DENCE Regional Medical Center Everett
Nursing Administration
1321 Colby Avenue
Everett, WA 98201
ph. 425-261-4047
December 28, 2020
Pursuant to the Nurse Staffing Law (Patient Safety Act.HB 1714), the following is provided to meet the
regulatory compliance Standard.
1. Matrix by Unit and Shift
2. Chief Executive Attestation Form
Please reach out to me if there are any questions, clarifications, or concerns. I am happy to respond and
clarify to the staffing plan for Providence Regional Medical Center.
Chief Nursing Officer
Providence Regional Medical Center Everett
T: 425.26 1.4077 I P : 425 .303.4849 I [email protected]
DENCE Regional Medical Center Everett
DENCE Regional Medical Center Everett
DENCE Regional Medical Center Everett
Nurse Staffing Coalition
Jan1, 2021
I, the undersigned with responsibility y for Providence Regional Medical Center Everett, attest that the
attached staffing plan and matrix was developed in accordance with RCW70.41.420 for 2020 and
includes all units covered under our hospital license under RCW70.4 1. This plan was developed with
consideration given to the following elements (please check):
IXl Census, including total numbers of patients on the unit on each shift and activity such as
patient discharge, admissions, and transfers;
IXl Level of intensity of all patients and nature of the care to be delivered on each shift;
IXl Skill mix;
IXl Level of experience and specialty certification or training of nursing personnel providing care;
IXl The need for specialized or intensive equipment;
IXl 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;
IXl Staffing guidelines adopted or published by national nursing professional associations, specialty
nursing organizations, and other health professional organizations;
IXI Availability of other personnel supporting nursing services on the patient care unit;
IXI 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
This staffing plan was adopted by the hospital on:
12/28/2020 As approved by Kim Williams, CEO
Kim E. Wi lliams, MS, RN, FA CH E
Chief Executive Officer Providence
Heath & Services
Northwest Washington Service Area
Nurse Staffing Plan Scope
The following areas of the hospital are covered by the nurse staffing plan:
• Emergency Department
• Cardiovascular Lab (CVL)
• Interventional Radiology (IR)
• Radiation Oncology
• Wound Ostomy Clinic
• Surgical Services
• Endoscopy
• Infusion Services
• Surgical Home
• Surgery Pre-op and PACU
• A - 3 Medical Unit
• A - 5 Medical Renal Unit
