Unit 64 Medicine is a 36-bed adult inpatient unit located on the sixth floor in the North Tower of UFHealth Shands. The unit consists of twelve private rooms and twelve semi-private rooms with two of the private rooms having negative airflow isolation capability and/or radiation implant capability.
Monitoring capabilities include continuous pulse oximetry for 24 patients and telemetry monitoring for Units 64, 65, 74 & 75, 95, 11-5, ADTU; maximum monitoring capacity is for 72 patients. Placing confused patients near the nurse’s station or providing a private room for patients receiving palliative care are examples of accommodating special care requirements. Care is provided 24 hours per day, 7 days per week. The unit is budgeted for an average daily census (ADC) of 31.40 (87% occupancy).
Description of Patient Population
The primary admitting services are the academic internal medical teams (Blue, Orange, and Gold), but also provides off-service boarding for services such as MHS, MGI, Red, Green.
Patients are admitted for a wide array of medical diagnoses from the Emergency Department, UFHealth Clinics, as well as hospital-to hospital referrals. Common medical diagnoses include heart failure, chest pain, sickle cell, pneumonia, COPD, diabetes and autoimmune diseases. The populations served include young adult, middle adult and older adult. 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. 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 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 his/her optimum level of health. Nursing care includes but is not limited to: pain management (including patient controlled analgesia); skin/wound management including Vacuum Assisted Closure Systems; respiratory management including pulse oximetry, oxygen therapy and chest tubes; 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; barcode medication management including immunosuppression, and electrolyte infusions; blood product infusions; safety precautions and patient/family education and support.
Nursing staff complete annual competencies/education in the areas of telemetry, glucose point of care testing, resuscitation skills, and restraint management and radiation therapy. RNs and PCAs also attend an annual skills fair focused on high risk areas such as central line associated blood stream infection (CLABSI), catheter associated urinary tract infection (CAUTI), and fall prevention.
Health Care Team
A Chief Medicine Resident is appointed annually by the Chairman and Program Director to provide leadership for the interns and residents. The faculty 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, 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 who 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. In addition to monitoring responsibilities, Monitor 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 64 is based on the total 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. Clerical coverage is provided 24 hours/day due for continuous monitoring of telemetry and pulse oximetry. Skill mix is 70% RN and 30% PCA. The predominant staffing ratio of nurses to patients is 1:4-6 days/evenings/nights. The Charge Nurse (CN) on days, evenings and nights does not routinely take a patient assignment. On all shifts, the CN is available to all staff for consultation and assistance in providing patient care. The CN coordinates bed placement, creates staffing assignments, serves as a resource for low/volume skills, and facilitates emergency response measures. Patient care assignments are made each shift by the CN, as described in the Hospital Plan for Nursing Care. Special considerations are made for patient placements such as: patient safety concerns, patient/family requests, monitoring capabilities, and staffing skill/experience. Patients requiring 1:1 observation as a result of personal safety concerns are assigned sitters. Sitter requests are coordinated through the Central Staffing Office.
Unit staffing budget is formulated using national benchmarks and historical unit acuity data. FY20 staffing planned was created using a 9.01 Direct HPPD, 5.81 Direct HPWI and acuity of 1.55. Daily staffing is adjusted based on unit census, complexity of the patient’s condition, relevant safety and infection control issues, etc. Additional staffing needs are met on Unit 64 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 Monitor Support Techs.
Requests for Paid Time off (PTO) are reviewed on a case by case basis with careful consideration for the unit’s staffing needs. 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, as reflected on the shift assignment sheets.