cascade valley hospital nurse staffing plan€¦ · staffing guidelines adopted or published by...

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The following is the nurse staffing plan for Cascade Valley Hospital, submitted to the Washington State Department of Health in accordance with

Revised Code of Washington 70.41.420.

x

x

x

x

x

x

x

x Availability of other personnel supporting nursing services on the patient care unit;

x

Reviewed by CVH Staffing Committee: December 12, 2019

As approved by Brian Ivie, CEO

This staffing plan was adopted by the hospital on: December 30, 2019 (date)

Strategies to enable registered nurses to take meal and rest breaks as required by law or the terms of an applicable

collective bargaining agreement, if any, between the hospital and a representative of the nursing staff;

Level of intensity of all patients and nature of the care to be delivered on each shift;

Skill mix;

Level of experience and specialty certification or training of nursing personnel providing care;

The need for specialized or intensive equipment;

The architecture and geography of the patient care unit, including but not limited to placement of patient rooms, treatment

areas, nursing stations, medication preparation areas, and equipment;

Staffing guidelines adopted or published by national nursing professional associations, specialty nursing organizations, and

other health professional organizations;

Attestation Form

I, the undersigned with responsibility for Cascade Valley Hospital, attest that the attached staffing plan and matrix was developed in accordance

with RCW 70l.41.420 for 2020 and includes all units covered under out hospital license under RCW 70.41. This plan was developed with

consideration given to the following elements:

Census, including total numbers of patients on the unit on each shift and activity such as patient discharges, admissions, and

transfers;

1-Dec-19

Nurse Staffing Plan Principles Access to high-quality nursing staff is critical to providing patients safe, reliable and effective care.

The optimal staffing plan represents a partnership between nursing leadership and direct nursing care staff.

Staffing is multifaceted and dynamic. The development of the plan must consider a wide range of variables.

Data and measurable nurse sensitive indicators should help inform the staffing plan.

*These principles correspond to the American Nursing Association Principles of Safe Staffing .

The committee’s work is guided by its charter.

The committee meets on a regular basis as determined by the committee’s charter.

o Individual and aggregate patient needs;

o Staffing guidelines developed for specific units of the hospital;

o The skills and training of the nursing staff;

o Resources and supports for nurses;

o Anticipated absences and need for nursing staff to take meal and rest breaks;

o Hospital data and outcomes from relevant quality indicators; and

o Hospital finances.

Nursing Staffing Plan Purpose

Nurse Staffing Plan Policy

This plan was developed for the management of scheduling and provision of daily staffing needs for the hospital, and to define a process

that ensures the availability of qualified nursing staff to provide safe, reliable and effective care to our patients. This plan applies to all

parts of the hospital licensed under RCW 70.41.

The committee’s work is informed by information and data from individual patient care units. Appropriate staffing levels for

a patient care unit reflect an analysis of:

*The American Nurses Association does not recommend a specific staffing ratio, but rather to make care assignments based

on acuity patient needs and staff competencies.

The nurse staffing committee (committee) is responsible for the development and oversight of the nurse staffing plan to

ensure the availability of qualified nursing staff to provide safe, reliable and effective care to our patients.

Nurse Staffing Plan Scope

*

The following areas of the hospital are covered by the nurse staffing plan:

Acute Care 2nd

Acute Care 3rd

CCU

FBC

ED

Operating room

Peri-Operative Services & PACU

The hospital is committed to ensuing staff are able to take meal and rest breaks as required by law, or collective bargaining

agreement. The committee considers breaks and strategies to ensure breaks when developing the plan. A global break policy

may be used, or individual patient care units may have discretion in structuring breaks to meet specific needs while meeting

the requirements of the law. Data regarding missed or interrupted breaks will be reviewed by the committee to help develop

strategies to ensure nurses are able to take breaks.

Hospitals licensed under RCW 70.41 are required by law to develop a nurse staffing plan. The plan must cover areas of the

hospital that: 1. fall under the hospital’s license (RCW 70.41) and 2. where a nurse(s) provides patient care (i.e., “patient

care unit”).

The analysis of the above information is aggregated into the hospital’s nurse staffing plan. Each individual patient care unit

may use the Nurse Staffing Committee Checklist to guide their work.

Staff continuously monitor individual and aggregate patient care needs and make adjustments to staffing per agreed upon

policy and collective bargaining agreement.

The committee will perform a semiannual review of the staffing plan. If changes are made to the staffing plan throughout the

calendar year, an updated staffing plan will be submitted to DOH.