• A - 6 Med-Surg (Close Observation Unit)
• A - 7 General Medical Unit
• C - 3 Pediatric/Adult Med-Surg Unit
• C - 4 Clinical Evaluation Unit (CEU Observation)
• D - 6N Thoracic & Vascular Care Unit
• D – 6S Medical Intensive Care Unit (MICU)
• D – 7N Cardiac Telemetry Unit
• D – 7S Surgical Intensive Care Unit (SICU)
• D – 8N Neurosurgery Unit
• D – 8S Orthopedic Unit
• D – 9N Oncology Unit
• D- 9S Surgical Unit
• D –10N Medical Telemetry Unit
• D – 10S Telemetry Unit
• P – 1S Behavioral Health
• P – 2N Med-Surg Pacific
• P – 2S Inpatient Rehabilitation Facility (IRF) Pacific
• P – PAV Neonatal Intensive Care Unit (NICU) Pacific
• P – PAV Obstetrics Family Maternity Center (FMC) L&D, Ante-partum and Post-Partum Pacific
• P – PAV Post-partum Clinic Pacific
• P – 1N Maternal Fetal Medicine Pacific
• P – PAV Lactation Services Pacific
Unit
ED
Week Day Weekend
Census RN EDT HUC RN CNA HUC
7:00 12 4 1 12 4 1
8:00 12 4 1 12 4 1
9:00 18 5 1 19 4 1
10:00 18 5 1 19 4 1
11:00 26 6 1 25 6 1
12:00 26 6 1 25 6 1
13:00 32 7 1 28 6 1
14:00 32 7 1 28 6 1
15:00 33 8 1 28 6 1
16:00 33 8 1 28 6 1
17:00 33 8 1 28 6 1
18:00 33 8 1 28 6 1
19:00 33 7 1 28 6 1
20:00 33 7 1 28 6 1
21:00 32 7 1 28 6 1
22:00 32 7 1 28 6 1
23:00 28 5 1 27 6 1
12:00 28 5 1 27 5 1
1:00 22 5 1 22 5 1
2:00 22 5 1 22 5 1
3:00 17 5 1 17 4 1
4:00 17 5 1 17 4 1
5:00 13 3 1 13 4 1
6:00 13 3 1 13 4 1
Unit Radiation Oncology
CENSUS RN MA
90-100 2 2
60-79 2 1
Up to 59 2 0
Unit In Patient Wound Clinic M-F
Hours: 08:00 to 16:30
Provider 1
RN 2 to 3
CAN 1
Scheduler 1 to 2
Cumulative each hour
PACU PACU
Week Day Weekend
RNs HCNA On Call
RNs RNs HCNA
On Call RNs
midnight 1 0 2 1 0 2
1:00 1 0 2 1 0 2
2:00 1 0 2 1 0 2
3:00 1 0 2 1 0 2
4:00 1 0 2 1 0 2
5:00 1 0 2 1 0 2
6:00 1 0 2 1 0 2
7:00 2 0 0 0 0 2
8:00 6 1 0 2 0 0
9:00 12 2 0 2 0 0
10:00 14 2 0 3 0 0
11:00 16 2 0 3 0 0
Noon 16 2 0 3 0 0
13:00 16 2 0 3 0 0
14:00 16 2 0 3 0 0
15:00 16 2 0 3 0 0
16:00 16 2 0 3 0 0
17:00 15 2 0 3 0 0
18:00 9 2 0 3 0 2
19:00 6 1 0 2 0 2
20:00 4 0 0 2 0 2
21:00 3 0 2 1 0 2
22:00 1 0 2 1 0 2
23:00 1 0 2 1 0 2
Cumulative each hour
Admissions/Preop Admissions/Preop
Weekday Saturday
RNs HCNA MA's RNs HCNA MA's
midnight 3 0 0 3 0 0
1:00 3 0 0 3 0 0
2:00 3 0 0 3 0 0
3:00 3 0 0 3 0 0
4:00 3 0 0 3 0 0
5:00 3 6 0 3 0 0
6:00 20 6 2 3 1 0
7:00 27 9 2 3 1 0
8:00 30 9 2 4 1 0
9:00 34 10 2 4 1 0
10:00 36 11 2 4 1 0
11:00 38 11 2 4 1 0
Noon 38 11 2 4 1 0
13:00 38 12 2 4 1 0
14:00 38 12 2 4 1 0
15:00 38 12 2 4 1 0
16:00 21 6 2 4 1 0
17:00 16 3 2 4 1 0
18:00 12 3 0 2 0 0
