The Cardiology ICU/IMC (Unit 76) is a 24-bed inpatient unit located on the 7th floor of the UF Health HVNM Hospital (east tower). This unit provides complex invasive hemodynamic monitoring and treatment of adult patients during the critical and intermediate phase of cardiac care management.
The unit consists of twenty-four private rooms, two that are negative air-flow compatible, one that is bariatric compliant. All bed spaces are equipped with hard wiring, and telemetry capable bedside monitors. Monitoring capabilities include EKG, pulse oximetry, non-invasive blood pressure monitoring, capnography and invasive hemodynamic pressure signals. Bedsides may also be equipped with bedside continuous cardiac output monitoring and SvO2 monitoring (invasive and non-invasive). Remote alarm capabilities (monitor and ventilator) exist at the central nursing station as well as within each nursing alcove. The patients are not segregated to a particular area based on ICU or IMC level of care. Patients are; however, placed strategically to provide optimal nursing care to meet individual patient and staffing needs. Care is provided 24 hours a day, seven days a week. Average bed occupancy is 82%.
Description of Patient Populations
Patients are admitted to the Cardiology Intensive Care/ Intermediate Care Unit (CICU/IMC) from the Cardiac Catheterization Lab, Emergency Department, general floor, or are directly admitted for continued cardiovascular monitoring. Patients admitted to the CICU require monitoring and or interventional therapy at intervals ranging between one to two hours. The cardiovascular population includes patient’s status post coronary artery revascularization, cardiac transplantations, and ventricular assist device implantation. Patients may also come from the cardiac catheterization lab status post PCI, STEMI or intra-aortic balloon pump (IABP) placement. Patients are also admitted to Unit 76 for targeted temperature managements post cardiac arrest, exacerbation of heart failure symptoms or in cardiogenic shock requiring short term mechanical circularity support. The ages of patients admitted to the CICU/IMC range from adult to elderly. The average length of stay is 4.9 days.
Common medical procedures and therapies performed in the unit include: arterial, central venous, and pulmonary artery line placement, chest tube removal, intubation and extubation, temporary cardiac pacing, mechanical ventilation, intra-aortic balloon counter pulsation, continuous veno-venous hemofiltration, hemodialysis, percutaneous tracheostomy and support with both long term and short term ventricular assist devices.
Nursing care is focused on the assessment, diagnosis, planning, treatment and evaluation of patients requiring intensive and intermediate care. Nursing activities include hemodynamic (arterial, central venous pressure, pulmonary artery pressures, intra-abdominal pressures, arterial and venous oxygenation and capnography) monitoring, rhythm interpretation, fluid and electrolyte monitoring, vasoactive and inotropic therapy, respiratory management in both mechanically- ventilated and spontaneously-breathing patients, postoperative recovery, specialized wound care, nutritional therapy, medical management, rehabilitation initiation, and comfort/palliative care measures as indicated. Patient and family education and emotional support related to the patient’s condition and treatment is an essential element in the nursing care provided.
Registered nurses in the CICU meet the basic requirements for Registered Nurse staff, and function in accordance with the nursing department job description, as described in the Hospital Plan for Nursing Care. Additional unit requirements for registered nurses include: temporary pacing, open cardiac arrest management, pulmonary artery catheter removal, chest tube removal, continuous renal replacement therapy, intra-aortic balloon pump, ventricular assist devices (temporary and durable), and targeted temperature management, and external cardiac defibrillation.
Health Care Team
The Medical Director for the cardiology ICU/IMC is a board certified heart failure cardiology attending physician. The cardiology faculty, residents, and advanced practice providers (physician assistants and nurse practitioners) provide 24-hour medical care to the patients seven days per week. Critical Care Medicine (CCM) faculty, fellows and advanced practice providers provide intensive care/ventilator management and care to select patient on Unit 76. Interdisciplinary, comprehensive care is provided by the medical and nursing staffs, respiratory therapy, social services, case management, rehabilitative services, food and nutrition services, cardiopulmonary services, pharmacy, pastoral care, and other health care providers as indicated by the patient’s health status and identified needs.
