The Pediatric Emergency Department (PED) is located on the first floor of the North Campus tower. It is comprised of 13 main treatment bed spaces, including specially equipped rooms for resuscitation and moderate sedation procedures, and 5 observation beds for pediatric patients.
There is a cardiac monitoring system at each bedside with oxygen saturation and several units equipped for ETCO2 capabilities all wired into a central monitoring station. Special patient care services include capability to provide invasive monitoring, in-department radiology, ventilator co-management with respiratory therapy, and emergent specialty procedures.
Description of Patient Populations
The Emergency Department exists to provide highest quality care in a safe environment to all patients that present to our facility from Gainesville, our surrounding areas, any areas within Florida or other states. The Emergency Department provides assessment, triage screening, diagnosis, and treatment to all pediatric patients that present to the Pediatric Emergency Department. The PED assists and supports care for Level I trauma patients in coordination with trauma services. If admission to the hospital is necessary, patient care is transferred to the appropriate admission team and service to provide the continuing care needed as an inpatient.
The most common nursing care activities include the ongoing assessment, treatment interventions, and ongoing re-evaluation related to potential or actual: altered respiratory function, altered cardiac function, altered/impaired neurological status, fluid and electrolyte imbalance, altered body temperature, impaired physical mobility, altered comfort, altered tissue/skin integrity, infection, and behavioral health challenges. 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 Director of the PED is board certified in Pediatric Emergency Medicine and Critical Care. The Emergency Department faculty, emergency medicine, pediatric, surgical, and medicine residents provide 24 hour medical care of the Pediatric Emergency Department. Multidisciplinary comprehensive care of the PED patients are provided by a multidisciplinary team consisting of: hospital based Flight Transport Program, PED nursing team, PED medicine, Paramedics/Critical Care Techs, Support Techs, 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, a Clinical Nurse Leader, RN Coordinator, and a non- RN as Unit Assistant, and a dedicated nurse educator, which covers all the ED’s. The unit staff includes Registered Nurses, Critical Care Techs, Paramedics, and Support Techs. Registered Nurses in the Pediatric Emergency Department meet 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.
Unit requirements for registered nurses in the Pediatric Emergency Department include completion of the following courses when hired or within 6 to 12 months hire to meet Level I verification requirements:
- ACLS provider
- PALS provider
- TNCC provider
- ENPC provider – preferred but not required
A department requirement is to successfully complete ESI Triage training within the first year of hire and completion of orientation to triage after training is completed or sooner if previous documented triage experience. 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.
Paramedics, Critical Care Techs, and Support Techs meet the basic requirements for their positions and functions in accordance with their unit-based job description as described in the Hospital Plan of Nursing Care. Additional unit requirements for Paramedics and Critical Care Tech’s include (but not limited to) training in phlebotomy, performing 12 Lead EKG’s, splinting of extremities, urinary catheter insertion, patient transport, holding for procedures, and maintaining a positive attitude toward patient care.
Nursing care in the Pediatric Emergency Department is based on the team nursing delivery model (as described in the Hospital Plan of Nursing Care). There is one charge nurse responsible for overall operation of each shift. The Nurse Manager, Clinical Nurse Leader and the RN Coordinator are also available for staffing the unit as needs warrant. The remaining Registered Nurses, paramedics, and the Critical Care Techs are assigned to a specific patient assignment. The Paramedic and Critical Care Tech are assigned under the direct supervision of a Registered Nurse and the PED Attending. Minimum staffing is based upon patient census, acuity mix, and the availability of assisting nursing staff. Support Techs provide secretarial and patient throughput support to the direct patient caregivers 24 hours a day.
The Nurse Manager, Clinical Nurse Leader, RN 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 Leader, are responsible for coordinating patient care assignments. Assignment will be done by the Charge Nurses 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 PED)
- Condition of the patient
- Technology required
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 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, educational offerings, other activities are coordinated so that patient care coverage is continuous, as reflected on the staff assignment sheets