Neuromedicine — Unit 56

Unit 56 is a 24-bed adult inpatient unit located on the fifth floor in the Heart Vascular and Neuro Medicine Hospital. The unit consists of twenty-four private rooms with two private rooms having reverse airflow/isolation capability. Monitoring capabilities include continuous pulse oximetry and cardiac telemetry. Patients requiring close monitoring are assigned near the nurses’ station. Average bed occupancy is 19.2.

Description of Patient Populations

Patients are admitted to Unit 56 from ICU units as transfers, the Emergency Department, the Recovery room, direct admissions from the lobby/clinic, and as hospital-to-hospital referrals. Patients are admitted for treatment of neurologic disorders/ diagnoses (Ischemic and Hemorrhagic stroke, seizure disorders, Myasthenia Gravis, optic neuritis, Gillian barre syndrome, seizure disorders). Unit 56 serves as a secondary unit for neurosurgical and cardiology patients. Ages of patients served include adult, middle adult and older adult.

Nursing Care

Nursing care is focused on the assessment, planning, treatment and evaluation of preoperative, postoperative, and rehabilitative patient needs. The unit 56 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: care of the neurologic patient including, but not limited to, neuro assessments; respiratory management including tracheostomy care, pulse oximetry, oxygen therapy; IV management including PIVs, PICCs, Ports, and other Central Venous Catheters; continuous cardiac monitoring (telemetry); nutritional management including G-tube/J-tube feedings; medication management including heparin infusions, rituximab infusions, electrolyte infusions; blood product infusions to include IVIG; pain management including patient controlled analgesia, nerve blocks; management of surgical drains including JPs, Duval drains; patient rehabilitation related to mobility; fall prevention program initiatives and close observation (behavioral and/or safety related) along with patient/family education and support.

Health Care Team

The patient’s primary service consists of attending physicians, fellows, residents, interns, PAs, ARNPs and medical students. Scheduling of rotations is maintained through the Department of Neurology. Available support services for Unit 56 patients include: Pharmacy, Respiratory Therapy, Rehabilitation services (PT, OT, SLP), Food and Nutrition Services, Social Work/ Case Management services, Lab/Phlebotomy, and Pastoral Care as well as Patient and Family services. Multi-disciplinary collaboration is fostered and determined by the medical, nursing, and supportive needs of the patients and families.

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 unit/role specific job descriptions and the Hospital Plan for 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. PCAs and STs meet the basic requirements for their positions and function in accordance with their unit-based job description, as described in the Hospital Plan for Nursing Care.

Staffing Plan

Nursing care on Unit 56 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 12.27 HPPD and acuity of 1.6 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 will take into account 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.