Adult Emergency Departments

The Adult Emergency Department (AED) is a 62-bed unit located on the first floor of the South Campus tower, within the medical network associated with the University of Florida. There are 44 monitored core beds, 3 triage screening rooms, a 9 bed lower-acuity area, and a registration area. There is also a 6-bed trauma/resuscitation area, with full monitoring capabilities with overhead x-ray in each of the trauma suites.

There are also three wireless portable units with cardiac non-invasive blood pressure and oxygen saturation capabilities wired to a central monitor station. The monitoring station is staffed 24/7 by a monitor support technician. There are telemetry and glucoview monitors at each nurses’ station and in the physician work areas in order to allow continuous clinical observation. Special patient care requirements include capability to provide invasive monitoring, ventilator co-management with respiratory therapy, and the ability to perform emergent specialty procedures. There are radiology services within the department. We are a Level 1 Trauma Center, and a tertiary care facility. The AED has an annual volume of 67,000 patient visits.

Description of Patient Populations

The AED exists to provide quality care to residents of Gainesville and the surrounding areas for patients that are acutely ill or injured. The AED provides assessment, triage screening with telemedicine capability, diagnosis, and treatment to all age populations, including pediatrics. The AED provides and supports care for Level I injured trauma patients in coordination with trauma services. The ED is a STEMI (PCI) receiving facility, and is accredited by the American College of Cardiology as a Chest Pain Center and Primary PCI with resuscitation. Our ED is also a Comprehensive Stroke Center. If admission to the hospital is necessary, patient care is transitioned to the appropriate admission team and service in order to provide the continuing care needed.

Nursing Care

The AED nursing staff provide comprehensive high-quality patient care for a variety of patients, many with highly-complex medical conditions. The most common nursing care activities include the assessment, diagnosis and treatment of potential or actual altered respiratory function, potential or actual altered cardiac function, potential or actual altered/impaired neurological status, potential fluid and electrolyte imbalance, potential or actual altered body temperature, potential impaired physical mobility, potential or actual altered comfort, potential or actual tissue/skin integrity, and potential or actual infection. Patient and family discharge education related to the patient’s condition and treatment is an essential element in the nursing care provided. Nurses care for all age populations as well as any diagnosis that may present to the department.

Health Care Team

The Medical Directors of the Emergency Department are board certified in Emergency Medicine and Critical Care. The Emergency Department faculty, emergency medicine, pediatric, surgical, and medicine residents provide 24-hour medical care of the Emergency Department. Multidisciplinary comprehensive care of the Emergency Department patients is provided by pre-hospital providers, a hospital based Flight Transport Program, nursing, medicine, social work services, pastoral care, pharmacy, cardiopulmonary services, and other health care providers as indicated by the patient’s health status and identified needs.

Nursing management for the unit includes Registered Nurses in the positions of Nurse Manager, Clinical Nurse Leaders (3), ED Coordinators (7), a non-RN as an Administrative Assistant, and a Unit Assistant (clerical support). The unit staff includes Charge Nurses, Registered Nurses, Critical Care Technicians, Monitor Support Technicians, Support Technicians, Mental Health Technicians, Materials Specialists, and Paramedics. Registered Nurses in the Emergency Department meet at a minimum the basic requirements for the Registered Nurse staff, and function in accordance with the unit-based job description, as described in the Hospital Plan for Nursing Care. We have specialty nurses to include Forensic Nurses (SANE), Stroke RN, Intake RN, and Telemedicine RNs to provide focused care to these populations.

Unit requirements for registered nurses in the Emergency Department include completion of the following courses when hired or within 12 months of hire to meet Level I Trauma Center verification requirements:

• ACLS provider
• TNCC provider
• ENPC provider or PALS provider
• Handle With Care (de-escalation training)
• Ventricular Assist Device (VAD) training
• Sexual Assault/Forensic Nurse training
• Emergency Severity Index (ESI) Training for emergency triage and assessment

An additional departmental requirement is completion of orientation of care of critically ill patients of all ages, and the ability, willingness, and interest to work with the age appropriate and developmental needs of patients.

