Shands Endoscopy Center (SEC) is an outpatient endoscopy facility located at 2001 SW 13th Street, Gainesville Florida. The facility includes 7 preoperative bays, 3 procedure suites, 7 postoperative bays, and 2 Motility procedure rooms. The SEC is dedicated to the delivery of care and procedural intervention for general endoscopic, liver biopsy, and motility procedures. Hours of Operation are from 6:30 a.m. – 4:15 p.m. or until procedures are complete. GI Procedural Scheduling is also located at SEC providing scheduling for both SEC and the Shands Cancer Hospital Endoscopy Suite. Hours of operation are Sunday 3:00 p.m.-7:00 p.m.; Monday through Thursday 8:00 a.m.-7:00 p.m.; Fridays 8:00 a.m.-4:00 p.m.
Description of Patient Populations
The patient population consists of adult outpatients receiving general endoscopy procedures, liver biopsies, and motility procedures (no sedation). Patients arrive from home accompanied by a responsible person who is capable of receiving discharge instructions, signing patient out, and driving them home or accompanying the patient home when there is an additional adult driver who is not the patient. The most common procedures include upper endoscopy, colonoscopy, flexible sigmoidoscopy, esophageal manometry, anorectal manometry, esophageal pH and impedance, esophageal BRAVO pH capsule, SmartPill, video capsule endoscopy, and liver biopsy.
The GI (gastrointestinal) staff strives to provide compassionate patient centered care that recognizes and respects the patient’s values, culture, and preferences consistent with Patient Rights and Responsibilities and Code of Ethics policies. The nursing staff strives to achieve excellence in quality patient care using the nursing process. The focus is on the pre, intra, and post procedure assessment and care of GI procedural patients. The GI unit specific job descriptions and competency requirements identify the skills required for each specific role. Standard of Practice guidelines utilized by the department are consistent with:
- Gastroenterology Nursing, A Core Curriculum
- American Society for Gastrointestinal Endoscopy
- Society of Gastroenterology Nurses and Associates, Inc.
- Association for the Advancement of Medical Instrumentation Standards
- Multisociety Guideline on Reprocessing Flexible Gastrointestinal Endoscopes
Health Care Team
The Endoscopy Medical Director is board certified in his/her respective specialty and a faculty member of the University of Florida Division of Gastroenterology, Hepatology, and Nutrition. Procedural Care is provided by gastroenterology, hepatology, and anesthesia attendings, fellows, CRNA’s, RN’s, PCA, and Surgical Technologists. Support and clerical staff includes a receptionist, financial representatives, and coder. Multi-disciplinary care is provided by nursing, medicine, pharmacy and other health care services as indicated by the patient’s health status and identified needs.
GI Procedural Scheduling is staffed by Coordinators of Scheduling supervised by the Clinical Coordinator.
The nursing management structure consists of a Nurse Director of GI/ Endoscopy and a Clinical Coordinator. In the absence of the Clinical Coordinator, the Charge Nurse will facilitate clinical care delivery and the Director will serve as a resource for problem resolution. There is an assigned Charge Nurse over the Pre/Intra /Post-Procedural areas and Motility every day. The SEC is under the umbrella of the Operations Division with nursing oversight from the CNO.
Staff is oriented to the unit during a planned orientation program based on job requirements and past experience. Competency assessment on identified skills and knowledge needs is performed initially, annually, and on an as needed basis. Staff educational requirements are defined by the unit/role specific job descriptions and organizational and Nursing expectations and requirements. All direct patient care staff are provided training experiences to obtain and maintain competencies in their role as defined by the job description for the specific role.
Basic RN requirements include licensure by the Florida State Board of Nursing and BLS/ACLS certification. Professional certification (CGRN) from the Society of Gastroenterology Nurses Association is available and encouraged.
Basic Surgical Technologist’s requirement is BLS. Professional certification (CFER) from the Certification Board for Sterile Processing and Distribution, Inc. (CBSPD) or CER from the International Association of Healthcare Central Service Materiel Management (IACSMM) is available and encouraged. SGNA Associates and Advanced Associates Programs are available and encouraged. Certification in Surgical Technology (CST) is available from the Association of Surgical Technologists (AST) as applicable.
The team nursing model is used as the method of care delivery on this unit. Staffing of caregivers is based upon actual number of planned cases and number of procedure rooms daily. Scheduled working hours may be flexible, based on the distribution of the case load. Staff support a rotation of an assigned shift on designated Saturdays at the Endoscopy Suite.
Staff coverage is provided from Monday through Friday 6:30am until 4:15pm or until procedures are complete for the day. The unit is closed holidays and weekends.
- Preop= 1 provider day: 2 RN; 2 provider day: 3 RNs
- IntraOp= 1 RN, 1 Surg Tech
- PACU= 1 provider day: 2 RNs; 2 provider day: 3 RNs
- Scope room= 1 Surg Tech
- Motility= 1 RN, 1 Surg Tech
- Resource= 1 RN
- Support: 1 PCA
In GI procedure scheduling, staff coverage is provided Sunday 3pm-7pm, Monday through Thursday 8am-7pm and Fridays 8am-4:00pm. Scheduling is closed holidays and Saturdays.
Patient assignments are made by the Charge Nurse and are based upon safety concerns, experience level/competencies of the staff member, degree of supervision required, relevant safety and infection control issues, complexity of care, monitoring capabilities, and skills required.
The Clinical Coordinator or designee, in accordance with the Hospital Plan for Nursing Care and nursing policy, determine the need for overall adjustment in staff, either increasing or decreasing according to census.
In the event of an emergency such as severe weather conditions or other disaster, the minimum amount of staff required to safely operate at 75% occupancy would be 6 Registered Nurses, 2 Surg Techs, 1 PCA and 1 receptionist.
Requests for Planned Time Off (PTO) 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.
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