19:00 12 2 0 2 0 0
20:00 9 1 0 0 0 0
21:00 5 1 0 0 0 0
22:00 3 1 0 0 0 0
23:00 3 1 0 0 0 0
Unit Name: Endoscopy
Unit Surgical Home
Core Staffing Monday-Friday
Advance Practice Caregivers 2
MA'S 3
Scheduler/Health Unit Coord 1
Admissions/Preop (2N + 3N) - Colby
A- 6A Medical Medical/Surgical (Close Observation)
A- 5A Medical Renal
A- 3A Medical
A- 7A- General Medical
Day NOC Day NOC Day 8Hr EVE 8Hr NOC
CENSUS Chg RN Chg RN RN RN HUC/CNA HUC/CNA HUC/CNA
13 1 1 3 3 1 1 0
12 1 1 3 3 1 1 0
11 1 1 3 2 1 1 0
10 1 1 2 2 1 1 0
9 1 1 2 2 1 0 0
8 1 0 2 2 1 0 0
7 0 0 2 2 1 0 0
6 0 0 2 2 0 0 0
5 0 0 2 2 0 0 0
4 0 0 2 2 0 0 0
3 0 0 2 2 0 0 0
2 0 0 2 2 0 0 0
1 0 0 2 2 0 0 0
C- 3C Pediatrics/Adult Med-Surg
C- 4C Close Observation Unit
D- 6N Thoracic Vascular
D-6S Medical ICU (MICU)
DAY SHIFT/NIGHT SHIFT
Patient
Census
Charge RN
Patient Care RN
Resource RN
CNA
Total # Staff
1 1 1 0 0 2
2 1 1 0 0 2
3 1 2 0 0 3
4 1 2 0 0 3
5 1 3 0 0 4
6 1 3 0 0 4
7 1 4 0 0 5
8 1 4 0 0 5
9 1 5 0 1 7
10 1 5 0 1 7
11 1 6 1 1 9
12 1 6 1 1 9
13 1 7 1 1 10
14 1 7 1 1 10
15 1 8 1 1 11
16 1 8 1 1 11
17 1 9 1 1 12
18 1 9 1 1 12
19 1 10 1 1 13
20 1 10 1 1 13
21 1 11 1 1 14
22 1 11 1 1 14
23 1 12 1 1 15
24 1 12 1 1 15
25 1 13 1 1 16
26 1 13 1 1 16
27 1 14 1 1 17
28 1 14 1 1 17
Day Eve 1 Eve 2 NOC Day Eve 1 Eve 2 NOC Day Eve 1 Eve 2
CENSUS RN RN RN RN NAC NAC NAC NAC HUC HUC HUC
32 10 10 10 10 4 3 3 3 1 1 1
31 10 10 10 10 4 3 3 3 1 1 1
30 10 10 10 10 3 3 3 2 1 1 1
29 10 10 10 10 3 2 2 2 1 1 1
28 10 10 9 9 3 2 2 2 1 1 1
27 9 9 9 9 2 2 2 2 1 1 1
26 9 9 9 9 2 2 2 2 1 1 1
25 9 9 8 8 2 2 2 2 1 1 1
24 8 8 8 8 2 2 2 2 1 1 1
23 8 8 7 7 2 2 2 1 1 1 1
22 8 8 7 7 2 1 1 1 1 1 1
21 7 7 7 7 2 1 1 1 1 1 1
20 7 7 6 6 2 1 1 1 1 1 1
19 7 7 6 6 2 1 1 1 1 1 1
18 7 7 6 6 2 1 1 0 1 1 1
17 6 6 6 6 1 1 1 0 1 1 1
16 6 6 5 5 1 1 1 0 1 1 1
15 6 6 5 5 1 0 0 0 1 1 1
14 5 5 5 5 1 0 0 0 1 1 1
13 5 5 5 5 0 0 0 0 1 1 1
12 5 5 4 4 0 0 0 0 1 1 1
11 4 4 4 4 0 0 0 0 1 0 0
10 4 4 3 3 0 0 0 0 1 0 0
9 4 4 3 3 0 0 0 0 1 0 0
D- 7N Cardiac Telemetry
D-7S Surgical ICU (SICU)
DAY SHIFT/NIGHT SHIFT
Patient
Census
Charge RN
Patient Care RN
RRT
Resource RN
CNA
Total # Staff
1 1 1 1 0 0 3
2 1 1 1 0 0 3
3 1 2 1 0 0 4
4 1 2 1 0 0 4
5 1 3 1 0 0 5
6 1 3 1 0 0 5
7 1 4 1 0 0 6
8 1 4 1 0 0 6
9 1 5 1 0 0 7
10 1 5 1 0 0 7
11 1 6 1 1 0 9
12 1 6 1 1 0 9
13 1 7 1 1 0 10
14 1 7 1 1 0 10
15 1 8 1 1 0 11
16 1 8 1 1 0 11
17 1 9 1 1 0 12
18 1 9 1 1 0 12
19 1 10 1 1 0 13
20 1 10 1 1 0 13
D-8N Neuro-Telemetry
D- 10N Medical-Telemetry
D- 10S Telemetry
D- 9N Oncology
D-8S Orthopedics
D- 9S Surgical
