Unit 65 Family Practice is a 36-bed adult inpatient unit located on the sixth floor, section 5 of the Patient Services Building the North Tower of UF Health Shands Hospital. The unit consists of 12 private and 12 semi-private rooms including two negative pressure isolation rooms. The unit has the capability to centrally monitor patients continuous pulse oximetry. Unit 65 is a remotely monitored telemetry unit. Placing confused patients near the nurse’s station or providing a private room for end of life care patients are examples of accommodating special care requirements. Care is provided 24 hours per day, 7 days per week. Our occupancy rate is 90%.
Description of Patient Populations
Unit 65 primarily serves the Family Medicine service, but also provides off-service boarding for services such as MHS, MIN, and MGI). Patients are admitted to Unit 65 from Admissions as scheduled appointments, Emergency Department, UF Health Clinics, and as hospital-to hospital referrals. Patients are admitted for a wide array of medical diagnoses including heart failure, chest pain, sickle cell, pneumonia, COPD, diabetes, and cystic fibrosis. The age of the population served include adult, middle adult and older adult. The average length of stay varies depending on the diagnosis and the patient’s state of health.
Nursing care is focused on the assessment, diagnosis, planning, treatment and evaluation of patients requiring acute care from admission to discharge. Emphasis is on the holistic delivery of care and focuses on the importance of a head to toe assessment. Patient/family members are primary recipients of education and teachings as well as viewed as collaborators in the delivery of their care. Patient and family education emphasize the identification of risk factors, lifestyle changes, rehabilitation efforts, and discharge planning. The 65 unit/role specific job descriptions identify the patient populations/common diagnoses served, equipment utilized, skills required to perform treatments/procedures, clinical parameters monitored, safety precautions initiated, and emergency events encountered. Nursing activities focus on the care of the patient across the continuum from admission to discharge with the goal to return the patient to the optimum level of health for them. Nursing care includes but is not limited to, assessment, diagnosis, planning, treatment, and evaluation, pain management, ambulation/physical activity, and nutritional support as required by patient condition, infection control, medication administration, basic skin care, and management of medical IV lines, drains, and tubes. Nursing staff are competency assessed annually to care for patients requiring continuous telemetry
Health Care Team
The Family Medicine Group provides leadership for the unit. The faculty, physician’s assistants, and residents provide 24-hour medical care of the medical/surgical patients. The emphasis is on a collaborative approach in the progression of care with the intent of decreasing length of stay. Multidisciplinary, comprehensive care of patients and families on the unit is provided by medicine, nursing, physical therapist, occupational therapist, respiratory therapist, CWOCN’s, social work services, case management, pastoral care, food and nutritional services, pharmacy, rehab services, arts in medicine service, 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 unit-based Unit Assistant and central Administrative Assistant and operates under the supervision of an AVP of Nursing Services. Nursing staff is provided training experiences to attain and maintain competence as defined by the unit/role specific job descriptions and the departmental education plan. The unit emphasizes degree advancement and national certification. Registered nurses and Patient Care Assistants provide direct nursing care. Support Technicians provide clerical support to the unit and mobility/ambulation support for patients. The Registered Nurse is responsible for guiding care of the patient based upon an individualized plan.
Nursing care on Unit 65 Family Medicine is based on the total patient care nursing 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 a Registered Nurse. Unit clerical coverage is provided 24 hours/day by the Support Tech. Skill mix is 70% RN and 30% PCA. The predominant staffing ratio of nurses to patients is 1:4-5 on days/evenings/nights. The Charge Nurse (CN) on days, evenings and nights infrequently takes a modified assignment of 1-2 patients or no patient assignment. On all shifts, the CN is available to all staff for consultation and assistance in providing patient care. The CN oversees bed placement, staffing assignments, is available to offer assistance for daily operations, acts as a resource and monitors staffing numbers. Patient care assignments are made each shift by the CN, as descried in the Hospital Plan for Nursing Care. Patient bed assignments are made by the CN and are based upon patient safety concerns, patient/family requests, monitoring capabilities, and skills required. Patients with significant safety concerns are assigned a 1:1 Patient Safety Attendant (PSA) via the utilization of a patient injury prevention algorithm to determine need for an observer by the charge nurse; requests for 1:1 patient safety attendant (PSA) are coordinated through the Central Staffing Office.
The staffing plan is based on a budgeted 9.41 Direct HPPD, 6.4 Direct HPWI and acuity of 1.47, this is adjusted for the skill mix as identified above.
Additional considerations for staffing include:
- Complexity of the patient’s condition (frequency and length of time for procedures, physical care needs) which are reflected in the Quadramed system
- Relevant safety and infection control issues
- Assignment from the previous day to insure continuity of care
- Central staff/float staff assignment to be altered due to their competency or skill level
- Patient transport requirements
Additional staffing needs are met on Unit 65 as described in the Hospital Plan for Nursing Care. The Nurse Manager or designee, in accordance with the Hospital Plan for Nursing Care and the nursing policy, determines the need for extra shifts/overtime.
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 6 Registered Nurses, 3 PCA’s and 2 Support Techs.
Requests for Paid Time Off (PTO) are reviewed on a case-by-case basis and will consider the staffing needs of the unit. Requests are granted if staffing numbers do not compromise patient safety and that coverage is maintained without incurring overtime.
Staff attendance at meetings, education offerings, and other activities is coordinated by the management team to assure adequate and continuous patient care coverage.