Trauma — Unit 5 West

Unit 5 West Trauma is a 24-bed inpatient unit located on the 5th floor of the South Tower of Shands UF. The unit includes twenty-four medical/surgical private rooms, including two negative isolation rooms. Monitoring capabilities include continuous telemetry and pulse oximetry monitoring. Care is provided 24 hours per day, 7 days per week. Average bed occupancy is 91%

Description of Patient Populations

The Primary admitting service for Unit 5 West consist of Trauma /Emergency (TRE). Common medical diagnoses of adult patients admitted to this unit include various trauma cases including but not limited to multiple traumas from motor vehicle crashes, craniofacial trauma, thoracic and neck trauma, head injuries, orthopedic trauma, stab wounds, gunshot wounds, spinal cord injuries, bowel resection, ulcerative colitis, abdominal trauma, and emergency surgery (appendectomy, cholecystectomy, small bowel obstructions). Patient population includes adolescents (15 years of age and older), adult, and geriatric. The average length of stay is 2.36.

Nursing Care

Nursing care is focused on the assessment, diagnosis, planning, treatment and evaluation of preoperative, postoperative, nonsurgical trauma patients from admission to discharge with emphasis on cardiovascular monitoring, airway management, patient/family education and support, post-operative and post-trauma care, and initiation of the rehabilitation process. The 5 West 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 epidural and patient controlled analgesia; wound management including Vacuum Assisted Closure Systems, JPs, Duvals; respiratory management including pulse oximetry, oxygen therapy and chest tubes; cardiac management including telemetry; neurological management including TLSO braces, cervical devices, and spinal stabilization; orthopedic management including traction, splints/cast care; nutritional management including TPN, NG-tube/G-tube/J-tube feedings; assessment and management of abdominal/GI drainage systems including G-tubes, J-tubes, NGs; medication management, safety precautions and patient/family education and support.

Health Care Team

The Directors of Trauma Surgery service provide leadership for the unit. The faculty, physician’s assistants, and residents provide 24 hour medical care of the med/surg patients. Multidisciplinary, comprehensive care of patients and families on 5 West are provided by medicine, nursing, social work services, case management, pastoral care, food & nutritional services, pharmacy, rehab services, and other health care providers as indicated by the patient’s health status and identified needs. Collaboration is fostered by weekly patient care conferences attended by nursing staff, medical staff, Patient and Family Services personnel, Rehabilitation Services staff (PT, OT when indicated) and Dieticians as well as by participation in daily service rounds.

Nursing management for the unit consists of registered nurses in the positions of Nurse Manager and Clinical Coordinator. Additional unit support is provided by the Unit Assistant. Unit staff includes registered nurses, patient care assistants, and clerk monitor technicians.

Registered nurses on the unit meet the basic requirements for Registered Nurse staff and function in accordance with the unit-based job description, as described in the Hospital Plan for Nursing Care. Additional unit requirements for registered nurses includes completion of the telemetry course, a positive attitude toward family-centered care, and the ability, willingness, and interest to work with the age-appropriate patients including adolescent, adult and geriatric.

Patient care assistants and Monitor support techs 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 5 West is based on the total nursing care delivery model as described in the Hospital Plan for Nursing Care with coworker assistance. The Patient Care Assistant is assigned under the direct supervision of a Registered Nurse. Unit Monitor Support Tech. coverage is provided 24 hrs. a day due to the monitoring needs of telemetry.

Unit 5 West skill mix consists of 75% RN and 25% PCA. The staffing ratio of nurses to patients is 1:4-5.for the med surg patients. The staffing plan is based on a budgeted 9.19 HPPD, acuity of 1.5 and HPWI of 5.97 and adjusted for the skill mix identified above with an average daily census of 22.84.

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 a sitters, increased number of 1:1 patients, etc.

The Charge Nurse does not typically take a patient assignment but is available for consultation and assistance in providing patient care. Patient care assignments are made each shift by the Charge Nurse, as described in the Hospital Plan for Nursing Care. Additional unit-based staffing need 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

Additional staffing needs are met on the Unit as described in the Hospital Plan for Nursing Care. The need for extra shifts/overtime is determined by the Nurse Manager or designee, in accordance with the Hospital Plan for Nursing Care. Patients requiring 1:1 observation as a result of personal safety concerns are assigned sitters. Sitter requests are coordinated through the Central Staffing Office.

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, 1 PCA and 1 Clerk monitor tech.

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.

Staffing

The minimum number of staff for emergency unit coverage is 2 RN’s on each shift.

Revised January, 2021