Medicine/Gynecology — Unit 10-5

Unit 10-5 MS Medicine/Gynecology (GYN) is a 24-bed adult inpatient unit located on the tenth floor in the North Tower. The unit consists of twenty private rooms and two semi-private rooms with one of the private rooms having reverse airflow/isolation capability. Patients requiring close monitoring are assigned near the nurse’s station. Average bed occupancy is 24.

Description of Patient Populations

Patients are admitted to Unit 10-5 MS from the intensive care units as transfers, the Emergency Department, the post-anesthesia care unit/recovery room, direct admissions from the lobby/clinic, and as hospital-to-hospital referrals. Patients are admitted for treatment of GYN reconstructions, panniculectomy, vulvectomy, ovarian cancer, bladder slings, uterine myomectomy, hysterectomy, omentectomy tumor debulking, tracheostomy, radical neck dissection, and thyroidectomy. Ages of patients served include adult, middle adult and older adult. Average length of stay is 72 hours.

Nursing Care

Nursing care is focused on the assessment, planning, treatment and evaluation of preoperative, postoperative, and rehabilitative patient needs. The 10-5 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 analgesia and epidural; wound management including Vacuum Assisted Closure (VAC) Systems; Jackson-Pratt drains(JP drain), Duval drains; respiratory management including pulse oximetry, oxygen therapy, chest tubes; intravenous management including peripheral intravenous lines (PIV), peripherally inserted central catheters (PICC), port-a-catheters, and other central venous catheters; telemetry; nutritional management including total parenteral nutrition (TPN), and nasogastric tube (NG tube)/gastrostomy tube (G-tube)/ jejunostomy tube (J-tube) feedings; assessment and management of abdominal/gastrointestinal drainage systems including G-tubes, J-tubes, ostomies, and NGs; medication management, including heparin infusions, electrolyte infusions, and blood product infusions; fall prevention program initiatives and close observation (behavioral and/or safety related) along with patient/family education and support.

Health Care Team

The patient’s primary service consists of attending physicians, fellows, and residents, interns, physician assistants (PA), advanced registered nurse practitioners (ARNP) and medical students. Scheduling of rotations is maintained through the Departments of GYN and Medicine. Available support services for Unit 10-5 MS patients include: pharmacy, respiratory therapy, rehabilitation services (Physical Therapy, Occupational Therapy, and Speech Language Pathology), food and nutrition services, social/case management services, and pastoral care, as well as patient and family services. Multi-disciplinary collaboration is fostered and determined by the medical, nursing, and supportive needs of the patients and families.

The nursing management structure consists of a unit-based Nurse Manager, Clinical Leader and Unit Assistant with support from a central Administrative Coordinator. The unit leadership group promotes autonomous and accountable nursing practice by supporting staff involvement in unit practice decision making. Nursing staff is provided training experiences to attain and maintain competence as defined by the unit/role specific job descriptions and the Hospital Plan for Nursing Care. Registered Nurses (RN) and Patient Care Assistants (PCA) provide nursing care. Support Techs (ST) provide secretarial and patient mobility support to the direct patient caregivers. The RN is responsible for guiding care of the patient based upon an individualized plan. PCAs and STs 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 10-5 MS Medicine/GYN is based on the total patient care nursing delivery model, as described in the hospital plan for nursing care, with coworker assistance. The PCA is assigned under the direct supervision of a RN. Skill mix is 70% RN and 30% PCA. The predominant staffing ratio of nurses to medical/surgical patients is 1:4-6 on days/evenings/nights. The Charge Nurse (CN) may need to take a modified assignment patient or no patient assignment. On all shifts, the CN is available to all staff to provide oversight of care of patients on the unit, support and foster continued staff education/development, along with aiding with patient care. Patient care assignments are made each shift by the CN. Patient bed placement is made in collaboration with the CN and is based upon unit-based patient population requirements, patient safety concerns, monitoring capabilities, and skills required. Patients requiring 1:1 observation as a result of personal safety concerns are assigned Patient Safety Assistant (observation) staff. Observer requests are coordinated through the Central Staffing Office.

The staffing plan is based on a budgeted 8.4 HPPD, 5.0 HPWI and acuity of 1.68 and adjusted for the skill mix as identified above. Adjustments to the staffing ratio are reflected in the targeted staffing projections in Shiftwizard Scheduler Program and are based on the unit census and acuity driven by nursing documentation in EPIC, our electronic medical record system.

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 RNs, 2 PCAs and 1 ST.

Requests for scheduled Paid Time Off (PTO) will be reviewed on a case by case basis and will consider 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 with management team to ensure patient care coverage is maintained.

Reviewed 01/12/2021

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Jennifer Zimmerman, RN, explaining to a parent and her daughter how to use a bedside asthma action plan.