Unit 8E Oncology/Medicine is a 24-bed adult inpatient unit located on the eighth floor in the UF Health Shands Cancer Hospital (South Tower). The unit consists of twenty-four private HEPA filter rooms, including two negative isolation rooms. Monitoring capabilities include continuous pulse oximetry on the unit and continuous remote cardiac telemetry monitoring from Unit 5W Patients requiring close monitoring are assigned near the nursing station. Average bed occupancy is 84%.
Description of Patient Populations
Patients are admitted to Unit 8E from Admissions as scheduled appointments, Emergency Department, Shands UF Clinics, and as hospital-to hospital referrals. Patients are admitted for common medical diagnoses include hematological/oncological and immunosuppression. Some of these diagnoses include lymphoma, lung cancer, breast cancer, osteogenic sarcoma, soft tissue sarcoma, acute and chronic leukemias and pre and post bone marrow transplant. Patients are also admitted post-operatively for gynecological oncology diagnoses such as cervical, ovarian and vulvar cancer. Ages of patients served include adult, middle adult and older adult. The average length of stay is 3.34 days.
Nursing care is focused on the assessment, diagnosis, planning, treatment and evaluation of patients requiring acute care. The 8E 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: medication management including immunosuppression, chemotherapy and electrolyte infusions; blood product infusions; pain management including patient controlled analgesia; respiratory management including pulse oximetry, oxygen therapy and chest tubes; wound management including Vacuum Assisted Closure Systems, JPs, Duvals; cardiac management including remote telemetry; nutritional management including TPN, NG-tube/G-tube/J-tube feedings; assessment and management of abdominal/GI drainage systems including G-tubes, J-tubes, ostomies, NGs; safety precautions and patient/family education and support.
Health Care Team
The Unit Chief of 8E Medicine is appointed by the Chief of Hematology/Oncology Division. The Hem/Onc Service consists of attending physicians, fellows, chief residents, residents, interns, Physician assistants, ARNPs and medical students. Scheduling of rotations is maintained through the Department of Medicine. Patient Care Resource Managers, Case Managers and Transplant Coordinators serve as liaisons between the Hem/Onc staff and multidisciplinary team, providing continuity of care for medical patients from admission through clinic follow-up. Available support services for Unit 8E patients include: Pharmacy, Respiratory Therapy, Physical Therapy, Occupational Therapy, Nutrition Services, Integrative Medicine, Enterostomal Therapy as well as Patient and Family services, . Collaboration is fostered by daily patient service rounds which are attended by medical staff, pharmacists, nursing staff, case manager and social worker as well as dieticians and Rehabilitation Services staff (PT, OT) when indicated. There may also be care conferences for more complex cases which would include many of the disciplines listed above.
The nursing management structure consists of a Nurse Manager and Clinical Leader with support from a Unit Assistant. 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 nursing care. Support Techs provide clerical support for the direct patient caregivers and mobility for the patients. The Registered Nurse is responsible for guiding care of the patient based upon an individualized plan.
Nursing care on Unit 8E Oncology/ 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 support tech coverage is provided 24 hours/day. Skill mix is 79% RN and 21% PCA. The predominant staffing ratio of nurses to patients is 1:3-5 on days and nights. The Charge Nurse (CN) may take a modified assignment of 1-2 patients, but typically does not take a patient assignment and is available for consultation and assistance in providing patient care. Patient care assignments are made each shift by the CN, as descried in the Hospital Plan for Nursing Care. Additional unit-based considerations include:
- Experience level of the staff and degree of supervision required
- Complexity of the patient’s condition (frequency of procedures, emotional needs, physical care needs which is reflected in the Medicus system)
- Technology required
- Relevant safety and infection control issues
- Previous days assignment to provide continuity of 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 requiring 1:1 observation as a result of personal safety concerns are assigned Patient Safety Attendants (PSA). Sitter requests are coordinated through the Central Staffing Office.
Unit staffing is based upon budgeted nursing hours per patient day (HPPD) which is formulated using national benchmarks and historical unit acuity data. Daily staffing is adjusted based on unit census and feedback from charge nurses to account for special circumstances that increase patient acuity, such as the need for PSA, increased number of 1:1 patients, etc. The 8E staffing plan is based on a budgeted 9.69 HPPD, 6.25 HPWI and acuity of 1.55 and adjusted for the skill mix as identified above.
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 5 Registered Nurses, 2 PCAs and 2 Unit Clerks.
Requests for Scheduled Time Off (STO) 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, education offerings, and other activities are coordinated so that patient care coverage is continuous.