The 94 Medicine IMC of UF Health Shands Hospital is a 36-bed unit and includes monitoring capabilities at each bedside. 94IMC provides treatment for patients requiring complex stabilization and care. These patients are admitted from the Emergency Department, referred from other hospitals, patients on med-surg units requiring a higher level of care or who have had a worsening in condition, patients that were downgraded from MICU, and patients requiring complex cardiovascular or pulmonary management and interventions.
A team of healthcare workers work together to provide excellent care and service: admitting attending physicians, residents, interns, specialists as requested by the primary teams, nurses, social workers, and ancillary personnel.
Description of Patient Populations
Monitoring capabilities include, but are not limited to: EKG monitoring, invasive hemodynamic monitoring, pulse oximetry, and temperature. The patient population consists of multiple medical diagnoses including, but not limited to, sepsis, pneumonia, COPD, respiratory failure, pre & post transplant, drug overdoses, Renal Failure, Liver Failure, ETOH/CIWA, GI Bleed, infectious diseases, cancer, and COVID-19.
Nursing care is focused on the holistic assessment, diagnosis, planning, treatment, and evaluation of patient care, interventions, and treatments. Nursing activities include hemodynamic monitoring, fluid and electrolyte monitoring, vasoactive and inotropic therapy, respiratory management, specialized wound care, nutritional therapy, medication management, and comfort/sedation measures. Patient and family education and emotional support related to the patient’s condition and treatment is an essential element in the nursing care provided.
Health Care Team
Care is provided to patients 24 hours a day/7 days a week. Scheduling of rotations is maintained through the Department of Medicine.
Nursing Management for the unit includes a Nurse Manager, Cosette C. Flores, MSN, RN-BC,Clinical Leader, Jennifer Huys, MSN, RN, CNN-C and Unit Assistant, Brandi Walker. Department of Nursing Staff is provided training experiences to attain and maintain competence as defined by the unit/role specific job descriptions and departmental education plan. Monitor Support Techs provide clerical support and central monitor support for the direct patient caregivers. The Registered Nurse is responsible for guiding care of the patient based upon the individualized care plan. The Patient Care Assistant (PCA) provide direct bedside care: assisting patients with ADL’s including CHG bath, mobility, and Glucometer check. PCA are under supervision of RNs.
Nursing care on the IMC is based on the total patient care delivery model (as described in the Hospital Plan for Nursing Care) with coworker assistance. The Patient Care Assistant (PCA) is assigned under the direct supervision of the Registered Nurse. Monitor support technician coverage is available 24 hours a day. Skill mix is RN 87% and PCA 13%. Each RN is assigned 2-3 patients depending on acuity. The staffing plan is based on a budgeted HPPD 13.71 acuity of 2.07 and HPWI of 6.53 On all shifts, the Charge Nurse (CN) is available to all staff for consultation and assistance in providing patient care. Patient care assignments are made each shift by the CN, as described in the Hospital Plan for Nursing Care. Patient bed assignments are made by the CN and are based upon patient safety concerns, monitoring capabilities, and skill required as well as Admit/ Discharge Criteria per Unit.
Additional unit-based considerations for staffing needs include:
- Complexity of the patient’s condition (frequency of procedures, emotional needs, and physical care needs)
- Technology required
- Relevant safety and infection control issues
- Previous day’s assignment to provide continuity of care
- Staff supplement/float RNs will not be assigned patients who are outside their competency/skill level
- Patient transport requirements
Requests for Scheduled Time Off (STO) will be reviewed on a case by case basis and will take into account the staffing needs of the unit. Requests are granted only if minimum staffing numbers are maintained with coverage that does not incur overtime.
Staff attendance at meetings, education offerings, and other activities are coordinated so that patient care coverage is continuous, as reflected on the shift assignment sheets.
In the event of an emergency such as severe weather conditions or other disaster, the minimum amount of staff required to safely operate up to 75% capacity would be 13 RNs and 2 monitor support technicians and 2 patient care assistants.