Nurse Staffing Plan Critical Elements

The following represents critical elements about the nurse staffing plan:

The need to have 2 CCU nurses in-house at all times when there is at least 1 CCU patient in-house

The availability of support services

AWHON Labor & Delivery Staffing guidelines

Nurse Staffing Plan Matrices

*Matrices are developed as a guide for shift-by-shift unit-based staffing decisions and are adjusted up or down based on patient

factors and skill-mix of hospital staff.

Cascade Valley Hospital, SRH

Acute Care - 2nd Floor

48 Hospital Licensed Beds

Date of Services Budgeted: FY 2020

Shift

LengthMon Tues Wed Thurs Fri Sat Sun

Avg Available

Hours per shift

RN

CNA 12.00 2 2 2 2 2 2 3

RN

CNA 12.00 2 2 2 2 2 2 2 24.00

Per Day Totals: 121.71

Day Evening Night

X X X

X

X X X

X X X

X

X

X

X X X

Other

Intensivist / Neonatologist

Nursing Student

Recreation / Milieu Therapist

1800pm - 6am

Intern / Resident

Rapid Response Team

Respiratory Therapy Support

Nutritionist

Rehab Activities (OT, PT, Speech)

Clinical Pharmacist

Licensed Social Services / Case

Management

C.N.A.

Clinical Manager

Additional Care Team Members

Unit Assistant

Unit Clerical Support

1:1 Sitter

Admissions Nurse There are many variables to consider in establishing safe,

efficiently staffed hospital units. Patient care units differ based

upon the types of patients cared for on a given unit, and the why in

which care is organized and delivered there. Education and

experience levels of unit staff, support from nurse educators and

nurse managers also factor into unit staffing decisions, as does the

unique characteristics and mission of the hospital.

Patient Transport Team

IV Therapy Team

Monitor Technician

X

Spiritual Services

Hospitalist / NP / PA

Other Team Members:

Staff Educator

Clinical Nurse Specialist

Additional Unit Information:

Click here for Care Team Member definitions

SkillsShift Coverage

3 3 3 36.00

Plan / Budgeted Direct WHPPD

(Worked Hours Per Patient Day)

37pm-7am 12.00 3 3 3

Night Shift (3rd Shift)

3 3 3 36.00

6am-1800pm25.71

Number of Staff

Direct Caregivers Scheduled Hours

Day Shift (1st Shift)

7am-7pm 12.00 3 3 3 3

Average Acute Care Census Per

Day:

18 in

2019A well-staffed unit is not only defined by the number of caregivers

included in a team, but by the carefully chosen members of each team

depending upon the needs of each patient and the unit overall.


Acute Care - 3rd Floor


# of Beds: 8


Shift


Avg Available

Hours per shift

Avg Available

Nurses per

shift

12.00 2 2 2 2 2 2 2 24.00 2

12.00 1 1 1 1 1 1 1 8.00 1

12.00 2 2 2 2 2 2 2 24.00 2.00

12.00 1 1 1 1 1 1 1 8.00 1.00

Per Day Totals: 64.00 6.00

Day Evening Night

X

X

X X X

X X X

X

X

X X

X X X

IV Therapy Team

Monitor Technician

Rapid Response Team


There are many variables to consider in establishing safe,

efficiently staffed hospital units. Patient care units differ based upon

the types of patients cared for on a given unit, and the why in which

care is organized and delivered there. Education and experience

levels of unit staff, support from nurse educators and nurse

managers also factor into unit staffing decisions, as does the


Nutritionist


Clinical Pharmacist

Spiritual Services

Hospitalist


Management

Unit Assistant

1:1 Sitter

Resource Nurse

Acute Care Director Non-DKA insulin drips 1:4 on all shifts

Clinical Nurse Educator

CNA

SkillsShift Coverage PCC patients 1:4

Pediatric patients 1:3/1:4

Clinical Manager Med-surg, non-tele patients: 1:5 dayshift

Plan / Budgeted Direct WHPU

(Worked Hours Per Unit)11.367

Additional Care Team Members Additional Unit Information:

Click here for Care Team Member definitions Staffing adjusted for acuity as follows:

0.00 0.00

Night Shift

RN 7pm-7am

CNA 1800pm-0630am

CNA 6am-1830pm

Number of Staff


Day Shift

RN 7am-7pm

Average Acute Care Census Per Day:18 in







7am 8am 9am 10am 11am 12 1pm 2pm 3pm 4pm 5pm 6pm

4 4 4 5 6 7 8 8 8 8 8 8

7pm 8pm 9pm 10pm 11pm 12 1am 2am 3am 4am 5am 6am

8 8 8 7 6 5 4 4 4 4 4 4

Day Evening Night

X

X X X

X X

X X X

X X X

X

X X X

X

XCardiac/Stroke Coordinator


Nutritionist

In Hospital Clinical Pharmacist

ED Tech

Unit Assistant - 12 - 0630








Rapid Response Team

Charge Nurse

Trauma Coordinator


Management

Clinical Manager

Other Team Members:

