Magnet Recognition Program® Request for Additional Documentation
Homestead Hospital
Homestead, FL
MGN20140102
EP9 Nurses are involved in staffing and scheduling based on established guidelines, such as ANA’s Principles for Nursing Staffing, to ensure that RN assignments meet the needs of the patient population.
EP9a Provide two examples, with supporting evidence, from different practice settings when input from clinical nurses was used to modify RN staffing assignments and/or adjust the schedule to compensate for a change in patient acuity, patient population, resources, or redesign of care.
The narrative did not describe, with supporting evidence, an example when input from clinical nurses was used to modify RN staffing assignments and/or adjust the schedule in the ICU to compensate for a change in patient acuity due to the use of therapeutic hypothermia for a patient admitted from ED to the ICU.
Describe, with supporting evidence, an example when input from clinical nurses was used to modify RN staffing assignments and/or adjust the schedule in the ICU to compensate for a change in patient acuity due to the use of therapeutic hypothermia for a patient admitted from the ED to the ICU. If the information and/or supporting evidence are not available, a new example may be provided.
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The requested information and supporting evidences are provided below.
NAME OF INITIATIVE
Staffing for High Acuity Critical Care (Therapeutic Hypothermia) Patients
RN Involvement in Staffing
As the Therapeutic Hypothermia (TH) program in Homestead Hospital began growing, more nurses were needed to take care of these high acuity patients who required one-on-one care. Since only a few nurses were initially trained, this core group became overworked due to the lack of flexibility in staffing for this therapy. ICU/PCU Clinical Nurse Andrea Tilleman, RN, one of the nurses who attended the first round of training, brought this up during the September 2012 staff meeting. She recommended that additional nurses be trained on TH (EP9 02a ICU/PCU Staff Meeting Minutes). Patient Care Manager Leslie Everett, RN, spoke with ICU/PCU Clinical Nurse Specialist Rosemary Lee, ARNP regarding Tilleman’s suggestion. Lee then contacted Clinical Educator Karen Baez, RN about arranging for more TH classes. Baez offered the classes in September and October of 2012 and again in August 2013. She invited nurses from ICU and ED to attend. Having more TH-trained nurses helped in alleviating the staffing issues. As a result of Tilleman’s input, the number of TH-trained ICU nurses has increased from 24% (2008) to 86% (2014).
Modifying RN Staffing Assignment with Clinical Nurse Input
TH patients were initially identified as candidates in the Emergency Department (ED). Barring the need to transfer these patients to another facility, they were usually admitted to the ICU. Once identified as a TH candidate, the ED staff would communicate this to the Patient Care House Supervisor, who in turn notified the ICU Patient Care Supervisor (PCS) or Relief Patient Care Supervisor (rPCS). The rPCS was a clinical nurse cross-trained to relieve the PCS. At this point, the ICU PCS or rPCS facilitated the patient’s transfer from the ED and arranged for staffing. Ideally, an additional RN was utilized to care for the TH patient. A collaborative endeavor would occur between the staffing office and ICU in calling additional nurses to come in. This scenario transpired on October 9th, 2013. On this day, Clinical Nurse Andrea Tilleman, RN was acting as the day shift Relief Nursing Supervisor. She spoke with Clinical Nurse Pat Meadows, RN, who was the ICU rPCS on that day, regarding a potential TH patient in the ED. Clinical Nurses Meadows and Tilleman both identified the need to provide an extra RN to accommodate the demands of a high acuity patient. Clinical Nurse Larisse Greenwell, RN, had not originally been placed on the schedule. Meadows called Greenwell, who agreed to come in and help. She arrived in the middle of the day shift and assumed care for this patient (EP9 03a ICU/PCU Staffing sheet & Shift Report 10/9/13).
Summary Attachments/Hyperlinks/Evidences
EP9 02a ICU/PCU Staff Meeting Minutes
EP9 03a ICU/PCU Staffing sheet & Shift Report 10/9/13