At its March 24 meeting, the Upper San Juan Health Service District Board of Directors, which oversees Pagosa Springs Medical Center (PSMC), heard about and approved the center’s Master Nurse Staffing Plan.
The plan, presented by Director of Nursing Dan Davis, is for the inpatient and emergency departments at PSMC.
In introducing the report, board chair Kate Alfred explained the state began requiring the plan in 2022.
Davis noted that PSMC has 18 beds total — seven in the Emergency Department and 11 inpatient beds.
Davis explained that the plan has to be reviewed and approved annually.
He indicated that the need for the plan stems from House Bill 22-1401, with the law becoming effective Sept. 1, 2022.
The law, according to Davis’ presentation, “Requires that all hospitals establish a Nurse Staffing Committee, composed of at least 60% nursing staff, along with nursing leadership representation.”
The presentation adds, “Essentially, the Nurse Staffing Committee is responsible for developing, overseeing and evaluating the Hospital’s Nurse Staffing Plan.”
The committee’s responsibilities, he presented, are to annually develop the plan and evaluate it quarterly; submit the staffing plan to the hospital’s senior nursing executive and governing body for review and approval; receive, track and resolve staffing concerns and other feedback from direct-care nurses and other clinical staff; meet the required staffed-bed capacity; and prepare an annual report for the Colorado Department of Public Health and Environment that includes details of the quarterly staffing evaluations and how PSMC is meeting all other requirements of the new law.
Davis also presented to the board that the nurse staffing plan has to be posted on the hospital’s website; a copy has to be provided to all new nursing hires; PSMC has to develop strategies to “promote the health, safety and welfare of the hospital’s employees and patients”; set written guidelines for “reducing nurse-to-patient assignments based on demand, patient acuity and safety”; and has to “Describe a written process for receiving, tracking and resolving complaints from clinical staff, providers or patients regarding the Nurse Staffing Plan.”
Davis then presented the 2024 nurse staffing plan, noting no changes were made from the 2023 plan since no complaints or concerns were received on the staffing plan.
Davis told the board the plan is based on nationally recognized nurse/patient staffing ratios and standards.
The Emergency Department, Davis presented, is staffed with a minimum of one registered nurse for each of the 12-hour day and night shifts, as well as one registered nurse and one Emergency Department tech/paramedic for the overlap shift of noon to 12:30 a.m.
Target staffing, according to the presentation, is two registered nurses per 12-hour shift, and there is a nurse administrator on call seven days per week, as well as a nurse manager, available to help address staffing needs.
Davis explained there is an on-site Emergency Department physician 24/7, and staffing levels may be adjusted based on patient acuity (level of illness or injury) and safety needs.
The inpatient/medical-surgical unit, Davis presented, is staffed with a minimum of one registered nurse for each of the 12-hour shifts, and nurse-to-patient ratios are not to exceed 1-to-6.
Target staffing, he presented, is two registered nurses per 12-hour shift and certified nurse aides and/or sitters if indicated to supplement care.
He noted that nurse-patient ratios can be adjusted based on patient acuity, staff skill mix and individual patient safety needs.
He added there is a registered nurse nurse manager available to help with staffing needs.
He also noted there is a licensed clinical social worker staffed Monday through Friday from 8 a.m. to 5:30 p.m. to assist with case management and patient discharge planning, and the inpatient unit is staffed by an on-site hospitalist (a doctor who works with inpatients) seven days a week from 8 a.m. to 5:30 p.m.
Davis also noted during his presentation that, in 2023, PSMC started a workplace violence committee that is working on specific strategies to promote the safety of staff and patients.
He also noted an employee recognition committee was formed to develop a plan to “promote employee engagement, recruitment and retention efforts, as well as staff recognition and appreciation.”
