Orthopaedic Unit — Unit 6 West

Unit 6 West is an inpatient adult medical surgical unit located on the 6th floor of UF Health Cancer Hospital. The unit consists of all private rooms, including two negative isolation rooms. Capability exists to monitor patients with continuous pulse oximetry to a central monitor in the nursing station and remote cardiac telemetry monitored on 5 West. Budgeted occupancy is 89% with an average daily census of 21.4.

Description of Patient Populations

The primary admitting services for Unit 6 West consist of Orthopaedic and Medical Hospitalist Services. Common medical diagnosis of the patients to this unit include elective total joint reconstruction of hips, knees and shoulders and malignant bone tumor removals such as osteosarcoma. Non-elective patients include various orthopaedic trauma cases and adult fragility fractures. Patient population includes adolescents (older than 13 years), adult and geriatric. Average length of stay is 2.36 days.

Nursing Care

Nursing care focuses on the assessment, diagnosis, planning, treatment and evaluation of preoperative, postoperative and non- surgical patients from admission to discharge with emphasis on post-operative care, functional assessment, pain management, patient/family education and support and initiation of early rehabilitation process. The 6 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 patient controlled analgesia, epidural analgesia and paravertebral blocks; wound management including Vacuum Assisted Closure Systems, JPs, and hemo-vac drains; respiratory management including pulse oximetry and oxygen therapy; cardiac management including remote telemetry; medication management, safety precautions and patient/family education and support.

Health Care Team

The Orthopaedic Surgical Services consist of attending physicians, fellows, residents, interns, physician assistants and medical students. Scheduling of rotations is maintained through the Department of Surgery. Medical Hospitalist Service includes attending physicians. Available support services for 6 west patients include: respiratory therapy, physical therapy, occupational therapy, nutrition services, pharmacy and wound therapy. Patient and Family services including nurse case managers, discharge facilitators and social workers assist in the smooth transition of care from hospital to home or another care facility. Collaboration is fostered by daily patient care rounds attended by nursing staff, medical staff, patient and family services personnel and rehabilitation services staff.

The nursing management structure consists of a Nurse Manager and Clinical Leader with support from a Unit Assistant. Department of Nursing staff is provided training experiences to attain and maintain competence as defined by the unit/role specific job descriptions and the departmental education plan. Registered Nurses and Patient Care Assistants provide nursing care. Support Techs provide both clerical support and patient mobility assistance. The Registered Nurse is responsible for guiding care of the patient based upon an individualized plan. Nursing care delivered by the PCA is coordinated under the direction of the Registered Nurse. The unit leadership group promotes autonomous, accountable nursing practice by supporting staff involvement in unit practice decision making.

Staffing Plan

Nursing care on 6 West is based on the total patient care delivery model (as described in the Hospital Plan for Nursing Care). The Patient Care Assistants (PCAs) are assigned under the direct supervision of the Registered Nurse (RN). Unit clerical coverage is available 24 hours a day. Skill mix is 70% RN, and 30% PCA. The predominant staffing ratio of nurses to patients is 1:5 on days, evenings and nights; however, this may vary based on patient acuity. The Charge Nurse (CN) does not usually take a patient assignment to be available to all staff for consultation and assistance in providing patient care. The CN may take a patient assignment if needed. Patient care assignments are made each shift by the CN, as described in the Hospital Plan for Nursing Care. Patient bed assignments are made by the CN and are based upon patient safety concerns, patient/family requests, monitoring capabilities, and skills required. Patients requiring 1:1 observation as a result of personal safety concerns are assigned sitters. Sitter requests are coordinated through the Central Staffing Office.

The staffing plan is based on a budgeted 9.527 HPPD, 5.91 HPWI, and acuity of 1.62 and adjusted for the skill mix as identified above. Adjustments to the staffing are based on the census and acuity of classified patients (WinfPFS Classification System). Additional staffing needs are met on 6 west as described in the Hospital Plan for Nursing Care. The Nurse Manager or designee, in accordance with the Hospital Plan for Nursing Care and nursing policy, determines the need for extra shifts/overtime.

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, 2 PCA’s and 1 Support 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. Supplemental staff is provided by the Central Staffing Office (CSO) and/ or float RNs from other medical/ surgical areas.

Revised 2/2/21

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