Unit P 1S-Behavioral Health DAY SHIFT NOC SHIFT
CENSUS RN CNA HUC RN CNA
14 2 0 1 2 0
13 2 0 1 2 0
12 2 0 1 2 0
11 2 0 1 2 0
10 2 0 1 2 0
9 2 0 1 2 0
8 2 0 1 2 0
7 2 0 1 2 0
6 2 0 1 2 0
5 2 0 1 2 0
4 2 0 1 2 0
3 2 0 1 2 0
2 2 0 1 2 0
1 2 0 1 2 0
Unit P-2N MedSurg
DAY SHIFT
EVENING 1
EVENING 2
NOC
CENSUS
RN
CNA
CNA
R N
CNA
CNA
RN
CNA
CNA
RN
CNA
CNA
19 3 3 *3 3 3 *3 3 3 *3 3 3 *3
18 3 3 *3 3 3 *3 3 3 *3 2 2 *3
17 3 3 *3 3 2 *3 3 2 *3 2 2
16 3 3 *3 3 2 *3 3 2 *3 2 2
15 2 2 2 2 2 2 2 2
14 2 2 2 2 2 2 2 2
13 2 2 2 2 2 2 2 2
12 2 2 2 2 2 2 1 2
11 1 2 1 2 1 2 1 2
10 1 2 1 2 1 2 1 2
9 1 2 1 2 1 2 1 2
8 1 2 1 2 1 2 1 2
Unit P-2S IRF
DAY SHIFT
EVENING 1
EVENING 2
NOC
CENSUS
RN
CNA
HUC
RN
CNA
HUC
RN
CNA
HUC
RN
CNA
19 4 3 0.5 4 3 0.5 4 3 0.5 4 2
18 4 2 0.5 4 2 0.5 4 2 0.5 3 2
17 4 2 0.5 4 2 0.5 4 2 0.5 3 2
16 4 2 0.5 4 2 0.5 4 2 0.5 3 2
15 3 2 0.5 3 2 0.5 3 2 0.5 3 2
14 3 2 0.5 3 2 0.5 3 2 0.5 3 1
13 3 2 0.5 3 2 0.5 3 2 0.5 3 1
12 3 1 0.5 3 2 0.5 3 2 0.5 2 1
11 3 1 0.5 3 1 0.5 3 1 0.5 2 1
10 2 1 0.5 2 1 0.5 2 1 0.5 2 1
9 2 1 0.5 2 1 0.5 2 1 0.5 2 1
8 2 1 0.5 2 1 0.5 2 1 0.5 2 0
7 2 0 0.5 2 1 0.5 2 1 0.5 2 0
6 2 0 0.5 2 0 0.5 2 0 0.5 2 0
5 2 0 0 2 0 0 2 0 0 2 0
4 2 0 0 2 0 0 2 0 0 2 0
3 2 0 0 2 0 0 2 0 0 2 0
2 2 0 0 2 0 0 2 0 0 2 0
1 2 0 0 2 0 0 2 0 0 2 0
Unit NICU
Shift
Nurse
NRRT
CNA
HUC
0630 to 1900
12
1
1
1
1830 to 0700
12
1
1
1
NICU Staffing Acuity
1:1 (1)
• Unstable and vulnerable infant requiring many simultaneous interventions more than every
hour
• Ventilated infant with complex respiratory status (HFOV, JET,INO)
• Multiple/Unstable chest tubes
• Multiple blood transfusions
• Exchange transfusion
• Hemodynamically unstable infant with multiple drips and frequent titrations
• Multiple central lines that requires frequent medications and fluid administrations
Unstable infant with seizures
• Complex IV fluid and medications administrations (i.e. multiple antibiotics, drips, severe
acid/base
or electrolytes corrections)
• Hemodynamically unstable (i.e. anuria, oliguria, severe adrenal insufficiency) requiring
close monitoring and intermittent treatment
1:2 (0.5)
Stable ventilated infants, CPAP, NIPPV, HFNC >2L
Frequent apnea and bradycardia spells requiring interventions > 5 times each shift (for possible
work-up)
Frequent apnea and bradycardia on babies who are already on caffeine and 02 but still having
events (8-10 times/24 hours that are needing interventions)
Multiple access sites: PICC/UVC, VAC/PAL
Seizure controlled by anticonvulsant but with Intermittent symptoms.