Regional Director





Total Direct Caregiver


(Worked Hours Per Patient Day)3.13 Premier

1

MHA

1 1 1 1 1 1ED Tech

2 2 2 2 2

3 3 3 3

MHA

3 3


Direct Caregivers

RN 6 6 6 5 4 4

6

ED Tech1 1 1 1 1 2 2 2

5 6 6 6 6 6

2 2 2 2


Number of Staff

Direct Caregivers

RN 3 3 3 4 5

Average Daily Visit Volume: 54 - 2019

A well-staffed unit is not only defined by the number of caregivers Total Emergency Visits: 18,879 in 2018

included in a team, but by the carefully chosen members of each team Total Number of Beds: 16

Emergency Department

Patient Population: Adult & Pediatric

Types of Services Provided: Acute Care

Specialty Services: Stroke/Trauma



# of CCU Beds: 6


Shift


Avg

Available

Hours per

shift

Avg

Available

Nurses per

shift

12.00 2 2 2 2 2 2 2 24.00 2

12.00 2 2 2 2 2 2 2 24.00 2.00


Day Evening Night

X

X

X X X

X X X

X X X

X

X

X

X X X







unique characteristics and mission of the hospital. At all times,

there shall be on duty at least 2 nursing personnel who can reach

the bedside of a critical care patient in the CCU within 60 seconds.

At least one of these should be an RN who has demonstrated

competence In caring for CCU patients. When there any CCU

patients in-house, there need to be 2 skilled nurses on duty in the

hospital (WAC 246-320-261).


C.N.A.


Nutritionist


Management


Clinical Pharmacist

Hospitalist

Rapid Response Team

Acute Care Director

1 1 1

Click here for Care Team Member definitions Staffing adjusted for acuity of patients 1:1

Skills

Other Team Members:

1

Shift Coverage


CNA

1.00


12.00 1.00



1800pm-0630am 12.00 1 1

A well-staffed unit is not only defined by the number of caregivers


CNA 0600am-1830pm 12.00

RN 7am-7pm


Number of Staff

Direct Caregivers

Critical Care Unit

1

1 1 112.00 1 1 1 1

RN 7pm-7am

Average Number of Patients Per Day:

Scheduled Hours





Shift


Avg

Available

Hours per

shift

Avg Available

Nurses per

shift

8.00 2 2 2 2 2 2 2 16.00 2.00

8.00 2 2 2 2 2 2 2 16.00 2.00

8.00 2 2 2 2 2 2 2 16.00 2.00


Day Night

guidelines set by the Association of

Obstetric and Neonatal Nurses (AWHONN).

Shift Coverage Additional Unit Information:

The Family Birth Center adheres to staffing

There are many variables to consider in establishing safe, efficiently staffed hospital units. Patient care units differ based upon the types

of patients cared for on a given unit, and the why in which care is organized and delivered there. Education and experience levels of unit

staff, support from nurse educators and nurse managers also factor into unit staffing decisions, as does the unique characteristics and

mission of the hospital. Our strategy to make sure Meal and Rest periods are being offered and taken, is by ensuring Mid-Shift Huddles

(MSH) are happening at a minimum of four (4) times per twenty-four (24) hour period. The leaders of the MSH will ensure lunches and

breaks are discussed and coverage is determined.

Family Birth Center

Average Number of

Monthly Deliveries

10 -




Number of Staff



RN 7am-3:30pm

Evening Shift (1st Shift)

Clinical Nurse Educator/Charge

Nurse X


RN 11pm-7:30am

RN 3pm-11pm





Skills

1 to 2

1 to 3

1 to 3-4

1 to 2

1 to 2

1 to 1

Cascade Valley Hospital, SRH Surgery


OR Suites: 3


*Varies per MD block Schedule - See attached staffing matrix.

