45 Pediatrics is a 35-bed (13 private and 11 semi-private) inpatient unit located on the east wing of the fourth floor in the North Tower of UF Health Shands Hospital. Within the 35 floor beds, there are 4 private, negative air flow isolation rooms. All beds can accommodate centralized continuous pulse oximetry and seizure monitoring systems located in the nursing station which is under continuous observation by the nursing staff. In addition, all beds also have remote telemetry monitoring capabilities.
Family centered care is provided to patients on the unit, allowing for one parent to be with their child 24 hours per day. A family resource room is available for families to congregate, and access information or communicate via internet. A family room, sponsored by Ronald McDonald® House, located on the 10th floor, offers a place for families to relax, prepare and eat meals, contact family members, and sleep in the hospital. Laundry facilities are also available to families on the fourth floor.
Description of Patient Populations
45 Peds is primarily a medical unit. The patients admitted to the unit represent medical and sub-specialty services, such as General Pediatrics, Pulmonology, Gastroenterology, Endocrinology, Immunology, and Nephrology. Children admitted to 45 Pediatrics range in age from neonates to young adults. Common medical procedures and therapies performed on the unit include intravenous fluid therapy, oxygen therapy, High-Flow Nasal Cannula, Continuous Nebulizer treatments, EKG monitoring, lumbar puncture, peripherally-inserted central catheters, blood administration, and patient controlled analgesia.
The average daily census for the floor is 21.1 patients per day with an average length of stay of 2.25 days. The unit is operational 24 days per 7 days per week.
Nursing staff is committed to providing family centered, age appropriate and innovative patient care through the assessment, diagnosis, planning, treatment and evaluation, and education of patients from admission to discharge. 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. The Registered Nurse is responsible for developing an individualized plan of care in conjunction with the other healthcare professionals. Nursing care delivered by LPNs and PCAs is delegated by the Registered Nurse.
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 staff nurses’ ability and annual performance appraisal.
Support Techs meet the basic requirements for their position and function in accordance with their unit-based job descriptions, as described in the Hospital Plan for Nursing Care. Techs support 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 consists of the Attending, Fellow, Chief Resident, Resident, Intern, Nurse Practitioner, and medical students. In addition to the nursing and medical staff, the multi-disciplinary team for patients also consists of: Licensed Social Workers, Case Managers, Child Life Specialist, Respiratory, Physical and Occupational Therapists, Pharmacist, Dieticians, Lactation Specialist, 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 nursing 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 all staff for consultation and assistance in providing patient care. Patient assignments are made by the CNs and are based upon patient safety, isolation requirements, patient acuity and staff competence. LPN and PCA patient assignments are under the direct supervision of the RN. Support Tech coverage is available 24 hours a day. The staff skill mix for the unit is 80% RN, and 20% PCA/LPN. The predominant staffing ratio of RNs to patients is 1:4. The CN generally does not take a patient assignment, unless necessary to achieve staffing ratios. Patients requiring 1:1 observation due to personal safety risks are assigned observers which are requested through the Central Staffing Office.
The staffing plan for direct patient care providers is based on a budgeted 11.34 HPPD, 8.10 HPWI, and acuity of 1.40. Staffing adjustments are made each shift and reflect projected staffing targets, unit census and acuity of the patients (Quadra-Med Classification System). Patient care assignments are made each shift by the Charge Nurses, based on:
- 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 needs
- Unit activity
In the event of an emergency or disaster, the minimum amount of staff required to safely operate a fully occupied unit with a 75% capacity is 7 RNs, 2 LPN/PCA and 1 ST per shift.
The unit scheduling committee is responsible for developing the staff schedules for the unit. Requests for Scheduled Paid Time Off (PTO) are reviewed individually and granted or denied based on the staffing needs of the unit. Employees submit their requests for time off in conjunction with the ShiftWizard calendar dates. Requests are limited to 2 RNs, and 1 ST and 1 PCA per shift. The following criteria is utilized to determine awarding requested time off: 1) date of PTO request, 2) amount of PTO taken in the past year, and 3) seniority. Requests are granted only if minimum staffing numbers are maintained. Staff is encouraged to trade shifts for day to day PTO requests after the deadline for scheduled requests has occurred. Schedule trades should not incur overtime.
Staff is granted time for educational programs by requesting Education Leave or Administrative Work for unit projects, attending departmental or hospital committees and councils. Mandatory programs sponsored by the unit are given 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.
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 float availability, or the staff may be utilized for unit activities such as quality monitoring, performance improvement initiatives, educational programs, and in-services. If floating is not required, the staff may be granted time off per request or on a rotating basis.
Addendum: Plan for Unit Coverage
When no CSO or Float help is available, the CN triages staff & patients in conjunction with the Nurse Manager/designee:
- Consider adjusting assignments based on acuity
- Relocate patients to facilitate adequate nursing assignment
- Evaluate possible schedule manipulations
- Ask if staff members are available to work additional hours. Ask what shifts they are willing to cover, work extra, or switch
- Ask current staff if they are willing to stay and work extra/overtime
- Nurse Manager or Clinical Leader takes a nursing assignment
- Utilize on call staff if available
- Evaluate status & abilities of orientees
- Evaluate role CN can take in meeting staffing needs
- Request Nursing Coordinator for assistance outside the usual float pool, e.g. STAT RN
- Collaborate with Nurse Manager/Nursing Coordinator of unmet staffing needs if above measures have not been able to meet the patients’ requirements.