New Jersey Department of Health

DAILY PATIENT CARE STAFFING: INPATIENT UNITS

REPORT FOR
(Date)
NOTICE TO CONSUMER

N.J.S.A. 26:2H-5f through 5h (P.L. 2005, c. 21) requires hospitals to post information about staffing and patient-to-staff ratios for the previous shift. Summary reports on staffing for each hospital will be available on the New Jersey Department of Health website at www.nj.gov/health/healthcarequality.

Name of Hospital

Name of Inpatient Unit

Unit Type (Check only one)

Medical-Surgical	Normal Newborn Nursery	Adult Open Psychiatric

Intermediate Care	Neonatal Intensive Bassinets	Adult Closed Psychiatric

Adult Intensive Care Unit/	Neonatal Intermediate Bassinets	Child/Adolescent Open Psychiatric

Critical Care Unit	Pediatrics	Child/Adolescent Closed Psychiatric

Obstetrics (Post Partum)	Pediatric Intensive Care Unit	Substance Abuse
8-Hour Shift (Day, Evening and Night)
Shift	Number of Patients	Staff Type	Actual Hours Worked	Number of Staff	Staff to Patient Ratio
DAY	Registered Professional Nurses	___.___	RNs	1 RN: ___.___ Patients
Licensed Practical Nurses	___.___	LPNs	1 LPN: ___.___ Patients
Unlicensed Assistive Personnel	___.___	UAPs	1 UAP: ___.___ Patients
EVE.	Registered Professional Nurses	___.___	RNs	1 RN: ___.___ Patients
Licensed Practical Nurses	___.___	LPNs	1 LPN: ___.___ Patients
Unlicensed Assistive Personnel	___.___	UAPs	1 UAP: ___.___ Patients
NIGHT	Registered Professional Nurses	___.___	RNs	1 RN: ___.___ Patients
Licensed Practical Nurses	___.___	LPNs	1 LPN: ___.___ Patients
Unlicensed Assistive Personnel	___.___	UAPs	1 UAP: ___.___ Patients
12-Hour Shift (Day and Night)
Shift	Number of Patients	Staff Type	Actual Hours Worked	Number of Staff	Staff to Patient Ratio
DAY	Registered Professional Nurses	___.___	RNs	1 RN: ___.___ Patients
Licensed Practical Nurses	___.___	LPNs	1 LPN: ___.___ Patients
Unlicensed Assistive Personnel	___.___	UAPs	1 UAP: ___.___ Patients
NIGHT	Registered Professional Nurses	___.___	RNs	1 RN: ___.___ Patients
Licensed Practical Nurses	___.___	LPNs	1 LPN: ___.___ Patients
Unlicensed Assistive Personnel	___.___	UAPs	1 UAP: ___.___ Patients
Information on the daily, hospital-wide number of respiratory therapists and physical therapists is posted at:

Description of methods used to determine and adjust direct patient care staffing levels:

HCQ-3

AUG 12

HCQ-3, Daily Patient Care Staffing, Inpatient

hcq-3, HCQ, Health Care Quality, patient care staffing, staffing, hospital, inpatient

ewhite

2007-01-16

NJDOH