Unit 57 is a 24-bed adult inpatient unit located on the fifth floor in the Cardiovascular Neuromedicine Hospital. The unit consists of twenty-four private rooms, including two negative pressure isolation rooms. Eight of the private beds are designated as the Epilepsy Monitoring Unit (EMU), patients are admitted to these beds electively for continuous EEG monitoring to aid in further diagnosis and treatment of their epilepsy. Monitoring capabilities include continuous pulse oximetry on the unit and remote cardiac telemetry monitoring from Unit 66. Patients requiring close monitoring are assigned near the nursing station. Average bed occupancy is 20.48.
Description of Patient Populations
Patients are admitted to Unit 57 from Neuro ICU as transfers, the Emergency Department, UF Health Shands Clinics, and as hospital-to-hospital referrals. Patients are admitted for neurosurgical procedures and neurological conditions which may include hemorrhagic and ischemic stroke, trigeminal neuralgia, intracranial mass/tumors, brain/spinal cord injuries, meningitis, neuromuscular disorders, spinal fractures, seizures, etc. Ages of patients served include adult, middle adult and older adult.
Nursing care is focused on the assessment, diagnosis, planning, treatment and evaluation of patients requiring acute care. The 57 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 (PCA) and epidurals; wound management, including Vacuum Assisted Closure Systems (wound VACs); lumbar drains, ventriculostomies, JPs, Duvals; respiratory management, including pulse oximetry, tracheostomies, oxygen therapy, and chest tubes; cardiac management including remote telemetry; nutritional management including gastric feedings; assessment and management of abdominal/GI drainage systems including G-tubes, J-tubes, ostomies; medication management, including heparin infusions, electrolyte infusions; blood product infusions to include IVIG; fall and safety precautions and patient/family education and support.
Health Care Team
The Neuromedicine services consist of attending physicians, fellows, chief residents, residents, interns, PA’s, ARNP’s and medical students. Scheduling of rotations is maintained through the Department of Neurosurgery. Patient Care Resource Managers, Case Managers and Social Services function as liaisons between the Neurosurgery medical staff and multidisciplinary team, providing continuity of care for patients from admission through clinic follow-up. Available support services for Unit 57 patients include: Pharmacy, Respiratory Therapy, Physical Therapy, Occupational Therapy, Nutrition Services/Dietician, Ostomy/Wound Care, Pastoral Care as well as Patient and Family services. Collaboration is fostered by monthly interdisciplinary quality care conferences attended by nursing staff, medical staff, Patient and Family Services personnel and support staff indicated above.
The nursing management structure consists of a unit-based Nurse Manager, Clinical Leader and Unit Assistant, with support from a central Administrative Coordinator. The unit leadership group promotes autonomous, accountable nursing practice by supporting staff involvement in unit practice decision making. Nursing staff is provided training experiences to attain and maintain competence as defined by the unit/role specific job descriptions and the Hospital Plan for the Provision of Nursing Care. Registered Nurses (RN) and Patient Care Assistants (PCA) provide nursing care. Support Techs (ST) provide secretarial and patient mobility support to the direct patient caregivers. The RN is responsible for guiding care of the patient based upon an individualized plan. PCA and ST meet the basic requirements for their positions and function in accordance with their unit-based job description, as described in the Hospital Plan for the Provision of Nursing Care.
Nursing care on Unit 57 Neuromedicine is based on the total patient care nursing delivery model (as described in the Hospital Plan for Nursing Care) with coworker assistance. The PCA is assigned under the direct supervision of a RN. Skill mix is 70% RN and 30% PCA. The predominant staffing ratio of nurses to medical/surgical patients is 1:5 on days/evenings/nights. The Charge Nurse (CN) is utilized primarily as a resource for staff but may need to take a modified assignment of 1-2 patients. On all shifts, the CN is available to all staff to provide oversight of care of patients on the unit, support and foster continued staff education/development, along with providing assistance with patient care. Patient care assignments are made each shift by the CN. Patient bed placement is made by the charge nurse in collaboration with the nursing coordinator and is based upon unit-based patient population requirements, patient safety concerns, monitoring capabilities, and skills required. Patients requiring 1:1 observation as a result of personal safety concerns are assigned Patient Safety Observers. Observer requests are coordinated through the Central Staffing Office.
The staffing plan is based on a budgeted 10.3 HPPD and acuity of 1.63 and adjusted for the skill mix as identified above. Adjustments to the staffing ratio are reflected in the targeted staffing projections in API healthcare and are based on the unit census and acuity driven by nursing documentation in EPIC, our electronic medical record system.
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 4 Registered Nurses, 2 PCAs and 1 Support Tech.
Requests for Scheduled Time Off (STO) will be reviewed on a case by case basis and depend upon 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 with management team to ensure patient care coverage is maintained.