide for the monitoring and care of patients with moderate or potentially severe physiologic instability requiring technical support but not necessarily arti���cial life support. Step-down patients are those patients who require less care than intensive care, but more than that which is available from medical/surgical care. ���Arti���cial life support��� is de���ned as a system that uses medical technology to aid, support, or replace a vital function of the body that has been seriously damaged. ���Technical support��� is de���ned as specialized equipment and/or personnel providing for invasive monitoring, telemetry, or mechanical ventilation, for the immediate amelioration or remediation of severe pathology. DHS/FSOR: ���Arti���cial life support��� and ���technical support��� are de���ned in regulation in order to differentiate the types of equipment and nursing care that would commonly be required by patients in step-down units, and, by extension, the degree of illness or impairment experienced by patients in this unit type. 10. The licensed nurse-to-patient ratio in a telemetry unit shall be 1:4 or fewer at all times. ���Telemetry unit��� is de���ned as a unit organized, operated, and maintained to provide care for and continuous cardiac monitoring of patients in a stable condition, having or suspected of having a cardiac condition or a disease requiring the electronic monitoring, recording, retrieval, and display of cardiac electrical signals. DHS/FSOR: ���Telemetry unit��� was de���ned in the original proposed regulations as a unit designated for the electronic monitoring, recording, retrieval, and display of cardiac electrical signals. The ���nal proposed de���nition was expanded in response to the requests of many public comments to improve clarity. The de���nition was expanded because the original language was so broad as to be confusing operationally. Many patients require monitoring of cardiac signals, including women in active labor, babies in utero, intensive care patients, surgical patients, and others. The added language will minimize confusion. It limits telemetry patients to those who are in stable condition, thus distinguishing them from step-down and ICU patients. It further de���nes telemetry unit as dedicated to patients having or suspected of having a cardiac condition or disease requiring speci���c monitoring and care. This de���nition is consistent with existing practice, is more precise, and will minimize confusion. Cardiac monitoring, which in the past was reserved to critical care units, is now used routinely in non-critical care settings to improve patient care and provide a more accurate and continuous assessment of cardiac function for those patients whose underlying disease state, e.g. conduction disturbances or arrhythmias, makes monitoring appropriate. The ratio is necessary because patients on NOVEMBER 2012 telemetry require licensed nurses to be readily available to expeditiously detect and treat the irregularities that the monitor identi���es. 11. The licensed nurse-to-patient ratio in medical/surgical care units shall be 1:5 or fewer at all times (beginning in 2005). A medical/surgical unit is a unit with beds classi���ed as medical/surgical in which patients, who require less care than that which is available in intensive care units, step-down units, or specialty care units receive 24-hour inpatient general medical services, post-surgical services, or both general medical and post-surgical services. These units may include mixed patient populations of diverse diagnoses and diverse age groups who require care appropriate to a medical/surgical unit. DHS/FSOR: This ratio is also proposed to apply to those medical/surgical units that serve diverse patient populations and age groups. These units, which for purposed of the DHS on-site study were identi���ed as ���mixed units,��� were found to contain patients with diseases, injuries, acuity levels, and care needs that closely approximated patients in more traditional medical/surgical units. The PCS will continue to coexist with the minimum ratio in these mixed units to require an increase in nurse staf���ng in response to increased patient acuity and/or the needs of the speci���c patient population, e.g. pediatric patients. The words ���who require care appropriate to a medical/surgical unit��� were added to clarify that mixed and medical/surgical units provide the same level of care and that the care level is necessitated by patients��� needs. 12. The licensed nurse-to-patient ratio in a specialty care unit shall be 1:4 or fewer at all times. A specialty care unit is de���ned as a unit which is organized, operated, and maintained to provide care for a speci���c medical condition or a speci���c patient population. Services provided in these units are more specialized to meet the needs of patients with the speci���c condition or disease process than that which is required on medical/surgical units, and is not otherwise covered by ���unit de���nition.��� DHS/FSOR: Specialty care units, those units which are organized, operated, and maintained to provide care for a speci���c patient population, are very varied, depending on the hospital, its location, its size, and the patient population it serves. Specialty care units are often found in large, urban hospitals and academic medical centers serving unique patient cohorts. While ���specialty care unit��� is not currently a supplemental service nor a licensing term, this is the generally understood meaning of the term. The speci���c specialties served by these units run the gamut from orthopedics to HIV/AIDS to metabolic transplants, and require more specialized skills and comprehensive care than is normally available in medical/surgical units. Minimum staf���ng, of course, will vary according to the needs of the patients, and will increase in response to the PCS. The most commonly found specialty care unit in California���s hospitals is the oncology unit, and, therefore, that is the unit type that was included in the DHS on-site study. 13. The licensed nurse-to-patient ratio in a psychiatric unit shall be 1:6 or fewer at all times. For purposes of psychiatric units only, ���licensed nurses��� also includes licensed psychiatric W W W. N AT I O N A L N U R S E S U N I T E D . O R G N AT I O N A L N U R S E 27