According to the ASPAN standards (2014, p. 23), “An appropriate number of registered nursing staff with demonstrated competence is available to meet the individual needs of patients and families in each level of perianesthesia care based on patient acuity, census, and physical facility.” Practice Recommendation 1 of the ASPAN standards (2014, p. 37) recommends that the extended observation level of care include “two competent personnel, one of whom is an RN possessing competence appropriate to the patient population, are in the same room/unit where the patient is receiving extended care level of care. The need for additional RNs and support staff is dependent on the patient acuity, patient census, and the physical facility.”
The recommendation is to have a ratio of one nurse for every three to five patients (ASPAN, 2014). The number of patients assigned should be based on patient acuity and the number of patients in the unit. If the observation patient is in an unmonitored bed, the staffing ratio could be the same as that on a hospital ward or unit where patients are in unmonitored beds. If the observation patient is on a monitored bed, the staffing ratio should match that of a monitored bed. Consideration must also be given to the actual physical makeup of the unit used for observation.
If ICU patients are housed in this observation unit, the staffing ratio will need to be one nurse to two patients, based on staffing literature and ASPAN standards. This represents one nurse to two patients based on the patient’s acuity (ASPAN, 2014; California Nurses Association, 2004). Nurses caring for patients as observation patients in the PACU should have limited responsibility for other patients in the unit, and every attempt to separate the PACU patient from the observation patient should be made. Support personnel and those assisting in the unit should have had an orientation to the policies and procedures and setup of the unit. Asking just anyone to assist and be the second person is inappropriate and can impact the quality of care provided. Use of float personnel, unless adequately trained, is discouraged.