The 5-East Unit is a 24-bed inpatient surgical unit located on the 5th floor in the South Tower of Shands Cancer Hospital. The unit consists of twenty-four private rooms, including two negative pressure isolation adult rooms and two rooms for the morbidly obese patients.
Monitoring capabilities include continuous pulse oximetry on the unit and continuous remote cardiac telemetry monitoring from 5-West. Patients requiring bed assignments are based upon patient safety concerns – i.e. placing confused patients and patients at risk for falls near the nursing station. Nursing care is provided 24 hours per day, 7 days per week. Budgeted bed occupancy is 89% with an ADC of 21.3, HPPD of 9.23, HPWI of 6.15, and acuity of 1.5.
Description of Patient Populations
The services of 5-East have a strong statewide referral base accepting patients as hospital-to-hospital transfers as well as admitting patients from the Emergency Department for acute illnesses. Patients are admitted to 5-East following operative procedures for cancers and other diseases of the abdomen, colon, pelvis, breast and gastrointestinal disorders. Common admitting diagnoses include breast cancer, pancreatic cancer, pancreatitis, colorectal cancer, liver cancer, gall bladder disease, abdominal abscess, small bowel obstruction and morbid obesity. The ages of patients served include older teenagers, adults, middle adults, and geriatrics.
Nursing care is focused on the assessment, diagnosis, planning, treatment and evaluation of patients requiring acute care. The 5-East 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 consist of: pain management including patient controlled analgesia; wound management including Vacuumed Assisted Closure Systems, JPs, Duvals; respiratory management including pulse oximetry, oxygen therapy and chest tubes; cardiac management including remote telemetry; nutritional management including TPN, NG-tube/G-tubes, J-tubes, ostomies, NGs; medication management including electrolyte infusions; blood product infusions; safety precautions and patient/family education and discharge support.
Health Care Team
The General Surgery and Surgical Oncology services consist of attending physicians, fellows, chief residents, residents, interns, physician assistants, ARNPs and medical students. Multidisciplinary, comprehensive care of patients and families on 5-East are provided by medicine, nursing, social work services, case management, pastoral care, food and nutritional services, pharmacy, rehab services, and other health care providers as indicated by the patients’ health status and identified needs.
The nursing management structure consists of a Nurse Manager and Clinical Leader. Additional unit support is provided by the Unit Assistant. Unit staff includes Registered Nurses, Patient Care Assistants and Support Techs. The unit leadership group promotes autonomous, accountable nursing practice by supporting staff involvement in unit practice decision making. The department of 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. Registered Nurses and Patient Care Assistants provide hands-on nursing care. Support Techs provide clerical support for the direct patient caregivers and are involved with patient ambulation/mobilization. The Registered Nurse is responsible for guiding care of the patient population based upon an individualized care plan.
Nursing care on 5-East 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 (RN). Skill mix is 70% RN and 30% PCA. The predominant staffing ratio of nurses to patients is 1:4-5 on days/evenings and nights. Depending on staffing needs the Charge Nurse (CN) may be required to take an assignment of patients or no patient assignment. On all shifts, the 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, patient/family requests, monitoring capabilities, and staff competencies. Patients requiring 1:1 observation as a result of personal safety concerns are assigned continuous bedside observers. Observer requests are coordinated by the Charge Nurse through the Central Staffing Office.
The staffing plan is based on a budgeted 9.23 HPPD, 6.15 HPWI and acuity of 1.5 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 the acuity of the classified patients. Additional staffing needs are met on Unit 5-East 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 disasters, the minimum amount of staff required to safely operate up to 85% capacity would be 5 Registered Nurses, 2 PCA’s and 1 Support Tech.
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 meets the patient care needs of the unit. RNs and PCAs do a self-schedule that is published on a 4 week interval, they are able to pick days to work which helps promote a better work life balance.
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.