6E is a 24-bed inpatient adult surgical unit located on the sixth floor in the South Tower. The unit consists of twenty-four private rooms including two negative isolation rooms. Capability exists to monitor patients with continuous pulse oximetry to a central monitor in the nursing station and remote cardiac telemetry to Unit 5W.
Description of Patient Populations
Patients are admitted to 6E following operative procedures for hepatobiliary diseases, kidney, liver transplants and urology. Also, general surgery and orthopedic patients are admitted to 6E. The services of 6E 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. Common admitting diagnoses include but are not limited to acute /chronic rejection, acute renal failure, end stage renal disease, end stage liver disease, urology resections, prostate and bladder cancer, and kidney stones. The average length of stay is 2.96 days.
Nursing care is focused on the assessment, diagnosis, planning, treatment and evaluation of preoperative and postoperative patients and non-surgical patients from admission to discharge with emphasis on renal, gastrointestinal and nutritional assessment, airway management, patient/family education and support, post-operative care, and initiation of the rehabilitation process. The 6E 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 and epidural analgesia; wound management including Vacuum Assisted Closure Systems, JP and Duval drains; 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, pancreatic drains, NGs; management of renal drains including ileal conduits, foley catheters, renal stents; prevention of post-operative complications and skin breakdown, medication management, safety precautions and patient/family education and support.
Health Care Team
The Transplant and the Urology services consist of attending physicians, fellows, chief residents, residents, interns, physician assistants, and medical students. Scheduling of rotations is maintained through the Department of Surgery and the Department of Medicine. Transplant Coordinators, Patient Care Resource Managers and Case Managers serve as liaisons between the surgical staff, Medical staff and multidisciplinary team, providing continuity of care for patients from admission through clinic follow-up. Available support services for 6E patients include: Transplant Coordinators, Respiratory Therapy, Physical Therapy, Occupational Therapy, Nutrition Services, Wound Therapy as well as Patient and Family services. Collaboration is fostered by weekly patient care conferences attended by nursing staff, medical staff, Patient and Family Services personnel, Rehabilitation Services staff (PT, OT, Communication Disorders when indicated) and Dietitians as well as by participation in daily service rounds. There is also a Comprehensive Unit Based Safety Program team that meets monthly.
The nursing management structure consists of a Nurse Manager and Clinical Leader with support from a Unit Assistant and central Administrative Coordinators. 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 Technicians provide clerical support for the direct patient caregivers and also provide rehabilitation support to patients. The Registered Nurse is responsible and accountable for guiding care of the patient based upon an individualized plan. Nursing care and rehabilitation support delivered by the PCA and Support Technicians are coordinated under the direction of the Registered Nurse. The unit leadership group promotes autonomous, accountable nursing practice by supporting staff involvement in unit practice decision making.
Nursing care on 6E is based on the total patient care delivery model (as described in the Hospital Plan for Nursing Care). The Patient Care Assistants (PCAs) are assigned under the direct supervision of the Registered Nurse (RN). Unit clerical coverage is available 24 hours a day. 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 although this may vary based on the acuity of patients. The Charge Nurse (CN) takes an assignment based on the acuity on the unit. 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 skills required. Patients requiring 1:1 observation as a result of personal safety concerns are assigned sitters. Sitter requests are coordinated through the Central Staffing Office.
The staffing plan is based on a budgeted 9.42 HPPD, 6.16 HPWI, and acuity of 1.53 and adjusted for the skill mix as identified above. A Staffing Grid based on the budgeted HPPD, acuity, and HPWI is identified below. Adjustments to this grid are reflected in the Targeted Staffing projections in Concerro and are based on the census and acuity of classified patients in EPIC .Additional staffing needs are met on 6E as described in the Hospital Plan for Nursing Care. The Nurse Manager or designee, in accordance with the Hospital Plan for Nursing Care and 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 5 Registered Nurses, 2 PCA’s and 2 Support Techs.
Requests for Scheduled Paid 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 so that patient care coverage is continuous. Supplemental staff is provided by the Central Staffing Office (CSO) and/ or float RNs from other medical/ surgical areas. The CSO and float RNs will not be assigned newly transplant patients unless the RN competencies for unit 6E have been completed or they are co-assigned with a 6E resource nurse. Every effort will be made to not assign patients with extensive care issues to CSO and/ or float nurses. STAT RNs will also provide staffing support within the guidelines of the float and unit policies.