Pulama is a 34 bed medical/surgical unit. The average age varies as well as the diagnoses of the patients. The most common diagnoses are pneumonia, cellulitis, and cancer. The unit has one negative pressure room, and is expanding its palliative care program and capacity. The day shift nurse-staffing ratio is 5:1 on day shift, and 6:1 on evening shift. CNAs are 10:1 regardless of the shift. We also have a patient care tech who runs the desk and is able to help with patient tasks. On days, a dedicated charge nurse may only take patients with increased staffing needs, or depending on other factors. There is also a unit pharmacist who is available M-F 8am to 430pm to answer questions, verify medications, and assist with discharge teaching for medications. Case management consists of RNs and Licensed Social Workers who assist in social service referrals, and discharge planning. Each Case Manager follows a specific physician; each hospitalist has a Case Manager and the community physicians have their own Case Manager that they work with.