The Renal Services Program at the University of Florida consists of separate inpatient and outpatient units for pediatric and adult patients. The nursing staff collaborates with other team members to care for patients receiving renal replacement therapy, for acute renal failure and End Stage Renal Disease.
Staff in the acute/pediatric unit have been cross-trained and are competent to treat acute adult patients as well as acute and chronic pediatric patients. Hemodialysis coverage for these populations is provided at Shands UF 24 hours a day, 7 days per week. The inpatient adult unit (acute dialysis) is an 11-station special care unit located on the hospitals fifth floor, north tower, and 6 stations in 6thFloor, East Tower (HVN).
The adult unit serves the medical/surgical population, certain percentage of stable ICU/IMC patients, and patients from Select Hospital. All patients with hemodynamic instability have their dialysis procedures performed at their bedside. The pediatric outpatient dialysis unit is a 5-station unit also located on the fifth floor of the hospital adjacent to, but physically separate from the inpatient adult unit. The pediatric unit provides second shift treatment for pediatric patients on side B of the 5th floor unit. Both the inpatient adult unit and the pediatric unit provide care to patients who require hemodialysis and peritoneal dialysis. Continuous Replacement Therapy (CRRT) is provided by trained ICU staff.
The Adult Chronic Unit is located at 2409 SW Archer Road. This unit has 24 hemodialysis stations and a home-training area with 3 clinical rooms. Hours of operation for the chronic area are: 05:00 am to 5:30 pm, with two shifts of hemodialysis, Monday – Saturday. Average occupancy is 100% first shift and 99 to 100 % second shift.
Description of Patient Population
The Renal Services/Dialysis Department exists to provide quality care to residents of Gainesville and the surrounding area. Staff working in the Renal Service Program strives to achieve a new standard of excellence in caring for the patient populations requiring renal replacement therapy. The staff is committed to patient advocacy and innovative patient care through encouraging family participation in care and soliciting patient and family feedback. The patient population is made up of patients who have been diagnosed with End Stage Renal Disease (ESRD) or Acute Renal Failure and require renal replacement therapy.
The staffs of the Renal Program assess and treat the needs of the unit’s patient population. Clinical functions include hemodialysis, peritoneal dialysis, administration of blood products (acute settings), intravenous medication administration, vascular access studies, and kinetic studies per regulations and standards of care.
Nursing care is focused on the assessment, diagnosis, planning, treatment and evaluation of patients requiring acute or chronic dialysis treatment. Modalities for acute and chronic patient population include Hemodialysis, Peritoneal Dialysis, and Continuous Renal Replacement Therapy (Acute settings-ICU). The dialysis unit/role specific job descriptions identify the patient populations, equipment utilized, skills required to perform treatments/procedures, clinical parameters monitored, safety precautions initiated, and emergency events encountered. Nursing activities consist of: perform safely and effectively dialysis treatment prescribed according to nephrologist prescription, respiratory management including pulse oximetry, oxygen therapy. Pain management including patient controlled analgesia (acute unit); assessment and management vascular access; medication management including blood product infusions (acute unit) ESA (Aranesp/ EPO) Zemplar, Sensipar, Parsavib, Ferrlecit administration; safety precautions and patient/family education and support.
Health Care Team
The Dialysis Units consists of medical director (acute, pediatric, & chronic unit), adult and pediatric nephrologist, physician assistant (chronic unit), and nephrology fellows.
The nursing management structure consists of a Director, Clinical Coordinator Chronic & Acute/Pediatric Dialysis, Assistant Business Manager, Administrative Assistant. The unit staff includes Registered Nurses, Vascular Access Coordinator (Certified Clinical Hemodialysis Technician). Receptionist / Clerks provide clerical support for the direct patient caregivers. The Registered Nurse is responsible for guiding care of the patient based upon an individualized plan.
Departments of nursing staff are provided training experiences to attain and maintain competence as defined by the unit-based specific job descriptions and the departmental education plan. Other members of the multidisciplinary care team include Social Worker and Dietitian at adult Chronic OP unit.