Critical Care Techs, Monitor Support Techs, Mental Health Techs, Support Techs, Materials Specialists and Paramedics meet at least the minimum requirements for their positions. They function in accordance with their unit-based job description as described in the Hospital Plan of Nursing Care. Additional unit requirements for Critical Care Tech’s include training in phlebotomy, performing 12 Lead EKG’s, splinting of extremities, patient transport, and a positive attitude toward patient care. Additional unit requirements for Paramedics include training in phlebotomy, IV placement, performing 12 Lead EKG’s, splinting of extremities, patient triage, patient transport, and a positive attitude toward patient care.

Staffing Plan

Nursing care in the Emergency Department is based on the team nursing delivery model (as described in the Hospital Plan of Nursing Care). There is an ED coordinator and one charge nurse assigned per shift, responsible for overall operation of the shift. We also have a “first nurse”, a registered nurse assigned to triage in the lobby. The Nurse Manager, Clinical Nurse Leaders, and the ED Coordinators are also available for staffing the unit as needs warrant. The remaining Registered Nurses, Paramedics and Critical Care Techs are assigned to a patient care team or the waiting room. The Critical Care Tech and Paramedic are assigned under the direct supervision of a Registered Nurse and the ED Attending. Minimum staffing is based upon patient census, acuity mix, and the availability of assisting nursing staff. Staffing varies slightly during the week according to predicted patient arrivals. Monitor support technicians provide cardiac monitoring 24 hours a day. Support Techs provide secretarial and patient mobility support to the direct patient caregivers 24 hours a day.

The Nurse Manager, Clinical Nurse Leaders, ED Coordinator, or assigned shift Charge Nurses will make decisions concerning overall adjustment of staff, either increasing or decreasing according to census/acuity. The Nurse Manager or Clinical Nurse Leaders are responsible for coordinating patient care assignments. Assignment will be done by the ED Coordinator on each shift based on the following:

• Experience level/competencies of the RN
• Degree of supervision needed by the individual and its availability
• Relevant safety and infection control issues
• Complexity of care of patients required by nurses
• Previous days assignment (staff rotating through all areas of the ED)
• Condition of the patient
• Technology required

UF Health is a designated Level 1 Trauma Center. In the designated trauma/resuscitation area, there will be a minimum of two (2) registered nurses per shift dedicated to that area. There is a core trauma team (Tier 1), consisting of highly-skilled ED RN’s who have completed a rigorous application process to be considered dedicated trauma nurses. All ED RN’s are trained in trauma care, and will rotate through the trauma area as additional support when census or acuity dictates. Trauma care is a specialized skill, and a priority is placed on ensuring that our team members are competent. Our trauma team document in the Trauma Narrator in the Epic EMR. This documentation includes, at a minimum:

1. The time EMS called the trauma alert
2. The time of the trauma alert patient’s arrival in the resuscitation area
3. The prehospital or hospital reason for trauma alert being called
4. The time of arrival for each trauma team member and physician consultant
5. Serial physiological measurements and neurological status
6. All invasive procedures performed, and results
7. Laboratory tests
8. Radiological procedures
9. The time of disposition and the patient’s destination from the resuscitation area
10. Complete nursing assessment
11. Weight for pediatric trauma patients
12. Immobilization measures
13. Total burn surface area and fluid resuscitation calculations for burn patients
14. The time the trauma alert ends
15. Critical Care Time documentation

Additional staffing needs are met in the Emergency Department (as described in the Hospital Plan of Nursing Care). The Nurse Manager or designee, in accordance with the Hospital Plan of Nursing Care determines the need for extra shifts/overtime. Requests for Paid Time Off (PTO) will be reviewed on a case by case basis and will consider 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, educational offerings, other activities are coordinated so that patient care coverage is continuous, as reflected on the staff assignment sheets.

Shands at UF Emergency Department Revised Staffing Plan Adult ED 2021

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