The nursing management structure consists of a Nurse Manager and Clinical Leader with support from a Clinical Nurse Specialist, and a Unit Assistant. The management team provides training experiences to attain and maintain competence as defined by the unit/role specific job descriptions and the departmental education plan.
Unit staff includes registered nurses and support techs. Support techs meet the basic requirements for their positions and function in accordance with their unit-based job description, as described in the Hospital Plan for Nursing Care. Their job responsibilities are performed under the direct supervision of the registered nurse.
Nursing care for the cardiology ICU/IMC is based on the total patient care delivery model with co-worker assistance, as described in the Hospital Plan for Nursing Care. Each shift has a designated charge nurse and support tech twenty four hours a day. Patient bed assignments are made by the charge nurse and are based upon patient safety/isolation concerns and acuity levels. The bedside registered nurse has authority and accountability for decision making for the patient(s) assigned on his/her shift.
The skill mix for the unit is 100% RN; no assistive staff. The usual staffing ratio is 1:2. Occasional changes in ratios, either 1:1 or 1:3 ratios, are accommodated based on the prescribed level of care and ongoing needs of the patient. The staffing plan is based on a budgeted 15.96 HPPD, 6.54 HPWI, and acuity of 2.44 and adjusted for the skill mix as identified above. Adjustments to this grid are reflected in the targeted staffing projections in ShiftWizard and are based on the census and acuity of classified patients. Additional unit-based considerations for staffing needs include:
- Complexity of patient condition
- Number and type of isolated patients
- Experience level of the staff
- Previous days’ assignment to facilitate continuity of care
- Frequency of monitoring and technological support
- Impact of complex family/social situations
- Competency level of supplemental and float staff; staff mix
- Off-unit requirements
- Unit activity
The Nurse Manager/designee makes decisions concerning overall adjustments of staff, including need for extra shifts and/or overtime, according to unit census and acuity in accordance with the Hospital Plan for Nursing Care. When additional staff is required, the Central Staffing Office is notified and additional staff may be sent, floated or scheduled. If census and/or acuity is decreased, the Central Staffing Office will be notified of float availability, or the staff may be utilized for unit activities such as quality initiative monitoring, educational programs, in-services, etc. If floating is not required, the staff, may be granted time off per request or on a rotating basis. Staff is granted time for educational programs by requesting Administrative Leave for off unit continuing education activities. Mandatory programs sponsored by the unit are given during shift hours or staff is paid to attend. Staff are paid for attending staff meetings. Staff attendance at meetings, education offerings, and other activities are coordinated so that patient care coverage is continuous.
Requests for Scheduled Paid Time Off (PTO) will be reviewed on a case-by-case basis and will take into account the staffing needs of the unit. The unit schedulers will be in charge of preparing the unit schedules for the staff. Preparation of the unit schedules will take into consideration the need to balance unit-staffing needs and requested time off. The schedule is ultimately reviewed and approved by the Nurse Manager/designee.
In the event of an emergency, such as extreme weather conditions or other disaster, the minimum amount of staff required to safely operate this unit with a 75% capacity is 12 RNs and 1-2 support techs per shift.
Addendum: Plan for Unit Coverage
When no CSO or Float help is available:
- Can assignments be adjusted to pair patients as acuity allows?
- Are 1:1’s due to unit geography? Can patients be moved to facilitate pairing?
- Are schedule manipulations possible; evaluate numbers for the week.
- Contact staff who may be interested in extra worktime. Ask what shifts they are willing to cover, work extra, or switch to.
- Ask current staff if they are willing to stay and work extra/overtime.
- Evaluate orientees ability to come off orientation or operated in an expanded role with their preceptor. This can only be considered if the orientee has been on the unit greater than eight weeks (for inexperienced nurses) or greater than a week (ICU experienced nurses).
- Evaluate whether the charge nurse is capable of coming into the numbers.
- Ask Nursing Coordinator for help outside of our usual float pool – do we have med/surg boarders and a MS nurse can manage, same with IMC float nurses.
- If all possible resources have been evaluated and implemented to the best of your ability, notify on call unit management team member.
Revised: January 7, 2021