0 0 0 0 0 0 0 0 0 0

1 RN and 1 CST 1515pm - 0645 M - TH

Day Evening 1 RN and 1 CST1515 - 0700 - Fr

1 0 1 RN and 1 CST 0700 - 0700 Sa

1 0 1 RN and 1 CST 0700 - 0645 - Su

1 0

1 0 1 RN End of Shift Last Scheduled PACU → 0730 - M - F

1 0 1 RN 0700 - 0700 - Sa

1 0 1 RN 0700 - 0730 - Su

SPD On Call:

0.3 0 1 SPT Tech 0900 - 2100 Sa/Su

1 1

0 0

0730

Starts

Anesthesia

Provider

1 2

1 2

1 1

2 3

2 3

2020 Goal: 1 OR Team (RN + CST) to 1715, M-F

CVH OR Staffing MatrixBased on Blocks 11/2019

2+/2

2+/3

OR+Chrg

OR Staff Matrix

2RN / 2CST

4 RN / 3 CST

2 RN / 2 CST

2 RN / 1 CST

4 RN / 3 CST

5 RN / 4 CST

4 RN / 3 CST

5 RN / 4 CST

PACU+Float/SCU

2+/2

2+/2

3/3

2+/3

2+/3

Whitman/Benecki

Friday 3Riojas/ Whitman/

GYN

3

4

4

Roesler Every Week

Riojas 1/2 Day QOW

Wednesday 3 Vellinga/Wolff

Skiles 1/2 Day QOW

Thursday

# Blocks

0730 Start

W/W 1/2 Day

Roesler Every Wk

Wolff

Vellinga/Wolff

Tuesday 2

Tuesday

ASC Tuesday QO

Wednesday

Monday

Preianesth Team

2+/2


Operating Room


Types of Services Provided: Surgical

Specialty Services:

Average Daily Case Volume: TBD

A well-staffed unit is not only defined by the number of caregivers Average Monthly Volume: 176

Number of Staff Monday Thru Friday

Direct Caregivers


Surgery Schedulers/Data

Regional Director


(OR Cases)


Clinical Manager


DOW

Business Manager

Ortho, GYN, ENT, General

Surgery, Trauma, Podiatry,

Vascular, GI Endoscopy

Implant Coordinator

SSA I

Data / Staffing Coordinator






nurse managers also factor into unit staffing decisions, as does

the unique characteristics and mission of the hospital.

Our strategy to make sure Meal and Rest periods are being

offered and taken. The leaders of the CVH SS will ensure lunches

and breaks are discussed and coverage is determined.

TBD

Additional Care Team Members Additional Unit Information: CVH OR Call

Click here for Care Team Member definitions OR On Call:

Charge Nurse

Anesthesia Assistant

PACU On Call:

Cascade Valley Hospital, SRH Surgery


# of Day Surgery Beds: 6

# of PACU Bays: 6


0545-1615 0630 0730 0800 0930 1130 1230 1330 1430 1615 1700

2 3 3 3 3 3 3 3 3 3 1

PACU: Number of Staff Monday Thru Friday

0730-1600 0800 0930 1130 1230 1330 1430 1530 1600 1630Saturday

7a-7a

1 2 2 2 2 2 2 2 2 1

Day Evening

1 0

1 0

1 0 Additional nurse required when floor holds are present.

1 0

1 0 Staffing matrix fluctuates according to census and in alignment

1 0 with ASPAN guidelines.

0.3 0

1 1

0 0

There are many variables to consider in establishing safe, efficiently staffed

hospital units. Patient care units differ based upon the types of patients

cared for on a given unit, and the why in which care is organized and

delivered there. Education and experience levels of unit staff, support from

nurse educators and nurse managers also factor into unit staffing decisions,

as does the unique characteristics and mission of the hospital.

Our strategy to make sure Meal and Rest periods are being offered and

taken. The leaders of the CVH SS will ensure lunches and breaks are

discussed and coverage is determined.

Additional Unit Information:

Staffing levels are based on ASPAN standards.

1:1 required when patient under 8 years of age.

1:1 required when patient is Isolation precautions

Two nurses required in PACU at all times when patients are present. OR RN

may be 2nd RN.

1 RN 0700 - 0700 Sa

1 RN 0700 - 0730 Su

Specialty Services:

Weekend Call

Day Surgery: Number of Staff Monday Thru Friday

Average Daily Case Volume: TBD

A well-staffed unit is not only defined by the number of caregivers

Average Monthly Volume: 176


2


Direct Caregivers

RN 1 2

Perioperative Service s & PACU


Types of Services Provided: Surgical


1

CNA 1 1 1 1 1 1 1

2 2 22 2

Sunday

7a-0730a

22

2 2

1 1 1

1 2 2 2 2

Clinical Manager

Regional Director




1 RN End of Scheduled Shift PACU → 0730 Next Day - M-F


(Worked Hours Per Patient Day)8.5

Ortho, GYN, ENT, General Surgery,

Trauma, Podiatry, Vascular, GI

Endoscopy


2 2 2 2 1

0

Direct Caregivers

RN

Implant Coordinator

SSA I

Data / Staffing Coordinator

Business Manager

Charge Nurse

Anesthesia Assistant

Surgery Schedulers/Data

cascade valley hospital nurse staffing plan€¦ · staffing guidelines adopted or published by...

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