44 Pediatrics is a 35 bed, acute care, Medical-Surgical unit with 9 private and 13 semi-private rooms located on fourth floor in the south wing of the north tower of UF Health Shands Hospital. Included within the 35 beds are 4 private, negative air flow rooms, and 4 private, hard-wired epilepsy monitored beds.
The unit has centralized continuous pulse oximetry, telemetry, and seizure monitoring systems located in the nursing station which is under continuous observation of the nursing staff.
Family centered care is provided, with accommodations for one parent to be with their child 24 hours per day. A family resource room is available on the unit for patients and their families to congregate, or access computers. Laundry facilities and a family shower are available on the 4th floor. A family room sponsored by Ronald McDonald® House is located on the 10th floor, which offers families a place to rest, relax, or congregate.
Description of Patient Populations
44 Pediatrics is the primary nursing unit for pediatric patients assigned to the ENT, Neurosurgery, Orthopedics, Oral & Maxillofacial, Pediatric Surgery/Burns/Trauma, Plastics, Transplant and Urology surgical services. The unit is also the primary unit for patients admitted to the Congenital Heart Center and Pediatric Neurology medical services. The unit admits overflow patients on the Pediatric Hospitalist & Pediatric Hematology/Oncology medical services. Children admitted to 44 Pediatrics range in age from newborn to young adult.
Patients undergo surgical or medical management of their diagnoses, congenital condition or traumatic injuries. Patients may present with a variety of underlying medical conditions such as seizures, cognitive disorders, delayed growth and development, or failure to thrive.
Common medical therapies performed on the unit include intravenous fluid therapy, oxygen delivery, EKG and seizure monitoring, peripherally-inserted central catheter management, epidural and patient controlled analgesia, lumbar puncture and blood administration.
The average daily census is 21.34 patients per day with an average length of stay of 2.28 days. The unit is operational 24 hours per day, 7 days per week.
The nursing staff is committed to providing family centered, age appropriate and innovative patient care through the assessment, diagnosis, planning, treatment, evaluation and education of patients and their families from admission to discharge. The Registered Nurse is responsible for developing an individualized plan of care in conjunction with the patients’ healthcare team and professionals. Nursing care that is delivered by the PCAs/LPN is delegated by the Registered Nurse. The nursing staff meets the basic requirements for Registered Nurse (RN), Licensed Practical Nurse (LPN) and Patient Care Assistant (PCA), and function in accordance with the unit-based job descriptions as described in the Hospital Plan for Nursing Care.
Additional unit requirements to prepare the staff to care for acutely ill children are met through a competency based unit orientation program. Following orientation, additional educational objectives are met according to the registered nurse’s ability and annual performance appraisal.
Monitor Support Technicians (MST) meet the basic requirements for their positions and function in accordance with their unit-based job descriptions, as described in the Hospital Plan for Nursing Care. MST staff supports the needs of the multi-disciplinary staff and team within the patient care environment.
Health Care Team
A board certified pediatrician, who is an assistant professor in the Department of Pediatrics, College of Medicine at the University of Florida is the medical director for the unit. The medical team is comprised of Attending, Fellow, Chief Resident, Resident or Intern Physicians, and/or Physician Assistant, Nurse Practitioner and medical students. In addition to the nursing and medical staff, the multi-disciplinary team for patients also consists of a Licensed Social Worker, Child Life Specialist, Case Manager, Respiratory, Physical or Occupational Therapists, Pharmacist, Dietician, and Wound-Skin nurses.
The nursing management structure for the unit consists of a Nurse Manager and Clinical Leader. The management team provides training experiences to maintain staff competency as defined by the unit and role specific job descriptions and the departmental education plan. A Unit Assistant provides administrative support to the unit management team and functions under the direction of the nurse manager.
Nursing care for the unit is based on the total patient care delivery model as described in the Hospital Plan for Nursing Care. Each shift has a designated Charge Nurse (CN) 24 hours per day, 7 days per week. The CN is available to the shift staff for consultation and assistance in providing patient care. Patient assignments are made by the CN and are based upon patient acuity, staff competence, patient safety needs, and isolation precautions. The LPN and PCAs are assigned to patients under the direct supervision of the RN. Unit MST coverage is available 24 hours a day
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 sitters, 1:1 patients, etc. Patient care assignments are made by the Charge Nurses and take into account:
- Complexity of patient condition
- Number and type of isolated patients
- Experience level of the staff
- Previous days’ assignment to facilitate continuity of care
- Frequency of monitoring, and technological or pharmacological support
- Unit geography and location of assigned patients
- Competency level of supplemental and float staff
- Skill mix
- Complexity of patient or family needs
- Unit activity
Scheduled Time Off:
The unit schedule committee is responsible for developing staff schedules. Requests for scheduled Paid Time Off (PTO) are reviewed individually and take into consideration the staffing needs of the unit. Development of the unit schedule takes into consideration the need to balance unit staff regarding competency and schedule requests. Employees submit their requests for time off in conjunction with the Shift Wizard calendar dates. Requests are limited to 2 RNs, and 1 MST and PCA per shift. The following criteria is utilized to determine awarding requests for time off: 1) date of PTO request, 2) amount of PTO taken in the past year, and 3) seniority. Staff is encouraged to trade shifts for day to day PTO requests after the deadline for scheduled requests has occurred. Schedule changes should not incur overtime.
Minimum Emergency Unit Coverage:
In the event of an emergency or disaster, the minimum amount of staff required to safely operate a fully occupied unit at 75% capacity is 7 RNs, 2 LPN/PCA and 1 MST per shift.
The Nurse Manager/designee makes decisions concerning overall adjustments for staffing, including the need for extra shifts or overtime, according to unit census and acuity in accordance with the Hospital Plan for Nursing Care. When additional staff is required, the Central Staffing Office is notified and additional staff may be sent, floated or scheduled. If census and/or acuity are decreased, the Central Staffing Office will be notified of staff float availability, or the staff may be utilized for unit activities such as quality monitoring, performance improvement initiatives, educational programs, in-services, etc. If floating is not needed, the staff may be granted time off on a rotating basis or per request. Staff is granted time for educational programs by requesting Education Leave or administrative time for unit projects, attending departmental or hospital committees or councils, etc. Mandatory programs sponsored by the unit are scheduled during shift hours, or staff is paid to attend. Staff is paid for attending staff meetings. Staff attendance at meetings, education offerings, and other activities are coordinated so that patient care coverage is continuous.
Addendum: Plan for Unit Coverage
When CSO or float staff is not available, the CN will triage unit staff & patients in conjunction with the Nurse Manager/designee:
- Can assignments be adjusted as acuity allows
- Can patients be relocated to facilitate assignments
- Are schedule manipulations possible; evaluate staffing numbers for the week
- Is staff available to work additional hours? Ask what shifts they are willing to cover, work additional, or switch
- Ask current staff if they are willing to stay and work extra/overtime
- Utilize on call staff if available
- Evaluate status & abilities of unit orientees
- Evaluate role of CN in meeting unit staffing needs
- Request Nursing Coordinator assistance from outside the usual float pool, e.g. STAT RN
- Request unit management team to staff
- Collaborate with Nurse Manager/Nursing Coordinator of unmet staffing needs if above measures have not been able to meet the patients’ requirements