Collaboration on the units among nurses is fostered by the mentoring of staff, the participation in multidisciplinary care rounds, and commitment to a team approach to care. Patient assignments are made by Charge Nurse based on the identification of patient care needs and competency levels of the practitioner. All registered nurses are required to complete the clinical skill measurements required for orientation, maintain annual competence, and annual clinical skill measurements. Nursing staff are provided training experiences to attain and maintain competence in their role as defined by the job description for the specific role and the departmental education plan.
Nursing care on Dialysis is based on the team nursing delivery model (as described in the Hospital Plan for Nursing Care) with coworker assistance. The Vascular Access Coordinator /Certified Clinical Hemodialysis Technician (CCHT) role is to focus in achievement of vascular access outcomes and support dialysis team as needed. VAC coordinates patient care with dialysis team, PA, and Medical team.
Staff coverage is provided from Monday- Saturday 12 hours shift (chronic OP unit) and 24/7 at acute/pediatric unit. Skill mix is 100% RN at acute/pediatric unit and 100 % RN at chronic OP unit. The predominant staffing ratio of nurses to patients is 1:4 at chronic OP unit, 1:1 at acute/pediatric when treatment is performed at patient bed side (ICU), 2: 6 at acute unit, 1:1, 1:2, 1:3 at pediatric unit based on patient weight. The Charge Nurse (CN) on day shift makes assignments, oversee patient outcomes, and facilitates daily flow, patient assignment to CN is based on acuity and census, etc.) At acute /pediatric unit, Chronic OP unit ratio is 1:4 patients including CN. On all shifts (except night shift), the CN is available to all staff for consultation and assistance in providing patient care.
Patient care assignments are made each shift by the CN, as described in the Hospital Plan for Nursing Care. Patient assignments are made by the CN and are based upon patient safety concerns, experience level/competencies of the RN, degree of supervision needed by the individual and its availability, relevant safety and infection control issues, complexity of care, monitoring capabilities, and skills required. Patients requiring 1:1 observation as a result of personal safety concerns are requested to have sitters present during procedure.
The Director of Renal Service or designee, in accordance with the Hospital Plan for Nursing Care and the nursing policy, determines the need for overall adjustment of staff, either increasing or decreasing according to census/acuity.
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 80% capacity would be 1:6 Registered Nurses (Chronic Unit), 1:4 at acute unit, and 2: 6 pediatric unit.
Requests for Scheduled 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 as reflected on staff assignment sheets.
Adult chronic unit
- Monday- Saturday: Six (6) RNs including Charge Nurse, 12 hour shift responsible for overall operation of the outpatient unit. Unit has 24 HD stations.
- An assigned RN in charge of home training program. RNs are assigned primary patients and they are responsible for Initial Orientation and Assessment and monthly Interdisciplinary Multifocal Plan of Care. Vascular Access Coordinator responsible for vascular access studies and coordination of prevention, maintenance, follow up care of hemodialysis patients.
- Daily performance, practice, productivity, and outcomes is overseen by Clinical Coordinator.
- Clerical support: Monday – Saturday 12 hr. shift.
Adult /Pediatric area
- Monday – Wednesday- Friday: Day shift- Six (6) RNs, one (1) RNs swing shift, and Charge Nurse.
- Night shift- 1 RN 12-hour shift.
- Tuesday-Thursday-Saturday: Day shift – Six (6) RNs, one (1) swing and Charge Nurse.
- Night Shift – 1 RN 12 hour shift.
- Sunday: Day shift – 2 RNs
- Night shift – 1 RN (12 hr. shift)
- Tuesday – Thursday-Saturday: Open for OP patients second shift
- Minimum staffing is based upon patient census, acuity mix, and the availability of assisting nursing staff.
- Daily performance, practice, productivity, and outcomes is overseen by Clinical Coordinator
- Chronic OP Unit: Monday- Saturday / 12-hour shift.
- Acute/Pediatric Unit: Monday – Saturday / 12-hour shift. Sunday: 8-hour shift.
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