Unstable NAS, scoring above 10 even on treatment
Arrhythmias requiring IV meds
Stable chest tubes
Nursing interventions/assessment/family interactions every 1-2 hours
1:3 (0.33)
NC, HENC </= 2L
Seizures controlled by medications and /or weaning from medications
Captured NAS on medications, scores <8
Occasional apnea and bradycardia, spells not requiring interventions
Phototherapy
R/O sepsis on antibiotics
Resolving hypoglycemia, weaning from IV fluid and working up on po feeding
NG feeding
AD lib feeding
Patient being discharge
Formula= Multiply 1:1 patients xl
Multiply 1:2 patients x 0.5
Multiply 1:3 patients x 0.33
Add total to equal number of needed nurses. Always round up. Add 2 for charge and flex
NICU Staffing Plan
Daily staffing 24/7
• 1 HUC
• 1 CN
1 Flex RN (to do transports, PICCs and deliveries as able)
Unit Family Maternity
Day NOC Total
Fixed Numbers
L&D Charge RN 1 1 2
Postpartum Charge 1 1 2
Triage RN 3 3 6
Flex Nurse 2 2 4
Surgical Techs 8hr 1 1
Surgical Techs 12 hr 2 2 4
HUC/CNA 1 1 2
HUC 2 2 4
C.N.A 2 2 4
L&D
CENSUS DAY NOC TOTAL RN
L&D Pts.
0 1 1 2
1 2 2 4
2 3 3 6
3 3 3 6
4 4 4 8
5 5 5 10
6 6 6 12
7 7 7 14
8 8 8 16
9 9 9 18
10 10 10 20
INDUCTIONS DAY NOC TOTAL RN
1 1 1 2
2 2 2 4
3 3 3 6
4 4 4 8
5 5 5 10
6 6 6 12
SCHED. C-SEC. DAY NOC TOTAL RN
1 2 0 2
2 3 0 3
3 4 0 4
4 4 0 4
ANTEPARTUM DAY NOC TOTAL RN
3 1 1 2
4 2 2 4
5 2 2 4
6 2 2 4
7 3 3 6
8 3 3 6
9 3 3 6
10 4 4 8
PP COUPLETS 4TH FLOOR CNA
PP COUPLETS 4TH FLOOR
DAY
NOC
TOTAL RN
DAY
NOC
TOT. CNA
1 1 1 2 0 0 0
2 1 1 2 0 0 0
3 1 1 2 0 0 0
4 2 2 4 1 1 2
5 2 2 4 1 1 2
6 2 2 4 1 1 2
7 3 3 6 1 1 2
8 3 3 6 1 1 2
9 3 3 6 1 1 2
10 3 3 6 1 1 2
11 4 4 8 2 2 4
12 4 4 8 2 2 4
13 4 4 8 2 2 4
14 5 5 10 2 2 4
15 5 5 10 2 2 4
16 5 5 10 2 2 4
17 6 6 12 2 2 4
18 6 6 12 2 2 4
19 6 6 12 2 2 4
20 7 7 14 2 2 4
21 7 7 14 2 2 4
22 7 7 14 2 2 4
23 8 8 16 2 2 4
24 8 8 16 2 2 4
25 8 8 16 2 2 4
26 8 8 16 2 2 4
27 9 9 18 2 2 4
28 9 9 18 2 2 4
29 9 9 18 2 2 4
Post-Partum Outpatient Clinic:
Staff Hours
ARNP (1) Mon - Wed 0800-1700
RN (2) Sun - Sat 0830-1700
Scheduler (1) Sun - Sat
730-1600
Maternal Fetal Medicine:
Staff hours
MD (2) Mon – Fri 830-1700
ARNP (1) Mon, Tues, Thu, Fri 0830-1700
Genetic Counselor (1) Mon-Fri 0900-1600
Dietician (1) Mon, Tues, Thu, Friday 0800-1700
LCSW (1) Mon, Tue, Thu 0800-1630
RN (3) Mon - Fri 0700-1730
MA (3) Mon, Tue, Thu, Friday. 0700-1730
*On Wed there will be (2) MA 0730-1630
Ultra Sound Tech (5) Mon – Fri 0830-1700
Scheduler (4) Mon – Fri 0630-1700
Unit Lactation
Day
Night
RN
1
1